Exam 2: NR414 Flashcards
1
Q
Blood dumps into
A
right atrium
2
Q
Cardiac Cycle.. (p.458)
A
3
Q
Heart consists of
A
- Heart (muscular pump)
- Blood Vessels- 2 cont loops
- pumonary cicrulation
- systemic circulation
4
Q
Mediastinum
A
5
Q
Right and left Cardiac Borders
A
6
Q
Apex and Base of heart
A
- know the landmarks
- base is up
- apex is down
7
Q
Apical Impulse (pic)
A
- feeling the contraction/ closure of valves
- feel all of them on kids
- adults not always able to feel
8
Q
What are the 4 chambers of the heart?
A
- Right Aorta
- Left Aorta
- Right Ventricle
- Left Ventricle- (probls occur here)
9
Q
3 Layers of the heart wall
A
- Pericardium
- Myocardium
- Endocardium
10
Q
What can cause infection in the cardiac
A
- bad gums
- central line
- weak valve
- inflammation
11
Q
Parts of the heart
A
- chambers
- valves
- av
- Tri
- Mitral
- semilunar
- pulmonic
- aortic
12
Q
Lub Dub sounds is..
A
valves closing
13
Q
Diastolic phase
A
- Filling
- Relaxing
- Atrial Kick
14
Q
Systole Phases
A
- contraction
- ejection
- blood pumped out
15
Q
Which side of the heart is pressure lower?
A
- Right side
16
Q
What is the first heart sound?
A
- Closure of AV valves (mitral/tri)
- (S1)
- louder at apex
17
Q
What is the second heart sound?
A
- closure of semilunar valves
- S2
- louder at the base
18
Q
What can effect respiration?
A
inspiration may cause a split S2
19
Q
S1
A
- Right atrium is filling
- pressure is high
- dumping blood into right ventricle
20
Q
S2
A
- left ventricle sending blood out
21
Q
Listening to the heart, what side of your stethoscope do you hear low pitched sounds?
A
Bell
22
Q
What is a brewy?
A
turbulent blood flow
23
Q
What does S3 sound like
A
- kentucky
24
Q
What does S4 sound like?
A
“Tenessee”
Gallop
25
When does S3 occur?
* early in diastole
* immediately after S2
* at the very end
26
Pathological Reasons for Listening for S3
* Anemia,
* sign of HF
* Volume overload
* hyperthyroidism
* pregnancy
* renal failure
* persists when sitting up
27
When does S4 occur
* End of diastole
* prestyole
* when ventricle is resistant to filling, just before S1
28
Where is S4 best heard
apex, left lateral position (left sided
29
Reasons for listenting for S4
* decreased compliance of ventricle
* systolic overload
* aortic stenosis
* systemic hypertension
30
Lifestyle that can affect heart
* Smoking
* Inactivity
* Sitting a lot
* Nutrition
31
How are murmurs graded?
1-4
32
What does a murmur sound like?
* washing machine
33
What are reasons for having a murmur
* During menstrual cycle (benign)
* During Exercise
* Thyroid level too high
* Anemia (low blood)-less rbcs, less oxygen
* expected for infants
* structural defects in valve
* unusual openings in chambers
34
What are you assessing for in heart sounds
* pitch
* volume/intensity
* duration
* timing- Sys, Dia
* noting you heard S1 & S2
35
Cardiac Output Formula =
* SV X HR
36
What is a resting adult CO
4-6 of blood/min
37
What is preload?
force of stretch in heart from venous return
38
What is afterload?
Ventricular pressure needed to eject blood
39
What are the neck vessels
* carotid artery
* jugular veins
40
What is important about carotid artery pulses
* pulse goes along with S1, nsync
41
What do the neck vessels say about the heart (carotid, jugular) p.473
how well the heart is functioning
42
What happens to the neck vessels when lying down vs sitting up
* sitting you can see it
* sitting up it goes away
43
What happens heart/neck when Aging?
* BP increases
* lifestyles
* sodium
* Left ventricle increases
* Increase Arrhythmias
* Orthostatic Hypotension (getting out of bed fast)
* check for bruits in carotid
* systolic heart murmurs
44
Where do you assess an adult heart
5th intercostal
45
Where do you assess an infant's heart?
3-4 intercostal
46
What is PMI referring to?
