Exam 3 Flashcards
Heart, Peripheral Vascular, Abdominal
1
Q
Definition of pulmonary circulation
A
Right side pumps blood to lungs by removing C02 & replenishing supply
2
Q
Definition of systemic circulation
A
Left side of the heart pumps blood to other parts of the body
3
Q
How is deoxygenated blood traveled through the heart?
A
Blows flows into superior and inferior vena cava-> right atrium-> tricuspid valve-> R.ventricle-> pulmonary valve-> R. pulmonary artery->Lungs
4
Q
How is oxygenated blood traveled through the heart?
A
Pulmonary veins-> L.atrium->mitral valve->L.ventricle->aortic valve->aortic arch->All parts of body
5
Q
What valves prevents from flowing in reverse direction?
A
Pulmonic & aortic (semilunar valves)
6
Q
Lays of the Heart & Function
A
Pericardium- Fibroserous sac that attache to great vessels & surround heart
Myocardium-Thickest layer, contracts muscle cells
Endocardium-Thin endothelial tissue & lines inner surface of heart
7
Q
Electrical Pathways of the heart
A
- SA node (sinus node) generates impulses & contracts to send blood to ventricles
- Impulse conducted to atria to AV node
- AV node relays impulse to AV bundle (bundle of His)
- Electrical impulses travel to right and left bundle branch & purkinje fibers in myocardium to both ventricles
8
Q
Definition of Diastole & Systole
A
Diastole-Relaxation of ventricles (filling)
Systole-Contraction of ventricles (emptying)
9
Q
Why is systole split into two?
A
S1- Beginning of systole, closing of AV valves (tricuspid & mitral)
S2-Ventricular emptying, decreased pressure & closing of semilunar valves (aortic & pulmonic)
10
Q
Normal Heart Sounds & Where are they heard the best
A
S1 (“lub”)-Best at apex
M1-mitral valve closure
T1-Tricupsid valve closure
S2 (“dub”)-Best at base
A2-aortic valves closure
P2-pulmonic valve closure
11
Q
Extra Hearts Sounds
A
Diastolic filling sounds
S3-early in diastole, after S2
S4-Late in diastole, before S1
12
Q
How to Calculate CO & Normal Output
A
SV*HR=CO
Normal: 5-6 L/min
13
Q
What type of oxygen do carotid arteries supply and what to assess for?
A
Supply neck and head (brain) w/oxygenated blood
Assess for amplitude & contour
14
Q
What type of oxygen do jugular venous pulse & why is it important?
A
Supply neck and head with unoxygenated blood via superior vena cava
15
Q
Definition of Murmur
A
Blowing, swishing sounds over valve area or intercostal space
(Described as musical, harsh, or rumbling)
16
Q
Biological (Genetic) Changes of Infants
A
Heart beat begins 3 weeks gestation
Oxygenation occurs via placenta
Formen ovale closes within first hour (Ductus arterioles closes within 10-15 hours)
17
Q
Biological (Genetic) Changes of Pregnant Women
A
Increased blood volume 30-40%
Increased SV & CO (pulse 10-15 bpm higher)
Decreased arterial blood pressure
Decreased BP drops during 2nd trimester, then increases back to normal
18
Q
Biological (Genetic) Changes of Older Adults
A
Systole BP (20 mm Hg) due to stiffening of large arteries
Increased LV wall thickness
Increased risk for arrhythmia & coronary artery disease
Ectopic beats (extra heart beats) are common
19
Q
S/S of Chest Pain
A
Angina: Cardiac chest pain; severe w/sense of pressure radiates to left shoulder or jaw
Diaphoresis: Sweating
20
Q
What does Tachycardia & Palpitations Indicate?
A
Tachycardia: Weak heart= Increased CO
Palpitations=Abnormal conduction or Increased CO
21
Q
What cardiac diseases is dyspnea associated with?
A
MI, HF, or contrary artery disease
22
Q
Definition of Orthopnea?
A
Sit upright to breathe due to fluid in the lungs
23
Q
Indicates HF
A
Orthopnea
Nocturnal dyspnea
White-Pinked tinged sputum (fluid accumulation)
24
Q
How does ARF & RHD develop?
