Exam 2: Respiratory, Cardiac, Immunizations Flashcards Preview

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Flashcards in Exam 2: Respiratory, Cardiac, Immunizations Deck (111)
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Cardiac: What do you listen for with the client in LLD?

mitral stenosis, S3, S4 - with bell


Cardiac: What do you listen for with the client leaning forward?

Aortic regurgitation murmurs - with diaphragm. "breathe in, breathe out, hold"


What heart sounds do you hear with the diaphragm?

high pitched: S1, S2, murmurs of AR and MR, AS, friction rubs, VSD


What heart sounds do you hear with the bell?

low pitched: S3, S4, diastolic murmurs (e.g. MS)


Cardio: what are the characteristics of sounds to be described?

Frequency (pitch) Intensity (loudness) Duration Timing (systole, diastole)


What are the valves of the heart?

Atrioventricular: tricuspid & mitral/bicuspid Semilunar: pulmonic & aortic


Name the areas of the heart

RV is most of anterior chest 

Base is superior aspect of heart at R & L 2nd IS

Xiphoid process is good landmark for RV. 


Tell me about a normal PMI

4th or 5th interspace, 7-9cm lateral to midsternal (at or just medial to midclavicular) 

Supine diameter: 1-2.5 (about a quarter)


Tell me about an abnormal PMI

Larger than 2.5cm (evidence of LVH, or enlargement, as seen in HTN and AS)

Lateral to midclavicular or >10cm lateral to midsternal (LVH)

Xiphoid/epigastric area (COPD)



Sinus arrhythmia

varies with respiration

normal HSs, though S1 may vary with the HR


Atrial or nodal premature contractions

Rhythm: atrial/nodal beat before next expected heart beat. Pause. Rhythm resumes

Heart Sounds: S1 may differ in intensity from normal S1. S2 may be decreased.


PVC (sporadic or regularly irregular)

Rhythm: ventricular beat comes before next expected beat. Pause. Rhythm resumes.

Heart Sounds: S1 may differ from normal, S2 may be decreased. Both likely split.


Afib & Aflutter w/varying AV block (Irregularly irregular)

Rhythm: ventricular rhythm is totally irregular, though possible short runs of regular-seeming 

Heart Sounds: S1 varies in intensity


Paradoxical Pulse

decrease in pulse's amplitude on quiety inspiration (st palpable, but possibly need BP cuff)

Systolic pressure decreases >10mmHg during inspiration

Causes: pericardial tamponade, exacerbatins asthma & COPD, st in constrictive pericarditis


pulsus alternans

pulse alternates in amplitude beat to beat even though rhythm is basically regular (must be). 

Indicates LV failure, usually accompanied by S3


Normal Pulse Pressure

~30-40 mmHg pulse pressure



small, weak pulse

Pulse pressure diminished, upstroke may feel slowed, peak prolonged

causes: decreased SV (HF, hypovolemia, severe AS); increased peripheral resistance (exposure to cold and severe HF)


Large, bounding pulse

pulse pressure increased, rise and fall may feel rapid, peak brief

Causes: increased stroke volume, decreased peripheral resistance, or both (fever, anemia, hyperthyroidism, AR, AV fistulas, PDA); increased stroke volume d/t slow HRs (bradycardia, complete heart block); decreased compliance/increased stiffness of aortic walls (aging, atherosclerosis)


Systolic click

Usually MVP (systolic ballooning into LA from both leaflet redundancy & elongations of chordae tendineae)

Mid to late systolic

High pitched, often followed by MR murmur

several positions recommended: supine, seated, squatting, standing (squatting delays click & murmur, standing moves them closer to S1)


Opening snap

very early diastolic sound

stenotic mitral valve

listen with diaphragm medial to apex along lower left sternal border


intermittently irregular beats

e.g., ectopic beats - PAC, PVC


Continuously irregular beats

a.k.a. "regularly irregular"

Afib: palpittions that warrant ECG


Superior view of heart valves


What happens during diastole (+atrial kick)

AV valves open, passive flow (about 75% of volume) move into relaxed ventricles, then atria contract & active flow accounts for about 25% into ventricles (atrial kick)


isovolumic phase of ventricular systole

interval between closing of AV valves and opening of semilunar valves


ECG: define p, qrs, t, u

p: atrial depolarization

qrs: ventricular depolarization

t: ventricular repolarization

u: ventricular diastole


ECG leads

6 limb leads, 6 precordial leads


CAD risk factors for women

DM, smoking, HTN, obesity


questions you ask if chest pain

O: when did pain start? having pain now?

L: where is pain located? Does it radiate?

D: how long have you had pain?

C: what does it feel like? Pressure, tightness, heaviness, stabbing? Associated symptoms?

A: aggravates/alleviates? rest? Nitro?

R: travel to any part of your body?

T: when did you notice? Intermittent or persistent?


characteristics: squeezing, discomfort, burning, stabbing

Associated symptoms: cough

Relieved by: rest or nitrogylcerin


Special considerations on pediatric cardiac exam

Listen in at least 2 positions

S3 heard through thin chest walls

S4 indicates poorly compliant ventricles - always abnormal

murmurs: should disappear when supine, be systolic, not be assoc w/clicks, rubs, or other sx

school age: may disappear w/sitting