Exam 3 Flashcards
(207 cards)
1
Q
Heart health history questions
A
chest pain, SOB, skin color changes, fatigue, edema, past medical/family history
2
Q
Heart assessment
A
- look for apical impulse
- look for heave
- palpate precordium
3
Q
Heart assessment: apical pulse
A
4th or 5th intercostal space, midclavicular line
4
Q
Heart assessment: heave
A
sustained forceful thrusting of ventricle, abnormal
5
Q
Heart assessment: palpate pericardium
A
- use palmar aspect of 4 fingers
- L sternal border, apex, and base
- search for any pulsations
- a thrill is a palpable vibration
- should not feel any pulsations - means turbulent blood flow
6
Q
Anatomy of the heart
A
- layers: pericardium, myocardium, endocardium
- 2 atriums
- 2 ventricles
- 2 AV valves
7
Q
Blood flow through the heart: oxygenated
A
lungs, pulmonary vv, L atrium, bicuspid AV valve, L ventricle, aortic semilunar valve, aorta, body tissues
8
Q
Blood flow through the heart: deoxygenated
A
body tissues, vena cava, R atrium, tricuspid AV valve, R ventricle, pulmonary semilunar valve, pulmonary aa, lungs
9
Q
Cardiac cycle
A
Diastole, systole, diastole again
10
Q
Diastole process
A
ventricles relax, AV valves open, pressure higher in atria, blood pours rapidly into ventricles, toward end, atria contract and push out last amount of blood
11
Q
Systole process
A
- ventricles full of blood = higher pressure in ventricles than atria
- AV valves swing shut (S1) = beginning of systole
- ventricle walls contract, builds pressure
- valves open, blood ejected rapidly
- after ventricle blood is ejected, valves swing shut, closure of SL valves = S2
12
Q
S1 heart sound
A
- occurs with closure of AV valves
- signals beginning of systole
- usually loudest at apex
13
Q
S2 heart sound
A
- occurs with closure of semilunar valves
- signals end of systole
- loudest at base
14
Q
Murmurs
A
- noisy flow, gentle, blowing, swooshing sound
- blood circulating normally makes no sound
- some conditions create turbulent blood flow and collision currents
15
Q
Auscultation spots
A
aortic valve, pulmonic valve, Erb’s point, tricuspid valve, mitral valve
16
Q
Aortic valve location
A
2nd ICS - R sternal border
17
Q
Pulmonic valve location
A
2nd ICS (L sternal border)
18
Q
Erb’s point lcoation
A
3rd ICS - L sternal border
19
Q
Tricuspid valve location
A
4th or 5th ICS - L sternal border
20
Q
Mitral valve location
A
5th ICS (mid-clavicular line)
21
Q
Heart Auscultation process summary
A
Listen with diaphragm of stethoscope
- firmly on chest, 5 areas
Locate apical pulse: 5th ICS, MCL
- count x 30 seconds
Identify S1 + S2
Listen for murmurs with bell
22
Q
Heart auscultation pattern
A
z pattern from base to apex
23
Q
If rate/rhythm of heart is irregular,
A
check for pulse deficit by auscultating the apical beat while simultaneously palpating radial pulse
24
Q
Carotid arteries assessment
A
palpate each artery one at a time, use gentle pressure
25
Carotid artery assessment findings
- should be normal strength and same bilaterally
- diminished pulse
- increased pulse
26
Diminished pulse can mean
cardiogenic shock
27
Increased pulse feels
full + strong, can be from exercise anxiety fear
28
Jugular veins
lets you assess central venous pressure and judge hearts efficiency as a pump
29
Jugular veins assessment process
- stand on right side of patient
- position patient supine at 30-45 degree angle
- use pen light to see better
30
Jugular veins findings
- may or may not see jugular
- should disappear by 45 degrees
- full distended jugular vv above 45 degrees signify increased CVP and heart failure
31
PVS
vv and aa to perfuse the lower part of the body + carotid and jugular veins
32
Lymphatic system
- retrieves excess fluid + plasma proteins
- forms part of immune system
- absorb lipids from small intestine
- lymph nodes
33
Pulse assessment locations
brachial, radial, popliteal, posterior tibial
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Pulse strength = 0
0 = absent
35
Pulse strength: 1+