A
Group A & B-hemolytic streptoccis
25
Mneumonic for Smoking
Ask, advise, Assess, Assist, Arrange
26
Normal & Abnormal Findings of Neck Vessels (Inspection)
Normal: jugular venous pulse not visible at 45 degrees or higher
Abnormal: Visible pulse (Increase venous pressure) indicated HF, pulmonary embolic, cardiac tamponade
Distention on one side-Kink or aneurysm
27
Positive Kussmaul Sign
Increased jugular venous pressure on inspiration indicates pericarditis
28
Normal & Abnormal Findings of Neck Vessels (Auscultation)
Use bell to auscultate carotid artery & patients holds their breath
Normal: No swishing, blowing, or other sounds
Abnormal: Bruit over artery indicates occlusive arterial disease
29
Definition of Bruit
Blowing/Swishing sound caused by blood passing through narrowed vessels
30
Normal & Abnormal Findings of Neck Vessels (Palpation)
Normal: Pulse 2+ bilaterally, contour smooth
Abnormal: 1+ (hypovolemia, shock, decreased CO)
+4 (hypervolemia, increased CO, thrills)
31
Normal & Abnormal Findings of Anterior Chest (Inspection)
Normal: Apical pulse may not be present (mitral area at MCL, fourth/fifth ICS)
Abnormal: Heaves/Lifts indicates enlarged ventricles
32
Definition of Heaves/Lifts
Abnormal outward pulsations
33
Normal & Abnormal Findings of Anterior Chest (Palpation)
Normal: Apical pulse in mitral area, 1-2cm, small amplitude
Abnormal: Unable to palpate (pulmonary emphysema); Large, displaced, long duration (Cardiac enlargement)
34
Normal & Abnormal Findings of Anterior Chest (Auscultation)
Diaphragm at apex
Normal: 60-100 bpm w/regular rhythm
Abnormal: Bradycardia/Tachycardia (Decreased CO)
35
How to auscultate pulse rate deficit
Palpate radial pulse & auscultate apical pulse (full minute)
36
Findings of Pulse Rate Deficit
Normal: Pulse identical
Abnormal: Indicates A.fib, A.flutter, blockage, or premature contractions
37
Abnormal & Normal Findings of Extra Sounds
Normal: No extra sounds
S3 heard at beginning of diastole pause in children, adolescents, and young adults
S4 heard at end of diastole in athletes & older adults 40-50
Abnormal: Ejection sounds or clicks indicate friction rub during systole
38
Normal & Abnormal Findings of Anterior Chest (Auscultation; Murmurs)
Normal: No murmurs
Abnormal: mid systolic, pansystolic, & diastolic murmurs
39
Definition of Murmurs
Swishing sound caused by turbulent blood flow through heart valves or great vessels
40
Definition of Arteries
Blood vessels that carry oxygenated, nutrient rich blood from the heart to capillaries
41
Majors Arteries of Arm & Components
Bronchial Artery
Radial Artery (thumb side)
Ulnar Artery (pinkie side)
42
Major Arteries of Leg & Components
Femoral Artery
Popliteal Artery: Artery front of thigh to back of thigh
43
Components of Popliteal artery
Anterior branch: Dorsalis pedis artery (Top of foot)
Posterior branch: Posterior tibial artery (behind medial malleolus of ankle)
44
Definition of Veins
Blood vessels that carry deoxygenated, nutrient-depleted blood from tissues to heart
45
Mechanisms of Venous Pressure
1. One way valves to prevent blood from flowing backwards
2. Skeletal muscles contract sending blood towards heart
3. Inspiration increased abdominal pressure creating pressure gradient
46
Definition of Perfusion
Interstitial fluid releases water, oxygen & nutrients & picks up products (CO2)
47
Biological (Genetic) Changes of Pregnant Women
Occurs in 3rd Trimester
Edema-Bilateral pitting edema in lower extremities
Variocosities-Enlarged & twisted veins under skin
Hemmorrhoids-Elarged & irritated veins or blood vessels around anus/lower rectum
48
Biological (Genetic) Changes of Infants
Peripheral system same as adults
Developed at birth
Acrocyanosis & skin molting at birth
49
Biological (Genetic) Changes of Older Adults
Increase risk for atherosclerosis & arteriosclerosis
Dorsalis pedis & posterior tibial pulse become difficult to find
Trophic changes: thin, shiny skin; thick-ridged nails; loss of hair on lower legs
50
S/S of Arterial Insufficiency
Cold, pale (pallor), clammy skin, thin skin on extremities
51
S/S of Venous Insufficiency
Warm skin, edema, brown hyperpigmentation
52
Definition of Intermittent Claudification and Indicates
Weakness, cramping, aching or pain w/activity
Indicates arterial disease
53
S/S of Peripheral Venous Disease and Indicates
Heaviness of legs, aching aggravated by standing/sitting. leg edema
Associated with delayed wound healing
54
What does Erectile Dysfunction indicated in male patient?
