Cardiovascular Assessment Lecture #1 Cont.

Question 1

What is the normal length of the QRS Interval?

Answer 1

0.04 - 0.11 seconds

Question 2

What is the normal length of the QT Interval?

Answer 2

0.36 - 0.44 seconds

Question 3

What is the normal length of the PR Interval?

Answer 3

0.12 - 0.20 seconds

Question 4

Blood enters the heart from the body via the ______ and _______.

Answer 4

Superior and Inferior Vena Cava

Question 5

Blood leaves the heart and enters the body through the Aortic Arch but first the heart perfuses itself with blood via the left and right _______ arteries.

Answer 5

coronary arteries

Question 6

_____ Coronary Artery Clot can inhibit SA and AV Node firing which will cause the heart to stop beating.

Answer 6

Right

Question 7

_____Coronary Artery Clot affects the LAD and is called the widow maker because it causes ventricular contraction to fail causing the body to lack perfusion.

Answer 7

Left

Left Anterior Descending Artery = LAD

Question 8

Ask if patient if they have any heart problems.

Is this cardiac assessment for subjective or objective data?

Answer 8

Subjective data

Question 9

Ask about previous history of rheumatic fever, tobacco use, anemia, syncope, congenital heart defects, stroke, hyper hypotension, thrombophlebitis, and edema.
Is this cardiac assessment for subjective or objective data?

Answer 9

Subjective data

Get specific when asking questions because patients may deny a history of heart problems.

Question 10

Ask about medication dose and frequency. Have the patient bring all home meds to the appointment. The patient may deny heart problems but will be on Hypertension meds, Anti-platelet meds, and Cholesterol meds. Is this cardiac assessment for subjective or objective data?

Answer 10

Subjective data

Question 11

Is the patient compliant with meds? If not why?

Is this cardiac assessment for subjective or objective data?

Answer 11

Subjective data

Exacerbations of heart failure can be caused by financial burdens. If the pt can’t afford medication that they need.

Question 12

Assess patient for knowledge deficiency related to what each of their med does.
Is the patient aware of side effects of meds and when to call the dr.
Is this cardiac assessment for subjective or objective data?

Answer 12

Subjective data

Question 13

Assess for usage of OTC meds and herbs.

Is this cardiac assessment for subjective or objective data?

Answer 13

Subjective data

Question 14

Compare ______ and _______ data to get an accurate cardiovascular history.

Answer 14

subjective and objective

Question 15

Ask if they have had heart surgery valve replacement, or any kind of heart bypass, or valve surgery to determine their cardiac history.
Is this cardiac assessment for subjective or objective data?

Answer 15

Subjective data

Question 16

Utilize functional health patterns for assessment of cardiac abnormalities:
Nutrition> changes in appetite
Elimination > decreased urination do to decreased perfusion
Activity/Exercise > increasing activity intolerance getting winded easily is a notable change
Is this cardiac assessment for subjective or objective data?

Answer 16

Subjective data

Question 17

Utilize functional health patterns for assessment of cardiac abnormalities:
Sleep/Rest > pt has to sleep sitting up in recliner because they cannot sleep laying down
Self perception > pressure ulcers related to sleeping sitting up in recliner all night.
Roles/Relationship > inability to go out and socialize r/t fatigue and activity intolerance
Is this cardiac assessment for subjective or objective data?

Answer 17

Subjective data

Question 18

Utilize functional health patterns for assessment of cardiac abnormalities:
Sexuality> inability to perform sexually r/t fatigue and activity intolerance
Coping /Stress Tolerance > changes? Sleeping sitting up? / may have to adapt ?
Prevention Strategies > what does the patient do to prevent further complications. Are they in a Low fat low salt diet? Exercising? monitoring their BP? Did they stop smoking? Are they compliant with medications?
Is this cardiac assessment for subjective or objective data?

Answer 18

Subjective data

Question 19

Gather a _______ this is what brought the patient to the hospital today?
When does the ______ occur? > When did the symptoms start?
What is the patients _______ of the complaint? Document patient words used to describe their signs and symptoms.
______ of onset and the duration of symptoms > What causes the s/sx and how long do they last?
Are there any ______ and _______ of these symptoms? (Do the s/sx come and go?)

Answer 19

History of present illness
Onset
Description
Mode
exacerbation and remissions

Question 20

Name the 10 most common cardiovascular symptoms a patient can have?

Answer 20

• pain > Angina/ Chest Pain with Activity
• edema > Fluid Overload
• dyspnea > On exertion
• cyanosis > Decreased Circulation
• clubbing > Hypoxemia
• fatigue > Decreased Circulation
• syncope > Temporary LOC caused by a drop in BP.
• hemoptysis > Coughing up blood.
• palpitations > Increased rate or strength of heartbeat. Flutter.
• intermittent claudication > Pain in the leg during exercise it is relieved by rest.

Question 21

Monitor Vital signs.
-BP & Pulses & Respiratory Status
-Palpation: assess upper and lower pulses for equality.
Is this cardiac assessment for subjective or objective data?

Answer 21

Objective Data

Question 22

Assess the Peripheral vascular system
- Assess for equality bilaterally on both sides of the body.
Is this cardiac assessment for subjective or objective data?

Answer 22

Objective Data

Question 23

1. Assess for edema, diaphoresis, cyanosis, cold extremities, shiny extremities, venous distension and JVD.
2. Shiny hair means good circulation to scalp.
   Is this cardiac assessment for subjective or objective data?

