cardiovascular assessment

Question 1

over what areas of the heart do nurses auscultate?

Answer 1

over valves

Question 2

precordium

Answer 2

area on anterior chest overlying the heart and great vessels

Question 3

4 chambers of the heart

Answer 3

atria and ventricles

Question 4

direction of blood flow to the heart

Answer 4

vena cava –> RA –> pulmonic valve –> pulmonary artery –> LA –> bicuspid valve–> LV –> aorta to body

Question 5

what kind of blood flow do we feel when taking a pulse?

Answer 5

arterial blood flow (arteries are muscular and veins are flat, so we cannot feel venous BF)

Question 6

diastole

Answer 6

relaxation of the heart

Question 7

systole

Answer 7

contraction of the heart

Question 7

what does it mean if there is not a clear S1 and S2 during auscultation?

Answer 7

it means there is a murmur in the heart

Question 8

swooshing over an artery is a…

Answer 8

bruit

Question 9

swooshing over the heart is a…

Answer 9

murmur

Question 10

S1

Answer 10

closure of bicuspid and tricuspid valves (lub)

Question 11

S2

Answer 11

closure of aortic and pulmonic valves (dub)

Question 12

abnormal/unexpected heart sounds

Answer 12

ventricular gallop (S3); S4

Question 13

thrills

Answer 13

palpable vibrations NOT a sound

Question 14

murmurs

Answer 14

can be diastolic or systolic; systolic occurs after S1, diastolic after S2
swooshing/blowing sounds

Question 15

systolic murmurs are..

Answer 15

innocent

Question 16

diastolic murmurs are..

Answer 16

indicators of a heart disease

Question 17

how to chart murmurs (6 characteristics)

Answer 17

timing, loudness, pitch, location, radiation, posture

Question 18

what would a provider chart for timing of a murmur?

Answer 18

systolic or diastolic

Question 19

what would a provider chart for loudness of a murmur?

Answer 19

grade 1-6; barely audible to loudest hear with stethescope off of the chest

Question 20

what would a provider chart for pitch of a murmur?

Answer 20

high, medium, low
musical, blowing, harsh rumbling

Question 21

what would a provider chart for location of a murmur?

Answer 21

where is it best heard

Question 22

what would a provider chart for radiation of a murmur?

Answer 22

does it move and be heard in other locations

Question 23

what would a provider chart for posture of a murmur?

Answer 23

does it disappear or enhance with posture

Question 24

what are examples of subjective data collected during assessment? (chest)

Answer 24

chest pain, dyspnea, orthopnea, cough, fatigue, cyanosis or pallor, edema, nocturia, past cardiac history, family cardiac history, patient centered care (risk factors)

Question 25

equipment

Answer 25

penlight, stethescope

Question 26

palpation of neck vessels

Answer 26

palpate the carotid artery, only one artery at a time; feel contour and amplitude of pulse, normal strength should be 2+

Question 27

auscultation of neck vessels

Answer 27

auscultate the carotid, with the BELL of the stethescope; assess for presence of bruit; lightly apply stethescope

Question 28

what are expected findings when auscultating for a bruit?

Answer 28

NO sound, arteries should be silent

Question 29

inspection of neck vessels

Answer 29

inspect the jugular venous pulse; use a penlight and patient in semi fowler’s position to observe for distention

Question 30

JVD

Answer 30

if the jugular vein has a shadow along it, it is a sign of JVD

Question 31

assessment of precordium

Answer 31

inspect anterior chest; observe for any possible pulsations or thrills
palpate apical impulse

Question 32

expected v. unexpected findings of precordium

Answer 32

expected: no thrill, no vibration
unexpected: palpable vibrations

Question 33

procedure of precordium auscultation

Answer 33

aortic valve area– second ICS, RSB
pulmonic valve area – second ICS, LSB
Erbs point – third ICS, LSB
tricuspid valve– fourth ICS, LSB
mitral valve – 5th ICS, MCL

Question 34

what to look for during precordium auscultation

Answer 34

note rate and rhythm, identify S1 and S2, listen for extra heart sounds, listen for murmurs

Question 35

abnormal systolic findings

Answer 35

• ejection click
• aortic prosthetic valve sounds
• midsystolic click

Question 36

abnormal diastolic findings

Answer 36

opening snap, mitral prosthetic valve sound, third or fourth heart sounds, pericardial friction rub

Question 37

3 step assessment of neck vessels

Answer 37

palpate the carotid artery, auscultate the carotid artery, inspect for JVD

Question 38

3 step assessment of chest wall

Answer 38

inspect apical impulse, palpate apical pulse, auscultate

Question 39

abnormal findings for precordium

Answer 39

thrill at the base, lift at the LSB, volume overload at the apex, pressure overload at the apex

Question 40

abnormal murmur findings

Answer 40

midsystolic ejection murmurs
pansystolic regurgitant murmurs
diastolic rumbles of AV valves
early diastolic numbers

Question 41

EKG

Answer 41

measures electrical activity of heart, PQRST complex

Question 42

risk factors for cardiovascular disease

Answer 42

HTN, smoking, serum cholesterol, physical activity, sex and gender differences

Question 43

modifiable risk factors

Answer 43

smoking and physical activity

Question 44

red flag findings for cardiovascular assessment

Answer 44

chest pain
unilateral pain, pallor, pulselessness, paresthesia
new onset irregular heart rhythm
tachycardia or bradycardia
waist circumference above 35 for women or 40 in men

Question 45

summary checklist of neck

Answer 45

carotid pulse - observe and palpate
observe jugular venous pulse
estimate jugular venous pressure

Question 46

summary checklist of inspection of precordium

Answer 46

describe location of apical pulse, not any heave or thrill

Question 47

summary checklist of auscultation of precordium

Answer 47

identify anatomic areas noting rate and rhythm, listen in systole and diastole for murmurs, listen at apex and base