Central arterial or venous disease
55
What does Peripheral Venous Disease Cause?
Blood clots, DVT, swelling, narrowing/blockage of vessels
56
What does oral contraceptives & smoking cause in females patients?
Increase risk for Raynaud, Edema, HTN, or Thrombophlebitis
57
Normal & Abnormal Findings of Arms (Inspection)
Normal: Bilaterally symmetric w/minimal difference; No edema
Abnormal: Lymphedema (Blocked or damaged lymphatic circulation)
58
Normal & Abnormal Findings of Arms (Inspection)
Normal: Color the same bilaterally
Abnormal: Raynaud Disorder
59
Definition of Raynaud Disorder
Vasoconstriction or vasospasm of fingers or toes; rapid color changes (pallor, cyanosis) & tingling, swelling, pain, coldness, or burning
60
Normal & Abnormal Findings of Arms (Palpation)
Normal: Skin warm to touch bilaterally. Capillary refill less than 2 sec.
Abnormal: Cold extremities (arterial insufficiency). Capillary greater than 2 secs (vasoconstriction, shock, hypothermia, decreased CO)
61
Normal & Abnormal Findings of Arms (Palpation, Pulses)
Normal: Radial pulse 2+ bilaterally & artery wall has resilient quality
Abnormal: 3+ or 4+ (hyperkinetic); 0+ or 1+ (arterial occlusion)
62
Why would you palpate the ulnar and brachial pulses?
Palpate if arterial insufficiency is suspected
63
What is the Allen test? Why is it ordered?
Test patency of radial and ulnar arteries
Essential for ABG's or arterial line placement
64
How to perform Allen test?
Patient makes a fist & occlude pulses. Patient releases fist and nurse removes thumb based on assessed artery
65
Findings of Allen Test
Normal: Pink coloration in 3-5 sec
Abnormal: Pallor persists indicates arterial insufficiency
66
Normal & Abnormal Findings of Legs (Inspection)
Normal: No changes in skin pigmentation
Abnormal: Pallor & rumor suggests arterial insufficiency. Cyanosis suggests venous
67
Normal & Abnormal Findings of Legs (Palpation)
Normal: No edema present in legs. Warm bilaterally.
Abnormal: Pitting edema (HF, Venous stasis, hepatic cirrhosis).
Cold (Arterial insufficiency). Warmth (Superficial thrombophlebitis)
68
Normal & Abnormal Findings of Legs (Palpation, Auscultated)
Normal: Pulse strong bilaterally. No sounds auscultated.
Abnormal: Arterial occlusion
69
How to find varicosities & thrombophlebitis?
Inspect while patient is standing
Normal: Veins are barely visible
Abnormal: Varicose veins (distended veins)
Thrombophlebitis (Redness, thick, & tender along vein)
70
What Abnormality is Common in Older Adults?
Varisocites are common in older adults
71
What are the three special tests?
Position change Test
Manual Compression Test
Trendelenburg Test
72
How to perform position change test?
Patient is supine and nurse places forearms under ankles/knee and raise the legs 12in above. Patient pumps their feet for 1 min. Patient sits up and dangles feet
73
Findings of Position Change Test
Normal: Pink color returns in 10 sec or less
Abnormal: Pallor remains & takes greater than 10 sec (arterial insufficiency)
74
How to calculate Ankle-Brachial Index (ABI)
Systolic ankle pressure/ Systolic brachial pressure
75
Normal & Abnormal Range of ABI
Normal: 1.0-1.4
Abnormal: <0.9 & >1.40 (Risk for stroke or heart attack)
76
What tests are used if a patient has varicose veins?