- weak or thready
- hard to palpate
- associated with decreased PO, peripheral arterial disease, aortic valve stenosis
36
Pulse strength: 2+
expected, normal, easy to palapte, strong
37
Pulse strength: 3+
- full and bounding
- pounds under fingertips
- associated with exercise, anxiety, fever, anemia, hyperthyroidism
38
Bilateral edema
may be related to heart disease
39
Unilateral edema
may be related to DVT
40
Swelling/edema +1
mild pitting, slight indentation, no perception of swelling
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Swelling/edema +2
moderate pitting, indentation subsides rapidly
42
Swelling/edema +3
deep pitting, indentation remains for a short time, legs swollen
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Swelling/edema +4
very deep pitting, indentation lasts a long time, legs grossly swollen
44
Inspect and palapte PVS
- color and temp of extremities
- hair distribution
- swelling/edema
- capillary refill
45
Unexpected findings of PVS
- PAD arterial
- PVD venous
- DVT
46
PAD arterial
- leg pain/cramps
- skin changes on arms./legs
- legs cool to touch
- swelling in arms/legs
- lymph node enlargement
- medications
- smoking history
- shiny dry leg skin with sparse hair growth
47
PVD venous
- aching tiredness in legs
- varicosities
- lower leg edema
- brown discolored skin
- ulcers at ankles
- weepy pruritic dermatitis
- shallow non-healing ulcers in lower leg
48
DVT
- immobility
- localized tenderness
- sharp deep pain
- warm skin
- pitting edema in leg
- tenderness to severe pain in leg
- cancer
- obesity
- hormones
49
S3 heart sound
due to vibration of ventricles that resist early, rapid filling
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S4
due to vibration of noncompliant ventricles when atria contract and push blood into them
51
Major risk factors for heart disease and stroke
high blood pressure, smoking, high cholesterol, physical inactivity
52
Developmental changes: before birth
- formaen ovale allows oxygenated blood from placenta to be shunted to L side of heart
- ductus arteriosus shunts blood into aorta
53
Developmental cardiovascular system changes: aging adults
- increase in systolic bp
- increased risk fo dysrhythmias
- CO decreases
54
Signs of heart disease in children
poor weight gain, DOE, developmental delay, tachycardia, tachypnea, cyanosis, clubbing
55
In pregnant patients, resting pulse rate
increases 10-20bpm
- bp decreases
56
In older adults, systolic bp
rises and orthostatic hypotension may occur
57
3 mechanisms keep blood moving toward the heart
- contraction of skeletal mm
- pressure gradient caused by breathing
- intraluminal valves - one direction
58
Organs that aid the lymphatic system
spleen, tonsils, thymus
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Spleen
- destroys old blood cells
- make antibodies
- stores RBCs
- filters organisms
60
Tonsils
- respond to local inflammation
61
Thymus
develops T lymphocytes
62
Peripheral artery disease causes
smoking, diabetes, obesity, elevated cholesterol, HTN
63
COVID-19 can increase risk for
DVT
64
In healthy infants and children, lymph nodes are
commonly palpable
65
PVS findings in pregnant women
- diffuse bilateral pitting edema
- varicose veins
66
PVS findings in aging adults
- dorsalis pedis + posterior tibial pulses may be hard to find
- trophic changes
67
Cranial bones
frontal, parietal, occipital, temporal
68
Sutures
coronal, sagittal, lamboid
69
Skull is supported by
cervical vertebrae C1-C7
70
The face is mediated by
CN VII - facial nerve
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Parotid gland location
cheeks over the mandible
72
Submandibular gland lcoation
beneath mandible at angle of jaw
73
Neck contains
sternomastoid mm, trapezoid mm, vessels, thyroid gland, lymph nodes
74
Lymph nodes
preauricular, posterior auricular, occipital , submental, submandibular, jugulodigastric, superficial cervical, deep cervical, posterior cervical, supraclavicular
75
