Cardiovascular Physical Assessment - Exam 1

Question 1

Bradycardia

Answer 1

Slow resting heart rate. Less than 60 BPM

Question 2

Tachycardia

Answer 2

Fast resting heart rate. Above 100 BPM

Question 3

Normal PR interval

Answer 3

0.12-0.20 seconds

Question 4

Normal QRS interval

Answer 4

Less than or equal to 0.12 seconds

Question 5

Normal jugular vein distention (JVD)

Answer 5

Less than 3cm at 30 degrees head elevation

Question 6

Order of assessment

Answer 6

Insepction, Palpation, Percussion, Auscultation

Question 7

Normal PR Interval

Answer 7

0.12-0.20 seconds which is 3-5 small boxes

Question 8

Normal QRS Interval

Answer 8

Less than or equal to 0.12 seconds which is 3 boxes or less

Question 9

S1

Answer 9

First heart sound. Soft “Lubb”

Occurs at the end of the QRS interval. The ventricles depolarize, causing them to contract and the M & T valves to snap shut. Happens during Systole.

Question 10

S2

Answer 10

Second heart sound. Sharp “Dubb”

Occurs during the T wave when the ventricles relax and the A & P valves snap shut. Happens during diastole

Question 11

Normal characteristics for pulses

Answer 11

Normally 2+, equal bilaterally, with 0 meaning absent and 4+ being strong and bounding

Question 12

Apical Pulse

Answer 12

Pulse counted for 1 minute at the 5th intercostal mid clavicular line

Question 13

Normal Characteristics of the Carotid Arteries

Answer 13

Pulses equal in rate, rhythm, and strength bilaterally; unchanged by inspiration, expiration, or rotation of the neck

Question 14

Normal characteristics of heart sounds

Answer 14

Regular intervals between each sequence of beats with a distinct pause between the two sounds. AKA lub dub, each lub dub counting as one heart beat.

Question 15

Normal characteristics of jugular veins

Answer 15

3cm or less above the sternal angle is considered normal (angle of Louis)

Question 16

Point of Maximum Impulse (PMI)

Answer 16

Point where apex of the heart is closest to the surface in the thorax (usually 5th intercostal mid clavicular line)

Question 17

Heaves

Answer 17

Sustained lifts of chest wall that can be seen or palpated

Question 18

Cardiac cell makeup

Answer 18

Cell is normally negative and more potassium is inside while sodium is outside. When the cell depolarizes, the cell becomes more positive and sodium rapidly enters the cell. Repolarization is the cell slowly going back to it’s normal state.

Question 19

Exercise/Stress Testing

Answer 19

Used to evaluate the cardiovascular response to physical stress (not used with pacemakers)

Question 20

What can be a cause of juglar vein distention?

Answer 20

Right sided heart failure

Question 21

Orthostatic BP normal results

Answer 21

Normal reduction from supine - standing is 20mm Hg and the HR should not increase more than 20 BPM

Question 22

What is the difference between BP taken in the lower extremities VS upper extremities?

Answer 22

BP taken in the lower extremities can be expected to be 10 mm Hg higher than in the upper extremities

Question 23

Normal Capillary Refill time

Answer 23

Less than 2 seconds

Question 24

Resting ECG

Answer 24

Used for: conduction abnormalities, cardiac dysrhythmias, cardiac hypertrophy, pericarditis, myocardial ischemia, site and extent of MI, pacemaker performance, effectiveness of drug therapy

Question 25

Ambulatory ECG Monitoring

Answer 25

Diagnostic info over greater amount of time than resting ECG

Question 26

Event Monitor/Loop Recorder

Answer 26

Patient starts it when they experience symptoms

Question 27

Systole

Answer 27

Ejection of blood from ventricles when ventricles contract. Represented by QRS on ECG tracing Sound S1

Question 28

Diastole

Answer 28

Relaxation of ventricles and refilling of chambers Represented by T wave on ECG S2

Question 29

Where is S1 best heard at?

Answer 29

Apex

Question 30

Where is S2 best heard at?

Answer 30

Base

Question 31

How many seconds does each small horizontal box represent (ECG)?

Answer 31

0.04 seconds

Question 32

How many seconds does each large box represent (ECG)?

Answer 32

0.2 second

Question 33

Cardiovascular Inspection

Answer 33

Use tangent light Look for apical impulse - 5th intercoastals mid-clavicular Alternate position - sit up, lean forward

Question 34

Cardiovascular Palpation

Answer 34

Light touch Point of maximal impulse (apical) Base of heart (thrills) Match PMI with carotid pulse

Question 35

Cardiovascular Auscultation

Answer 35

1. Sites: aortic, pulmonic, 2nd pulmoic (3rd intercostal), tricuspid (4th intercostals), mitral (5th intercostal) 2. Patient may lean forward 3. Check rhythm and rate 4. Listen S1 while palpating carotid - begins systole 5. Listen S2 - begins diastole 6. Sound at apex S1\>S2 7. Sound at base S2\>S1 8. Neck Auscultation (listen for bruit)

Question 36

Sinoatrial (SA) Node

Answer 36

Located in the upper right atrium Initiates atrial depolarization and thus contraction The natural pacemaker Inherent rate of 60-100

Question 37

Atrioventricular (AV) Node

Answer 37

Slows the electrical impulse to give ventricles time to fill Considered the 2nd pacemaker Inherent rate of 40-60 Begins conduction of the impulse to the ventricles

Question 38

Bundle Branches and the Purkinje Fibers

Answer 38

Inherent rate of 20-40 if the SA and AV node stop Ventricular depolarization and contraction Any alteration in this conduction system is called a dysrhythmia/arrhythmia

Question 39

Isoelectric Line

Answer 39

Area on a normal ECG strip that is electrically neutral Nothing is happening in the heart at this time (electrically)

Question 40

Normal characteristics of P Waves

Answer 40

Small Rounded Upright position in Lead II One for every QRS All same shape and size Normal P waves indicate that the electrical impulse originated in the SA node and atrial depolarization occurred

Question 41

Normal characteristics of PR Interval

Answer 41

The time it takes for the electrical impulse to leave the SA node and travel through to the Bundle of His Measured from the beginning of the P wave to the beginning of the QRS complex A normal PR interval measures 0.12-0.2 seconds or 3-5 small boxes

Question 42

Normal characteristics of QRS complex

Answer 42

Represents the time it takes for the electrical impulse to depolarize the ventricles The QRS is measured as the first wave leaves the baseline to where the last wave of the complex begins to flatten out A normal QRS measures 0.12 (3 boxes or less)

Question 43

Normal characteristics of T wave

Answer 43

The final phase of ventricular repolarization Normal T waves are round, upright in lead II, smaller than QRS

Question 44

How to measure heart rate from ECG

Answer 44

Refers to the ventricular rate. Count the number of R waves in a 6 second strip and multiply by 10

Question 45

How to measure rhythm using an ECG

Answer 45

Measure from P to P and R to R - is it regular or irregular? use calipers or a peice of paper

Question 46

Analyzing P waves ECG

Answer 46

Look at the P waves- is there one for each QRS, are they nearly identical?

Question 47

Analyzing PR interval ECG

Answer 47

Measure the PR interval - is it normal, between 0.12-0.2 seconds?

Question 48

Analyzing the QRS complex

Answer 48

Is each QRS preceded by a P wave? Do they all look nearly identical and is the complex less than or equal to 0.12 seconds?