Manual Compression Test & Trendelenburg Test
77
What is the Manual Compression Test?
Performed when patient has varicose veins and used to assess competence of veins.
78
How to perform Manual Compression Test
Patient stands & nurse puts hand on lower portion of veins & other hand 6-8in above the first hand. Test for pulsations in upper hand
79
What is the Trendelenburg Test?
Tests saphenous veins & retrograde
80
How to perform Trendelenburg Test?
Elevate patient leg 90 degrees for 15 secs & apply tourniquet to upper thigh. Patient than stands & observe venous filling
81
Findings of Trendelenburg Test
Normal: No pulse palpated. Saphenous veins fill less than 30 sec
Abnormal: Pulse is in upper fingers. Filling above tourniquet. Rapid filling
82
What are the Court Quadrants?
RUQ, RLQ, LLQ, LUQ
83
Three layers of abdominal Wall
External abdominal oblique
Internal abdominal oblique
Trasverse abdominis
84
What is the linea alba?
White line that joins muscles fibers & aponeurosis at midline of abdomen
85
What are the types of abdominal viscera?
Solid viscera & Hollow viscera
86
Definition & Example of Solid Viscera
Organs that maintain their shape
Liver, pancreas, spleen, adrenal gland, kidneys, ovaries, uterus
87
Definition & Example of Hollow Viscera
Organs that change their shape
Stomach, gallbladder, colon, small intestine, & bladder
88
Biological (Genetic) Changes of Infants
Umbilical cord (2 arteries, 1 vein)
Bladder high than abdomen
Round contour expected
Organs easily palpable
89
Biological (Genetic) Changes of Pregnant Women
Nausea/Vomiting
Pyrosis- Heartburn or indigestion
Hemorrhoids
Diminished bowel movements
Skins changes (melasma, linea nigra)
Decreased GI motility
90
Biological (Genetic) Changes of Aging Adults
Accumulation of abdominal fat
Decreased musculature, salivation, liver size
Constipation
Increased risk for gallstones
91
Causes of abdominal pain
Inflammation, infection, distention, obstruction, pressure, or trauma
92
What kind of ulcer awakens a person at night?
Duodenal ulcer
93
Gastric or Duodenal ulcer indicated by?
Epigastric pain w/tarry stools
94
S/S of GERD
Heartburn, dry cough, asthma symptoms, or trouble swallowing
95
What does hematemesis indication?
Hematemesis: Vomiting w/blood
Espohageal varices or duodenal ulcers
96
Normal Bowel Movements
2-3x a day or 3x a week
97
What does bloody or mucoid stools indicate?
Inflammatory disease (Crohn disease, ulcerative colitis)
98
What does clay colored or fatty stools indicate?
Malabsorption syndrome
99
What medications cause GI bleeding?
Aspirin, ibuprofen, & steroids
100
Definition of Brain-Gut Axis
High stress felt in the gut
101
Types of pain & their definitions
Visceral pain (hollow)- Dull, aching, burning, cramping in organs that are distended or forcefully contract
Parietal pain- Peritoneum becomes inflamed; severe or steady pain
Referred pain-Distant sites that experience that same pain as organ
102
Organs in the RUQ
Liver (majority)
Right Kidney
Transverse/ascending colon
Pancreas (small portion)
Gallbladder*
Small intestines
103
Organs in the LUQ
Live (small portion)
Spleen*
Left kidney
stomach
Transverse/Descending colon
Pancreas (Majority)
Small intestine
104
Organs in the RLQ
Ascending colon
Small intestines
Righter urters
Appendix*
Right ovary (female)
Right fallopian tube (female)
105
Organs in the LLQ
Descending/Sigmoid colon
Small intesine
Lefter urters
Left ovary (female)
Left fallopian (female)
106
Normal & Abnormal Findings of Abdomen (Inspection)
Normal: Abdomen similar to skin tone. Silver, pink or blue stria. Pale olde scars. Abdomen is free of lesions or rashes.