Preauricular lymph node location
in front of ear
76
Posterior auricular lymph node location
superficial to mastoid process
77
occipital lymph node location
base of skull
78
Submental lymph node location
midline, behind tip of mandible
79
Submandibular lymph node location
halfway between angle and tip of mandible
80
Jugulodigastric lymph node location
under angle of mandible
81
Superficial cervical lymph node location
overlying sternomastoid mm
82
Deep cervical lymph node location
deep under sternomastoid mm
83
Posterior cervical lymph node location
in posterior triangle along edge of trapeqius mm
84
Supraclavicular lymph node location
just above and behind clavicle, at sternomastoid muscle
85
Fontanels
- soft spots
- gradually ossify
- posterior (closed by 1-2 months)
- anterior (closed between 9 months-2 years)
86
Inspect and palpate skull
- note general size and shape
- palate temporomandibular joint
- inspect face
87
Inspect/palpate skull: size/shape
- normocephalic
- assess shape: place fingers in person's hair and palpate scalp
- skull normally feels symmetric and smooth
- no tenderness
88
Inspect/palpate skull: temporomandibular joint
have person oepn mouth and note normally smooth movement with no limitation or tenderness
89
Inspect/palpate skull: inspect face
- facial expressions should be appropriate to mood
- symmetry
- note any involuntary movements
90
Neck examination
- symmetry
- assess ROM
- advance practice provider might assess lymph nodes and thyroid
91
Infant/children assessment
- measure infant head size
- note shape or deformities (caput succedaneum, cephalhematoma, positional plagiocephaly)
- fontanels
- head posture and control
92
Inspection: eyelids
- eyelids approximate completely when eyes closed
- no swelling, discharge, lesions
93
Ptosis
drooping of upper lid
94
If eyelids do not close completely
risk for corneal damage
95
Inspection: eyeballs
- aligned normally
- no protrusion or sunken appearance
96
Exophthalmos
protruding eyes
97
How to inspect sclera
- have patient look up, using thumbs, slide lower lids along bony orbital mm
98
Expected sclera findings
- china white
- dark skinned patients may have brown macules, yellow deposits, gray-blue, muddy
99
Abnormal sclera findings
redness, scleral icterus (yellowing), tenderness, foreign body, discharge
100
Inspect lacrimal apparatus by
pressing index finger against sac, just inside lower orbital rim
101
Abnormal lacrimal apparatus findings
red, swollen, tender to pressure, regurgitation of fluid, may indicate blocked duct
102
How to inspect eye movement
- have patient hold head steady
- follow your finger only with eyes
- finger should be 12 in away from face
- progress clockwise, coming back to center after each movement
103
Expected eye movement findigns
parallel tracking of finger with both eyes
104
Abnormal eye movement findings
- eye movement not parallel
- could indicate weak mm or cranial n dysfunction
- nystagmus
105
nystagmus
fine, oscillating movements
106
Consensual light reflex
constricts pupil, opposite eye
107
Direct light reflex
efferent n constricts pupil, same eye
108
PERRLA
pupils, equal, round, reactive to light, accommodate
109
Assessing PERRLA
1. darken room
2. have client stare into distance
3. are pupils equal size - use penlight (expected 3-5 mm)
4. are both pupils round
5. advance light from the side and note response
- advance light from side twice on each side
- pupils should decrease in response to light
- 1st time, look for direct light reflex
- 2nd time, look for consensual light reflex
6. note measurement of pupils with constriction
110
Abnormal PERRLA response
dilated pupils, dilated and fixed, unequal or no response
111
Accommodation assessment
1. have patient focus on distant object - dilates pupil
2. have patient shift gaze to near object
- should see pupillary constriction and convergence of eye axis
112
External ear has
auricle and auditory canal
113
Auricle
