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NURS 500 > Exam 2 - cardiovascular > Flashcards

Exam 2 - cardiovascular Flashcards

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1
Q

Symptoms of peripheral arterial disease

A

Fatigue, aching, numbness, pain that limits walking or exertion in legs Erectile dysfunction Poorly healing or non healing wounds of legs or feet Pain present when at rest in lower leg or foot and changes when standing or supine Abdominal pain after meals and associated “food fear” and weight loss

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2
Q

What is claudication?

A

Exertional calf pain relieved by rest

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3
Q

What are the types of claudication? What do they indicate?

A

1) Vascular - blood flow that cannot match increased demand of muscles in oxygen during walking
2) Neurogenic - narrowing in the spinal canal (stenosis) creates pressure on the spinal nerves

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4
Q

Vascular claudication

A

Also referred to as intermittent claudication

Pain or cramping in legs during exertion that is relieved by rest within 10 minutes

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5
Q

Neurogenic claudication

A

Pain with walking or prolonged standing, radiating from spinal area to butt, thighs, lower legs, or feet

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6
Q

What symptoms and exam findings would you expect in peripheral arterial disease?

A

Fatigue, numbness, cool dry hairless skin, trophic nail changes, diminished to absent pulses, pallor with elevation, ulceration, gangrene

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7
Q

What symptoms and exam findings would you expect in DVT?

A

Asymmetric calf diameters, painful calf swelling with erythema, distal

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8
Q

What symptoms and exam findings would you expect in thrombophlebitis?

A

Pain and tenderness along course of superficial vein

Local swelling, redness, warmth; if palpable nodules or cords, consider superficial or DVT Immobility makes it worse; walking makes it better

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9
Q

What symptoms and exam findings would you expect in cellulitis?

A

Erythema, edema, warmth Involves deeper dermis, adipose tissue; enlarged tender lymph nodes and fever

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10
Q

What symptoms and exam findings would you expect in lymphangitis?

A

Commonly found on arm/leg

Red streaks on skin with tenderness; enlarged, tender lymph nodes, and fever

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11
Q

What symptoms and exam findings would you expect in compartment syndrome?

A

Tight, bursting pain in calf muscles, sometimes with overlying dusky red skin

Tingling, burning sensations in calf, muscles feel tight, full; numbness, paralysis if unrelieved

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12
Q

What symptoms and exam findings would you expect in Buerger disease?

A

Often digit or toe pain progressing to ischemic ulcerations –> may progress to gangrene at tips of digits Migratory phlebitis and tender nodules along blood vessels, usually involves two limbs

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13
Q

What is Buerger disease?

A

Inflammatory nonartherosclerotic occlusive disease of small to medium sized arteries and veins (esp in smokers)

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14
Q

What symptoms and exam findings would you expect in Raynaud disease?

A

Effects distal portions of fingers, pain not prominent unless fingertip ulcers develop

Numbness and tingling common

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15
Q

What is Raynaud disease?

A

Episodic reversible vasoconstriction in fingers and toes

Triggered by cold temperatures

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16
Q

What is Buerger’s disease also referred to as?

A

Thromboangiitis obliterans

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17
Q

What is the Allen test?

A

Compares patency of ulnar and radial arteries

Release pressure over ulnar artery; if ulnar artery is patent, palm floss within 3-5 seconds

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18
Q

What does a negative Allen test indicate?

A

Patient does not have adequate dual blood supply to the hand (palm still pale)

Negative indication for catheterization, removal of the radial artery, or any procedure which may result in occlusion of the vessel

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19
Q

What are the American Heart Association Cardiovascular Categories for Women - high risk?

A

>/=1 of these high risks states: existing CHD, CVD, PAD, abdominal aortic aneurysm, DM, end stage or chronic renal disease 10 year predicted risk of >10%

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20
Q

What are the American Heart Association Cardiovascular Categories for Women - at risk?

A

>/=1 major risk factor: smoking, BP >120/>80 or treated HTN, total cholesterol >200 mg/dL, HDL <50 mg/dL, treated dyslipidemia, obesity, poor diet, physical inactivity, family history of premature CVD Evidence of advanced atherosclerosis, metabolic syndrome, poor exercise capacity on treadmill test Systemic autoimmune collagen vascular disease Hx of preeclampsia, gestational DM, pregnancy induced HTN

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21
Q

What are the American Heart Association Cardiovascular Categories for Women - ideal cardiovascular health?

