Clinical Assessment of CV Patient - Lab Manual

Question 1

explain flow of assessment for CV patient

Answer 1

interview patient
ask about chest pains
review special tests
perform visual inspection
assess blood pressure
determine symptoms

Question 2

if a patient has excessive nasal secretions what is indicated

Answer 2

Upper respiratory infection
allergies

Question 3

what is important to understand about one’s cough

Answer 3

its onset
duration and quality
- chronic vs acute
- morning or evening

Question 4

white sputum indicates

Answer 4

irritation

Question 5

yellow sputum indicates

Answer 5

infection

Question 6

green sputum indicates

Answer 6

stagnant pus in dilated bronchi
lung abscess
infected sinus

Question 7

rusty sputum indicates

Answer 7

pneumonia

Question 8

currant jelly sputum indicates

Answer 8

pulmonary embolus or neoplasm

Question 9

pink sputum indicates

Answer 9

pulmonary edema

Question 10

black sputum indicates

Answer 10

old blood
aspergillosis
soot

Question 11

when observing sputum what needs to be considered

Answer 11

color
consistency
odor

Question 12

frothy consistency indicates

Answer 12

common in CHF

Question 13

gelatinous consistency indicates

Answer 13

neoplasm

Question 14

what pathology does hemoptysis indicate

Answer 14

pneumococcal pneumonia
- streaky with specks of blood

Question 15

bright red blood in the spit indicates

Answer 15

rupture of vessels
- could be manifestation of pulmonary TB or cancer

Question 16

foul smelling sputum may indicate

Answer 16

systemic infection

Question 17

explain the 4 point scale of dyspnea

Answer 17

1 - mild exertion (short distance on level surface, normal pace)

2 - moderate exertion (running short distance/climbing flight of steps)

3 - minimal exertion (breathlessness while talking, shaving, or washing)

4 - breathlessness at rest

Question 18

what can be used to assess baseline dyspnea

Answer 18

borg dyspnea scale

Question 19

what is necessary to palpate? why?

Answer 19

upper and lower chest
lower ribs bilaterally
back bilaterally

– in order to determine breathing pattern

Question 20

what does S1 sound like? what does it represent?

Answer 20

high pitched and split sound at cardiac apex

mitral and tricuspid valve closure

Question 21

when will an accentuated S1 be present

Answer 21

mitral or tricuspid valve is widely separated in diastole
or
mitral or tricuspid valves that are hard to open

Question 22

what would cause S1 to be dampened

Answer 22

when a stenotic valve becomes nearly immobile

Question 23

what pathologies may cause a soft S1

Answer 23

moderate-severe aortic insufficiency
advanced HF
prolonged P-R interval
mitral valves are incompetent

Question 24

what does S2 represent?
what physiological action can we assume causes it

Answer 24

closure of semilunar aortic / pulmonary valves
deceleration of blood in the root of pulmonary artery at end-systole

Question 25

where can S2 be auscultated

Answer 25

second ICS in midclavicular line with diaphragm of stethoscope

Question 26

what can a soft semilunar aortic valve (A2) closure be indicative of

Answer 26

incompetent aortic valves severe aortic stenosis decreased diastolic pressure air trapping of COPD

Question 27

an accentuated S2 can be caused by

Answer 27

a loud A2 or P2 P2 = when pulmonary component of S2 is louder than S1

Question 28

explain timing component of S2

Answer 28

A2 precedes P2

Question 29

what is wide splitting of S2

Answer 29

when P2 is delayed after A2 - early aortic valve closure or delayed pulmonic valve closure

Question 30

what is paradoxical splitting of S2? what may cause this?

Answer 30

A2 occurs after P2 early pulmonary valve closure delayed activation of left ventricle prolongation of left ventricular contraction

Question 31

what pathologies may cause wide splitting of S2?

Answer 31

severe mitral regurgitation RBBB

Question 32

what pathologies may cause paradoxical S2

Answer 32

early pulmonic valve closure = severe tricuspid insufficiency delayed activation of left ventricle = LBBB prolongation of left ventricle contraction = HTN, aortic stenosis, severe systolic dysfunction

Question 33

what is fixed splitting? what may cause this?