moveable cartilage and skin, funnels sound waves into opening
114
Auditory canal
terminates at eardrum, lined with glands that secrete cerumen
115
Tympanic membrane
separates external/middle ear, translucent pearly gray, oval and slightly concave
116
Middle ear
- air filled cavity in temporal bone
- malleus, incus, stapes
- opens to outer ear and eustachian tube
117
Middle ear functions
- conducts sound vibrations from outer to inner ear
- protects ear by reducing amplitude of noise
- eustachian tube allows equalization of air pressure to prevent rupture
118
Eustachian tube
connects middle ear with nasopharynx and allows passage of air - opens when swallowing or yawning
119
Inner ear
- has sensory organs for equilibrium and hearing
- vestibule, semicircular canals
- cochlea
120
Inspection + palpation of ear
- size and shape
- skin condition
- tenderness
121
Abnormal ear findings
redness, swelling, foreign bodies, discharge, irritation from hearing aids
122
Darwin's tubercle
small painless nodule at helix - not concerning
123
Checking for ear tenderness
- move pinna and push on tragus
- palpate mastoid process
124
Expected findings for tympanic membrane
shiny, translucent, pearl-gray
125
Unexpected findings for tympanic membrane
red color = ottis media = ear infection
126
Section of malleus are visible through translucent drum
umbo, manubrium, short process
127
Testing for hearing acuity
- begins during history
- ask directly if there is hearing difficulty
128
If patient reports hearing difficulty
perform audiometric testing
129
If patient reports no hearing difficulty
use whispered voice test
130
Whispered voice test
1. test one ear at a time while masking the other
2. shield your lips
3. with your head 30-60cm away from the ear, whisper slowly a two-syllable word
4. expected: person can repeat words correctly
131
Rhinorrhea
runny nose
132
Epistaxis
nosebleed
133
Dysphagia
difficulty swallowing
134
Teeth malocclusion
misaligned teeth
135
Pertussis
whooping cough
136
Xerostomia
dry mouth
137
Nasal cavity
warms, moistens, filters air
138
Kiesselbach's plexus
vascular network in anterior septum - common site of nosebleeds
139
Lateral walls of each nasal cavity contain 3 bony projections
superior, middle, inferior turbinates
140
Turbinates function
increase surface area for vessels and mucous membranes
141
Olfactory receptors are located
roof of nasal cavity in upper 1/3 of septum
142
Sinuses function
lighten weight of skull, resonate sound provide mucous
143
Which pairs of sinuses are examinable
frontal, maxillary
144
Inspect/palpate external nose
- should be symmetric, midline, in proportion
- note deformity, asymmetry, inflammation, skin lesions
- palpate gently for any pain or break in contour
145
Inspect nostrils for
patency
146
Inspect/palpate nasal cavity
- pen light, view each cavity with head erect and tilted back
- inspect nasal mucosa - normal red, smooth, moist
- note swelling, discharge, bleeding, foreign body
147
Inspect/palpate nasal septum
observe for deviation, perforation, bleeding
148
Palpation of sinus areas
using thumbs, pressure frontal sinuses by pressing up and under eyebrows and over maxillary sinuses below cheekbones
149
Mouth function:
first part of digestive system, airway
150
Oral cavity includes
lips, palate, uvula, cheeks
151
Hard palate
anterior, made of bone
152
Soft palate
posterior, arch made of mobile mm
153
Frenulum
midline fold of tissue connecting tongue and bottom of mouth
154
Salivary glands
parotid, submandibular, sublingual
155
Mouth inspection
begin anterior and move posteriorly
- use penlight and tongue blade
156
Lips inspection
color, moisture, cracking, lesions, retract lips
157
African americans lips normally ahve
bluish tint and dark line on gingival margin
158
Teeth inspection
- condition is index of general health
- note diseased, absent, loose, or abnormally positioned
159
Tongue inspection
color, surface, moisture
160
Uvula inspection
- ask to say "ahhh" and note soft palate and uvula and rise in midline