Abnormal:
Grey Turner sign: Purple discoloration of flanks (bleeding)
Pale taunt skin (fluid in abdominal cavity)
Spider angioma: Dilated surface arterioles & capillaries w/central star
DARK blueish-pink striae (Cushing syndrome)
107
What is a Cullen Sign?
Bluish or purple discoloration around umbilicus (periumbilical ecchymosis)
108
Definition of hernia
Protrusion of the bowel through abdominal wall
109
Normal & Abnormal Findings of Aortic pulsations
Normal: Slight pulsation of aortic pulse
Abnormal: Exaggerated or wide pulsations (abdominal aortic aneurysm)
110
What is a Peristaltic waves?
Ripple like fashion from LUQ to RLQ seen with obstruction
111
Normal & Abnormal Findings of Abdomen (Auscultate)
Normal: soft clicks or gurgles heard every 5-30/min
Abnormal: Hyperactive Bowels-Rushing, tinkling, or high-pitched
Hypoactive-diminished bowels (paralytic ileus, inflammation, or obstruction)
112
What does an auscultated bruit indicate?
An aneurysm or renal arterial stenosis (RAS)
113
Definition of Friction Rubs (Auscultate)
High pitched, Rough grating sound that's created when liver or spleen rubs peritoneum
114
What is the normal & abnormal percussed tone in all quadrants?
Normal: Generalized tympany over abdomen. Dullness over spleen and liver
Abnormal: Accentuated tympana or hyperressonace (abdominal distention)
115
Definition of Hepatomegaly
Enlarged liver (tumor, cirrhosis, abscess, or vascular engorgement)
116
What is the Scratch Test?
Determines the location and size of liver and spleen
117
How to perform the Scratch Test?
Place diaphragm of stethoscope at second to last intercostal place, MCL. Slightly stroke the skin moving towards lower costal margin.
118
What is the Shifting Dullness Test?
Used if ascites is suspected. A special percussion technique.
119
What is Positive sign of Shifting Dullness Test?
Dull percussion around the flanks
120
What is ascites?
Fluid in abdominal cavity, which is a sign of liver failure due to hypertension
121
What is the Fluid Wave Test?
Another way to test for ascites
122
How to Perform Fluid Wave Test?
Nurse places ulnar side of hand and lateral forearm on midline of abdomen. Use other hand to tap opposite side of abdomen
*Requires Assistance
123
Normal & Abnormal findings of Fluid Wave Test
Normal: No fluid wave is felt
Abnormal: Movement of fluid against resting hand
124
How to perform Rebound Tenderness?
Palpate deeply at 90 degrees halfway between umbilicus & anterior iliac crest (McBurney Point). Then suddenly release pressure and assess for pain
125
What is a Blumberg Sign?
A patient with rebound tenderness experiences sharp, stabbing pain when pressure is released. Indicated peritoneal irritation (appendicitis)
126
How to Perform Referred Rebound Tenderness Test?
Palpate deeply in LLQ & quickly release pressure
127
What is a Positive Rovsing Sign?
Patient feels pain in RLQ during pressure in LLQ (acute appendicitis)
128
What is a Psoas Sign?
Pain in RLQ due to irritation of the iliopsoas muscles related to appendicitis
129
How to assess for Psoas Sign?
Lie patent in left lateral position & hyperextend patients right leg.
130
What is a Obturator Sign?
Pain in RLQ due to irritation of obturator muscle related to appendicitis
131
How to assess for Obturator Sign?
Support patients right knee & ankle. Flex the hip the knew & rotate the leg internally and externally
132
What is the Hypersensitivity Test?
Pain or exaggerated sensation of RLQ related to appendicitis
133
How to perform Hypersensitivity Test?
Stroke the RLQ with sharp object or pinch skin and release quickly.
134
How to test for Cholecystitis?
Press fingers on liver border in RUQ & ask patient to inhale deeply
135
What is a Murphy Sign?
Sharp pain that causes patient to hold their breath (inspiration). Associated with cholecystitis (inflammation of gallbladder)