* Point of Maximal Impulse
* Where to assess
* Mitral Area
47
High risk factos for heart disease
* high blood pressure
* smoking
* high cholesterol
* diabetes
* obesity
48
What protects the heart for women?
estrogen
49
How does obesity affect Cardiovascular Disease?
* fat around the organs (stomach)
*
50
What are you assess for objective data
* room prep
* position and draping
* equipment needed
51
what type of assessment do you take for bruit?
auscultate
52
What type of assessment do you take for carotid arteries?
palpate
53
What is difficult to see in healthy people related to the heart?
jugular veins
54
What type of assessment do you take for the Precordium
inspect, palpate (PMI), percussion (not reliable)
55
**A**ll **p**atients **t**ake **m**eds Mneumonic
* Aortic Valve
* Pulmonic Valve
* Tricuspid Valve
* Mitral Valve
56
What do blood vessels do?
Transport Blood which transports oxygen
57
What do lymphs do?
* Helps vessels control fluid,
* **gets rid of waste.**
* Immunity.
58
What are you markers for major arteries?
ulnar, radial, brachial
59
When feeling pedal pulses what artery?
* femoral
* politeal
* posterior tibial
* **doral pedis** (top of foot)
60
What are signs getting good blood flow?
* Cap refill less that 3
* Warmth
61
Intraluminal valves help to ensure
blood moves towards the heart
62
What do varicose veins look like?
* blue
* torturous
* you can feel
63
How would the skin present itself if you had arterial insufficiencies?
* thin, shiny skin, thick nails
* less hair on legs
64
What is a DBT
* Deep vain thrombosis
* Clott
* pain & warmth
* on one side
65
How are pulses measured
**0-4**, *2 is normal*
66
Modified Allen's Test
* should see blanching
* compression on radial & ulnar arterties
67
What are some peripheral vascular disease
* raynaud's syndrome
* lymphedema
68
What is blooms taxonomy?
* *helps to define different questions*
* Creating
* Evaluating
* Analyzing
* Applying
* Understanding
* Remembering
69
What is the precordium?
anterior chest overlying the heart and great vessels
70
Describe the Tricuspid Valve
Right atrioventricular valve
71
What is the function of the pulmonic valve?
protect the orifice between the right ventricle and the pulmonary artery
72
Jarvis:
How does atrial systole occur?
independently of ventricular function
73
Jarvis:
The second heart sound is the result of:
closing of the mitral and tricuspid valves
74
Jarvis:
When palpating an apical impulse what is the normal size?
2 cm
75
Jarvis:
Where do you listen in the pulmonic valve area?
the 2nd Left Interspace
76
Jarvis:
What is the difference between S2 & S3?
S3 is lower pitched and is heard at the apex
77
Jarvis:
When auscultating the heart your first step is to:
identify S1 & S2
78
Jarvis:
Where is a split S2 heard most clearly?
pulmonic
79
Jarvis:
Why is the stethoscope placed lighting against the skin?
it does not act as a diaphragm
80
Jarvis:
What is the function of the venous system?
Hold more blood when blood volume increases
81
Jarvis:
What organs aid the lymphatic system?
spleen, tonsils, thymus
82
Jarvis:
What causes varicose veins in pregnant women?
pressure of the growing uterus on the veins
83
Jarvis:
A 4+ edema of the right leg is documents. The best description of theis type of edema is:
very deep pitting, indentation lasts a long time
84
Jarvis:
A known risk for venous ulcer development is:
obesity
85
Jarvis:
What does Brawny mean?
non pitting edema
86
What are we listening for in the heart? x 5
1. Rhythmn/Rate
2. S1 & S2 together
3. S1 & S2 separate
4. S3 & S4
5. Murmurs
87
When do we switch from diaphram to bell?
S3 & S4, murmurs
88
Where is the aortic valve?
2nd intercostal rt sternum
89
Where is the pulmonic valve
2nd intercostal left sternum
90
Where is the tricuspid valve?