Answer 33

when time interval between A2 and P2 does not increase during inspiration large atrial septal defect severe right ventricle failure

Question 34

when is S3 found

Answer 34

early in diastole

Question 35

how to auscultate for S3

Answer 35

end expiration with bell near apex - patient in left lateral decubitus position

Question 36

explain the occurrence of S3

Answer 36

normal in children and young adults >40 y/o = increase in passive diastolic filling in either right or left ventricle

Question 37

left ventricle S3 is caused by

Answer 37

HR hypertrophic cardiomyopathy left ventricular aneurysm hyperdynamic states

Question 38

how is right ventricle S3 auscultated

Answer 38

patient supine 3rd intercostal space at left sternal border

Question 39

what would accentuate RVS3

Answer 39

inspiration

Question 40

how is S4 auscultated

Answer 40

bell of stethoscope apex of heart in left lateral decubitus position

Question 41

when does S4 occur? how to distinguish it?

Answer 41

just before S1 can be extinguished by firm pressure on the bell of stethoscope

Question 42

what causes S4

Answer 42

vigorous atrial contraction to propel blood into stiffened left ventricle

Question 43

when will S4 accentuate

Answer 43

inspiration

Question 44

what is a ventricular gallop associated with

Answer 44

S3

Question 45

explain ventricular gallop

Answer 45

occurs early in diastole when LV is passively filling will require a very compliant LV can be a sign of systolic CHF

Question 46

what is an atrial gallop associated with

Answer 46

S4

Question 47

explain atrial gallop

Answer 47

late in diastole during active LV filling almost always abnormal noncompliant LV sign of diastolic CHF

Question 48

what does a high-pitched diastolic click signify

Answer 48

abnormal semilunar valves dilation of great vessels augmented flow states

Question 49

what does a mid-diastolic opening snap indicate

Answer 49

opening of a stenotic mitral valve -- will disappear when stenotic valve becomes severely calcified because it does not move

Question 50

what does a dull sound early to mid-diastolic knock indicate

Answer 50

abrupt cessation of ventricular filling -- secondary to a non-compliant and constructive pericardium

Question 51

if a murmur is present in the right 2nd ICS what is it called? what is indicated?

Answer 51

aortic area murmur - systolic murmur aortic stenosis / aortic valve sclerosis

Question 52

if a murmur is present in the left 2nd ICS what is it called? what is indicated?

Answer 52

pulmonic area -- systolic ejection murmur pulmonic stenosis atrial septal defect flow murmur

Question 53

if a murmur is present in the left 3rd ICS what is it called? what is indicated?

Answer 53

Erb Point -- diastolic murmur via aortic or pulmonic regurgitation -- systolic murmur via hypertrophic cardiomyopathy

Question 54

if a murmur is present in the left 4th ICS what is it called? what is indicated?

Answer 54

tricuspid area -- holosystolic murmur via tricuspid regurgitation or ventricular septal defect -- diastolic murmur via tricuspid stenosis

Question 55

if there is a murmur in the 5th ICS at apex of the heart what is it called? what is indicated?

Answer 55

mitral area -- holosystolic murmur via mitral regurgitation -- systolic murmur mitral valve prolapse -- diastolic murmur via mitral stenosis

Question 56

location of tricuspid valve in auscultation

Answer 56

just left laterally of sternum 5th ICS

Question 57

location of pulmonic valve in auscultation

Answer 57

just left laterally of sternum 2nd ICS

Question 58

location of aortic valve in auscultation

Answer 58

just right laterally of sternum 2nd ICS

Question 59

explain process of auscultation

Answer 59

begin at apex (midclavicular line 5th ICS) - listen for S1/S2 move to tricuspid (5th ICS by sternum) move to pulmonic (2nd ICS left of sternum) move to aortic (2nd ICS right of sternum) repeat process with bell looking for murmurs -- have patient lie on their left side to listen to murmurs at apex

Question 60

when will gallops be heard

Answer 60

S3 = following S2 S4 = just before S1