A

Total cholesterol <200 mg/dL BP <120/<80 Fasting glucose <100 mg/dL BMI <25 kg/m2 Abstinence from smoking

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22
Q

What type of cardiac screening do athletes require?

A

History and physical exam

No imaging unless risk factors are present or positive physical exam abnormalities

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23
Q

What are the events of the cardiac cycle?

A

Systole: ventricular contraction

Diastole: ventricular relaxation

S1: closure of mitral valve

S2: closure of aortic valve

S3/S4: atrial contraction, usually pathologic in adults

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24
Q

How do you calculate cardiac output?

A

CO = SV x HR

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25
Where would the FNP assess for the aortic, pulmonic, mitral, tricuspid, and Erb’s point?
Aortic: 2nd ICS RSB Pulmonic: 2nd ICS LSB Erb's: 3rd ICS LSB Tricuspid: 4th ICS LSB Mitral: 5th ICS MCL
26
What do heaves and lifts indicate? How would you assess for each?
Use palm and/or finger pads flat or obliquely against chest Sustained impulses that rhythmically lift fingers; produced by enlarged R/L ventricle or atrium, occasionally ventricular aneurysms
27
What do thrills indicate? How would you assess for each?
Press ball of hand firmly on chest to check for buzzing or vibratory sensation caused by underlying turbulent flow If present, auscultate same area for murmur
28
How would you assess for JVP?
1) Raise HOB to 30 degrees, patients head to left side 2) Use tangential lighting, identify internal jugular venous pulsations 3) Identify highest point of pulsation in right jugular vein 4) Extent card horizontally from highest point and ruler vertically from sternal angle (makes exact right angle) 5) Measure vertical distance where horizontal object crosses 6) Add 5cm (distance from sternal angle to center of RA)
29
What is a normal JVP finding?
JVP \>3cm above sternal angle, or more than 8cm in total distance, is ABNORMAL
30
What does an abnormal JVP finding indicate?
Acute/chronic HF, tricuspid stenosis, pulmonary HTN, SVC obstruction, cardiac tamponade, constrictive pericarditis \>95% specific for increased LV end diastolic pressure and low LV EF
31
How would the FNP evaluate the carotid pulse?
Supine, HOB 30 degrees, inspect for pulsations, index and middle finger on R carotid artery DON'T palpate both at the same time
32
How would the FNP evaluate the carotid pulse - amplitude?
Amplitude of pulse correlated with pulse pressure
33
How would the FNP evaluate the carotid pulse - contour?
Speed of upstroke, duration of summit, speed of downstroke Normal: brisk, smooth, rounded, less abrupt
34
How would the FNP evaluate the carotid pulse - pulses alternans?
Rhythm of pulse remains regular, but alternating strong vs weak pulse d/t ventricular contractions Indicates severe left ventricular dysfunction
35
How would the FNP evaluate the carotid pulse - thrill?
Vibration
36
How would the FNP evaluate the carotid pulse - bruit?
Murmur like sound
37
How would the FNP evaluate the carotid pulse - brachial artery?
Assessed in patients with carotid obstruction, kinking, or thrills
38
What would S3 and S4 indicate?
S3 - abrupt deceleration of inflow across mitral valve (rapid ventricular filling) S4 - increased LV end diastolic stiffness which decreases compliance (atrial contraction)
39
How would the FNP elicit murmurs?
Supine with HOB 30 degrees, left lateral decubitus position (listen at lower right sternal border for right sided murmurs with bell)
40
How are murmurs graded?
41
What would a systolic click indicate?
Heard in mid and late systole (early systolic ejection sound) Occur shortly after S1, sudden halting of aortic and pulmonic valves as they open in early systole Indicates CVD
42
What are the symptoms of an acute MI?
Dyspnea, N/V, sweating, weakness
43
What physical exam findings would be associated with heart failure?
Crackles, cyanosis of lips, tongue, oral mucosa, pallor and sweating Cough, orthpnea, paroxysmal nocturnal dyspnea, sometimes wheezing Exterion and lying down aggravate
44
What physical exam findings would be associated with aortic stenosis?
Midsystolic murmur, **delayed carotid upstroke**, thrills in carotid arteries from suprasternal notch or 2nd ICS, diminished S2, chest pain
45
What physical exam findings would be associated with pulmonic stenosis?
Wide physiologic splitting of S2, systolic murmur
46
Aortic stenosis murmur