5th ICL left sternum
91
Where is the mitral valve
5th intercostal midclavical
92
S1 is the closure of which valves?
av valves (mitral/tri) @apex
93
s2 is the closure of which valves?
semilunar, pulmonary/aortic (at base)
94
Where do you hear split S2
pulmonic valve stays open a little bit during **inspiration**
95
Where is the systolic contraction
in between lub and dub
96
Where is the diastolic?
before or after lub dub
97
Posterior Throacic Cavity/Locating Lungs
* vertebra prominens (c7)
* spinous processes (knobs)
* inferior border of scapula (7th/8th rib)
* 12th rib
98
Where are the highest point in the lungs
apex, above clavical
99
Where is the lateral lung
Apex of acula, 7th or 8th rib
100
Are the lobes of the lungs symmetrical
no
101
What is different about the lung because of the heart?
left lung lobe is more narrow
102
Anterior Reference Lines for the lungs
*
103
Which side as 3 lobes
right side
104
Where is the base of the lungs?
lower border, rest on diaphram (6th intercostal)
105
Which lung lobe is shorter?
the right side, because of the liver
106
Why do you have to listen to posterior, anterior, lateral?
your missing significant lung space
107
What is the pleura
a membrane
108
What does visceral pleura
sack for the lungs
109
Parietal pleura is where
lines the inside of the chest wall and diaphragm
110
What is the pleural cavity
inside of envelope, filed with only mL of lubricating fluid. Negative pressure
111
Why is the negative pressure?
lungs are being pulled open, otherwise lungs would collapse
112
Costodiaphragmatic recess
pleurae extend 3cm below level of lungs. If area fills with fluid will cause problems. Shortness of breath.
113
Pleural friction rub?
114
Trachea dn Bronchial Tree
* dead space, not available for gas exchange
* gas xchange occurs in bronchial
115
4 major function of respiratory syst
1. supply o2 for energy
2. see slides
116
What is controlling respiration
CO2
117
What controls the respiration
ponds and medula of brain stem
118
Hypercapnea
too much CO2
119
hypoxia
low oxygen
120
hypoxemia
low oxygen in the blood
121
What is the major muscle of inspiration
diaphram
122
Is expiration passive or active
passive
123
What happens to adults lung capacity
decreases
124
What increases for adults
kyphosis, infection, dysnia, thorax becomes rounded
125
What infectious disease has declines
TB
126
What is the BCG vaccine?
TB vaccine
127
What percent of the us pop has asthma
5-12%
128
What hemoptysis?
coughing up blood
129
What do you ask for SOB
what brings it on, how long does it last
130
What health hx are you looking for (subj data)?
1. smoking history
2. environmental exposure
3. self care behaviors
4. chest pain with breathing
5. SOB
6. Cough
7. past history of resp infections
131
What vaccination do you want to ask about for self care behavior?
* flu shot
* pneumonia
* ppd
132
What do you ask older adults for health hx lungs?
* fatigue
* exercise
* chest pain when breathing
133
What is your objective data for lungs?
1. position- start at back
2. draping
3. timing during a complete exam
4. posterior and then anterior
5. cleaning stethoscope end piece
134
What equipment do you need for lung exam?
1. stehoscope
2. sruler
3. marking pen
4. alcohol swabs
135
What is a normal ratio for antero to posterior (transvers)
1:2 or 5:7(side to side)
136
What is barrel chest
* COPD
* 1:1
* chest comes out farther
137
What position do you put person
orthopneic position, tripod
138
What is tactle fremitus
* palpable vibration
* ulnar edge of hand
* chest wall thickness
* 99, blue moon, generate strong vibe
* should be symmetrical
* position of bronchi to chest wall
139
When is percussion used?
* low pitched, clear, hollow sound
* for lung fields
* want to hear resonance
140
What does dull sounds mean?
something blocking, increased density of tissue
141
Auscultation of the lungs?
* should be hearing clear sounds
* apices in supravlacilular around down to 6th rib
142
Brochovesicular breath sounds
moderate pitch. Inspiration = expiration. All over bronchi. Midline
143
What are crackles?rales
* caused by fluid
144
Vesicular
Inspiration greater than expiration. on lung tissue
145
What does adventitious ounds mean?
abnormal
146
What is wheezing
narrowing of the airways
147
Atelectatic crackles
* a portion of the lung is collapsed and airless
* end-inspiratory crackles
* hear posterior
148
Voice Sounds
* bonchophony
* egophony
* whispered
149
WOB
* work of breathing
* quality of reps
* Rib interpaces- retractions?