Answer 23

Objective Data

Question 24

1. Nail clubbing.
2. Assess for ulcers r/t decreased circulation.
   Is this cardiac assessment for subjective or objective data?

Answer 24

Objective Data

Question 25

What are the 8 Palpable Artery Locations and where are they Located?

Answer 25

``` Carotid Brachial Radial Ulnar Femoral Popliteal Posterior Tibial Dorsalis pedis ```

Question 26

Start assessing pulses at the _____ because that means the entire leg has pulses.

Answer 26

feet

Question 27

Auscultate arteries for bruits, heart sounds for murmurs and lung sounds for crackles. - Signs of heart failure Is this cardiac assessment for subjective or objective data?

Answer 27

Objective Data

Question 28

What is significant to remember about the Angle of Louis?

Answer 28

It is located at the second rib below it is the second intercostal space. This is where you will begin listening to heart sounds. This is located between the Aortic and Pulmonic Valves.

Question 29

What are the locations that you auscultate on the heart named in order by location? Which is heard louder S1 or S2?

Answer 29

Aortic Valve heard at the RT 2nd ICS > S1 is louder than S2 Pulmonic Valve heard at the LT 2nd ICS > S1 is louder than S2 Erb's Point Valve heard at the 3rd ICS LT STERNAL BORDER > S2 is louder than S1 (Different than NAU!!!) Tricuspid Valve heard at the 5th ICS LT STERNAL BORDER > S2 is louder than S1 Mitral Valve heard at the 5th ICS LT midclavicular line S2 is louder than S1 (under the breast in women)

Question 30

Auscultation: | Lub S1 ______ valve closing. (Best place to hear this rhythm) and tricuspid valves closing > Systole

Answer 30

Mitral

Question 31

Auscultation: | Dub S2 ______ valve closing. (Best place to hear this rhythm) and pulmonic valves closing > Diastole

Answer 31

Aortic

Question 32

REMEMBER: Lub > Systole > ______ of Atria. Dub > Diastole > ________ of Ventricles. Tell the patient do not take deep breaths and be quiet to assess heart sounds accurately.

Answer 32

Contraction Relaxation

Question 33

The S1 sound occurs at the ____ in the QRS complex of the EKG. This is called Systole. The S2 sound occurs immediately after the ____ wave is over on the EKG. This is called Diastole.

Answer 33

R T T

Question 34

Notifying a Dr where a murmur is found during auscultation: | ____ > Lub Dub Dub > Abnormal early diastolic sound during period of rapid ventricular filling.

Answer 34

S3

Question 35

Notifying a Dr where a murmur is found during auscultation: | _____ > Lub Lub Dub > Abnormal late diastolic sound during atrial systole.

Answer 35

S4

Question 36

Why would you assess a patient’s hair in a cardiovascular assessment?

Answer 36

Dry brittle hair means poor nutrition and circulation.

Question 37

Why would you assess a patient’s lips and tongue in a cardiovascular assessment?

Answer 37

blue tongue > cyanosis / decreased blood flow | dry tongue > dehydrated

Question 38

Why would you assess a patient’s neck in a cardiovascular assessment?

Answer 38

JVD: distended neck veins b/c of right sided HF r/t increased BP.

Question 39

Why would you assess a patient’s lungs/chest in a cardiovascular assessment?

Answer 39

Assess lung sounds for crackles in lungs r/t left sided HF. | Assess for heart rate, rhythm, and murmurs.

Question 40

Why would you assess a patient’s blood pressure in a cardiovascular assessment?

Answer 40

Signs of hypertension or hypotension. HTN is a BP of 140/90 increased cardiac workload leading to HF.

Question 41

Why would you assess a patient’s abdomen in a cardiovascular assessment?

Answer 41

Enlarged abdomen also known as ascites r/t HF

Question 42

Why would you assess a patient’s skin in a cardiovascular assessment?

Answer 42

Dry and cool r/t dehydration and poor nutrition Cyanosis r/t decreased oxygenation and perfusion. Pallor indicates anemia or decreased circulation.

Question 43

Why would you assess a patient’s sacrum in a cardiovascular assessment?

Answer 43

Check for edema in bed ridden patients.

Question 44

Why would you assess a patient’s nails in a cardiovascular assessment?

Answer 44

Clubbing r/t chronic low 02 saturation. Ex. Congenital cardiac disease or pulmonary disease. Thick nails r/t poor nutrition and impaired 02 delivery.

Question 45

Why would you assess a patient’s lower extremities in a cardiovascular assessment?

Answer 45

Absence of hair r/t poor circulation to superficial epidermis r/t arterial insufficiency. Brown Socks r/t Venous insufficiency.

Question 46

Why would you assess a patient’s legs, ankles, and feet in a cardiovascular assessment?

Answer 46

Check for edema, decreased pulse, decreased sensation, and pressure ulcers r/t decreased circulation.

Question 47

Early sign of clubbing caused by ______ deficiency. Early clubbing is assessed as a loss of angle. Hold the fingers against each other to check for clubbing. Late clubbing is very noticeable.

Answer 47

prolonged 02

Question 48

_______ is caused by chronic hypoxemia, cystic fibrosis, lung cancer, bronchiectasis, endocarditis heart defects of the heart because of prolonged 02 deficiency.

Answer 48

Clubbing