- tests one function of vagus nerve
161
Oropharynx
separated from mouth by fold of tissue on each side, the anterior tonsillar pillar
162
Tonsils
- behind folds
- mass of lymphoid tissue
- granular and surface shows deep crypts
163
Tonsillar tissues enlarges during
childhood until puberty
164
Nasopharynx
continuous with oropharynx, above oropharynx, behind nasal cavity
165
Throat inspection
- enlarge view of posterior pharyngeal wall by depressing tongue with tongue blade
- scan posterior wall for color, exudate, lesions
- notice any halitosis
- observe tonsils
166
Halitosis causes
poor oral hygiene, smelly foods, alcohol, smoking, dental infection
167
Expected tonsils observations
pink, surface peppered with indentations/crypts, no exudate
168
Tonsils grading: 1+
visible
169
Tonsils grading: 2+
halfway between tonsillar pillars and uvula
170
Tonsils grading: 3+
touching uvula
171
Tonsils grading: 4+
touching each other
172
Tonsil infection
- swollen to 2-4+
- bright red, exudate, large white spots
173
HEENT: infants
- obligatory nose breathers
- sucking tubercle presents in middle of the lip
174
HEENT: infants and toddlers
20 deciduous teeth begin showing at 6 months and finish by 2 years
175
HEENT: older adults
- gums recede
- teeth wear down
- taste reduction
- saliva decreases
- dry mouth
176
HEENT: pregnancy
nasal stuffiness, epistaxis, swollen gums
177
During pregnancy, the thyroid gland
enlarges due to hyperplasia of tissue and increased vascularity
178
In aging adults, facial bones and orbits
appear more prominent - skin sags from decreased elasticity, moisture, subq fat
179
To obtain subjective data about HEENT, ask about
headache, head injury, dizziness, neck pain, ROG, lumps, swelling, surgery
180
If palpation reveals lymph node abnormalities
explore area proximal to affected ndoe
181
If thyroid is enlarged,
auscultate for bruits and a soft pulsatile, whooshing sound
182
Tonic neck reflex
fencing posture - newborn reflex
183
HEENT: in pregnant women, assess for
chloasma and thyroid gland enlargement
184
Chloasma
blotchy, hyperpigmented area over cheeks and forehead
185
HEENT: in aging adults, observe for
prominent temporal arteries, spine kyphosis, senile tremors
186
Canthus
corner of eye where lids meet
187
Caruncle
located at inner canthus
188
Tarasal plate
strip of CT that gives shape to upper lid
189
Meibomian glands
secrete oily lubricant onto the lids
190
Newborn vision
- eye function is limited
- peripheral vision is intact
- macula is absent, mature by 8months
191
Infant eye movement is
poorly coordinated by matures by age 3-4 months
192
Eye reaches adult age by
8 years old
193
Eye changes during aging
- decreased tear production
- pupil decreases
- losses elasticity
- presbyopia
- cataracts
- visual acuity diminishes
194
In older adults, the most common causes of decreased vision are
cataracts, glaucoma, age-related macular degeneration, diabetic retinopathy
195
Confrontation test
assess visual fields for loss of peripheral vision
196
Diagnostic positions test
6 cardinal positions of gaze
197
Hirschberg test
assess corneal light reflex and extraocular mm function
198
Conductive hearing loss
- partial hearing loss
- dysfunction of external or middle ear
199
Sensorineural loss
- perceptive hearing loss
- dysfunction of inner ear
200
Infant ears
- eustachian tube is short and wide
- easier to get infections
201
Adult ears <40
- otosclerosis is common cause of conductive hearing loss
202
Aging adults ears
- hearing acuity may decrease from stiff cilia lining ear, compact cerumen, nerve degeneration
203
Romberg test
assess vestibular apparatus - standing balance
204
Older adult tympanic membrane
appears whiter, more opaque, duller
205
Gag reflex tests cranial nerves
IX, X
206
In neonates, palpate nose/mouth/throat for
integrity of palate and sucking reflex
207
In pregnant women, assess nose/mouth/throat for
gum hypertrophy, epistaxis, nasal stuffiness