* accessory neck muscles
150
Forced expiratory time or volume
normal is about 4 seconds
151
what is the 6 min distance walk
means they can complete adls if can go 300 meters.
152
Know breathing patterns 18-4, 18-5, 18-6
153
What is the difference between biots and cheyne stokes?
biots is irregular
154
What are discontinuous sounds?
crackles
atelectic crackles
pleural friction rub
155
What are continuous sounds
wheeze, stridor
156
What are fine crackles vs course crackles?
157
plearual friction rub
* leather rubbing together
* pleuritis
158
What are high pitches wheezing?
asthma, sibilant
159
What are low pitched wheezing
sonorous, copd
160
What is a life threatening sound
stridor, crowing
161
What are some nursing diagnoses for lungs?
162
What is the nose function
* warms, moistens, filters inhaled air, smells
163
Where does the nasal cavity extend
* roof of mouth,
* septum,
* turbinates.
contain boney projections
164
Paranasal sinuses
* frontol- above eyes
* maxiallary, cheek bone
* ethmoid, eyes
* sphenoid
165
What is the mouth
* airway for the respiratory sys
* hard palate- whitish
* soft palate- pinker
166
Parotid lies within
cheeks, in front of ear
167
submandibular
beneath maniblee
168
What are 3 salivary glands
parotid
submandibula
sublingual
169
How many teeth do you have
32
170
Developmental care for aging adult
reduce smell, gum loss, nose more prominent
171
What is rhinorrhea
fancy word for nasal discharge
172
What do you ask about for nose sub data
colds, sins pain, trauma, epistazis, allergies, altered smell, discharge
173
What self care behavior for moth and throat
brushing teeth, dental visits, floss
174
What age do you start going to the dentist?
2-3 yrs
175
Where do you test patency of nostrils
CN 1- sense of smell
176
Where is the most common place to see mouth cancer?
underneath tongue
177
Tonisl grading
* 1+ you can see them
* 4+ almost blocking off airway
178
What do tonsils look like
deep divet/crips (pockets)
179
When should you do the oral exam for children
at the end
180
What are abnormalities of the nose
* epistaxis- bloody nose
* acute rhinitis- membranes dk red, drainage- purulent
* allergic rhinitis- white gray- serous drainage
181
Where do blood noses start?
* inside your nostrils (anterior)
* back of your nose (posterior).
182
How do you assess for abnormal findings of nose?
nasal flaring
183
Small Intestine is for
184
large intestine
* waste
* absorbs water/electrolytes
* elimination
185
defecation
process of elimnation of waste
186
Feces
semi solid mass of fiber, undigested food
187
Where does fecal material reach
rectum
188
What do stretch receptors initiate
contraction of sigmoid colon/rectal muscles
189
What is valsalva maneuver
involuntary bearing down
190
what does the external sphincter do
relaxes
191
What factors affect bowel elimination
* diet/fiber
* activity
* hydration
* meds
* developmental stage
* dont get control of sphincter until 2 yrs
192
What are the words used and how often is it normal?
* poop, stool, bm, feces, defecate
193
When do we get concerned about bowel movement
if they have not gone in 3 days
194
What parts of bowel routine is importance?
* daily time clock
* hot drinks
* stool softeners
* privacy
* position and ab pressure
* bearing down
195
What should you asses when assistance with elimination
privacy, how does patient feel
196
What encourages defecation
* water,
* fiber
* exercise
197
What does poop that floats mean?
high fat
198
Common alterations in defecation
* diarrhea,
* constipation,
* fecal impaction,
* bowel diversion
199
How do we monitor for fluid impalances
* turgor,
* mucos membranes
* in/out
200
What is a diarrhea diet
* clear liquid
* BRAT
* avoid cafeine, spicy foods
201
Anti diarrheal meds
lomotil, imodium
202
Should meds be given for diarrhea caused by food poisonoing?
no
203
Managing fecal impaction
* prevention
* determine presence
* enemas
* man/dig stimulation
* establish bowel program
204
What is an enema
* fluid breaks up fecal mass,
* intiiates defecation reflex
* position patient left lateral position
* promotes defecation
* phys order
* chux undereath
205
How much solution for enema of adult
350-500 mL
206
Common Diagnostic tests
* stool for ocult blood- "guaiac test"
* direct visualization
* radiographic view- flat plate of ab