Location: R 2nd/3rd ICS Intensity: soft, but often loud with **thrill (grade 4/6)** Pitch: medium, harsh, **crescendo-descresendo higher at apex** Quality: harsh, may be **musical** at apex Manuever: **best with patient sitting and leaning forward**
47
Pulmonic stenosis murmur
**Normal JVP**, R ventricular impulse sustained; if severe, S2 widely split Location: **L 2nd and 3rd ICS** Radiation: if loud, toward L shoulder and neck Intensity: soft to loud; if loud, **associated with thrill** Pitch: medium, **crescendo-decresendo** Quality: harsh
48
What physical exam findings would be associated with mitral regurgitation?
Apical impulse may be diffuse and laterally displaced Location: apex Intensity: soft to loud; if loud, associated with apical thrill Quality: harsh, holosystolic Maneuver: intensity of murmur **does not** change with inspriation
49
What physical exam findings would be associated with tricuspid regurgitation?
Location: lower LSB; if right ventricular pressure is high and ventricle enlarged, murmur is loudest at apex (can be confused with mitral regurgitation) Radiation: right of sternum, xiphoid, left MCL, **NOT** axilla Quality: **blowing**, holosystolic Maneuvers: intensity increases with inspiration
50
What physical exam findings would be associated with Still's murmur?
**Grade** **1-2**/6 murmur, musical, vibratory Multiple overtones, early and midsystolic murmur over mid/lower LSB Mid/lower LSB, can be associated with a carotic bruit **Diminishes from supine to sitting**
51
What physical exam findings would be associated with left ventricular hypertrophy?
Isolated systolic HTN, widened pulse pressure PMI \>2.5cm, displacement of PMI lateral to midclavicular line, sustained high amplitude PMI
52
What physical exam findings would be associated with coarctation of the aorta?
Lower BP in legs than upper extremities (BP difference of 10mmHg or higher) Diminished/delayed femoral pulses Due to narrowing of thoracic aorta
53
What physical exam findings would be associated with venous hum?
Nonvalvular Timing: **continuous murmur** w/o silent interval (loudest in diastole) Location: above medial third of clavicles (esp R), **best heard when patient is sitting**, disappears when patient is supine Intensity: soft to moderate, hum **obliterated by pressure on internal jugular** vein Quality: **humming, roaring**
54
What physical exam findings would be associated with pericardial friction rub?
Nonvalvular Timing: coarse grating sound; rubs heard with or without pericardial effusions Location: heard best in L 3rd ICS with patient sitting and leaning forward with breath held after expiration Intensity: superficial sound of varying intensity that seems "close to the stethoscope" Quality: scratchy, scraping, grating Pitch: high (heard better with diaphragm)
55
What is paroxysmal nocturnal dyspnea?
Need to sit up at night to ease breathing Sudden dyspnea and orthopnea that awaken
56
What does paroxysmal nocturnal dyspnea indicate?
Chest pain, left ventricular failure (left side HF)
57
What are general physical exam findings in the pediatric patient with congenital heart disease?
Severe acrocyanosis that does not disappear within 8 hours of warming, central cyanosis (tongue/oral mucosa) w/o acute respiratory symptoms Murmur + central cyanosis
58
What does split S2 sounds indicate?
Left sided closure of aortic valve and right sided pulmonic valve
59
What do split S1 sounds indicate?
M1 (cardiac apex) and T1 (lower LSB) - does not vary with respirations
60
What do the components of an EKG indicate?
P wave: atrial depolarization QRS complex: ventricular depolarization Q wave: septal depolarization R wave: ventricular depolarization T wave: ventricular repolarization
61
Cardiac history: swelling (edema)
Interstitial tissue can absorb up to 5L of fluid, 10% weight gain before pitting edema occurs Obtain daily weights Causes frequently cardiac
62
Cardiac history: fainting/syncope
Most common cause is neurocardiogenic (vasovagal syncope)
63
Causes of aortic stenosis
Bicuspid aortic valve
64
Causes of pulmonic stenosis
Congenital heart defect
65
Causes of mitral regurgitation
Structural, mitral valve prolapse, infectious endocarditis, rheumatic heart disease, collagen vascular disease Functional - ventricular dilation and mitral valve dilation
66
Causes of tricuspid regurgitation
R ventricular failure and dilation w/ resulting enlargement of tricuspid orifice Induced by pulmonary HTN or left ventricular failure Endocarditis

NURS 500 (8 decks)

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