Exam 3 Cardiovascular Flashcards
(128 cards)
1
Q
What is the factor characteristics for arterial pulses?
A
Rate
Rhythm
Contour
Amplitude/振幅
Absent
1 = Weak
2 = Normal
3 = Increased, full, bounding
2
Q
Pitting vs. non-pitting edema
Pitting?
A
Interstitial spaces contain such excessive amounts of fluid that the skin remains depressed after palpation
Movement of excess interstitial fluid, in response to pressure Usually unilateral (often DVTs)
3
Q
The aortic and pulmonic valves are called __________ valves because each of their leaflets is shaped like a half moon.
A
semilunar
4
Q
Health Promotion and Counseling
Factors
A
- Smoking
- Weight control
- Exercise
- HTN control
- DM management
- Limit alcohol intake
- Foot care
5
Q
Myocardium
A
The muscular wall of the heart; it does the pumping
6
Q
Function of arteries
a) Supply what?
b) What ischemia affect the body?
A
a) Oxygen & essential nutrients to tissues
b) Partial blockage (ischemia) creates an insufficient supply
reduced blood flow
7
Q
The mitral valve, when closed, prevent blood from back flowing into the??
A
Left atrium
8
Q
1) Blood from the body’s organs and tissues returns to the heart from the a)________
2) Then empties into the b)________ and travels through the c)________ .
Then into the d)________ which pumps it through the e)________ into the f)________
A
a)superior and inferior venae cava
b) right atrium
c) tricuspid valve
d) right ventricle
e) pulmonary valve
f) pulmonary artery
9
Q
Physical Examination/Inspection
A
Apical pulse
Heaves (lift)
Outward movement of the precordium associated with heart failure
10
Q
The arteries
a) Thicker or thinner?
b) More or less stretch and expand?
c) More or less pressure than the veins?
A
a) Thicker with a greater smooth muscle layer
b) Less ability to stretch and expand from internal pressure
c) Much more pressure than are the veins
11
Q
Auscultation
Best heard in an area is the anatomic site because the sound is transmitted in the direction of?
A
blood flow
12
Q
What is the Jugular veins at?
A
- Two jugular veins present in each side of neck
- Empty unoxygenated blood directly into superior vena cava
13
Q
What are Murmurs?
A
A sound when blood volume in the heart increased or its flow altered.
Use bell of the stethscope
14
Q
The __________ is the heart muscle that does the pumping
A
Myocardium
15
Q
Assessing for Pitting Edema
Press for how many seconds?
Describe 1 to 4 stages
A
For 5 seconds and release
1+ Mild pitting, slight indentation
2+ Moderate pitting, indentation subsides rapidly
3+ Deep pitting, indentation remains, leg looks swollen
4+ Very deep pitting, indentation lasts long time, leg very swollen
16
Q
Blood pressure?
Pulse pressure?
Mean arterial pressure?
A
Force of blood pushing against side of wall
Difference between systolic and diastolic pressures
Pressure forcing blood into tissues
17
Q
The veins
a) More or less sturdy?
b) Veins has valve? T or F?
A
a) Less sturdy and more distensible
Venous return is less forceful than blood flow through the arteries
b) T/valves to keep blood flowing in one direction
18
Q
Differentiate between murmurs, bruits, heave (lift), and thrill
Thrill?
A
19
Q
Mediastinum
A
The heart and great vessels are located between the lungs in the middle third of the thoracic cage
(holds the heart & the great vessels)
20
Q
Venous disease, factor?
A
-Thrombophlebitis
-prolonged immobilization
pregnancy, obese
21
Q
Inadequate venous return from the legs to the heart is
A
DVT
22
Q
In __________, left ventricular pressure continues to drop and falls below left atrial pressure
A
diastole
23
Q
When palpate?
Touch hard or light?
A
Touch lightly
Sensation decreases as you increase pressure and feel for thrills
24
Q
Position auscultate heart sounds
A
Supine
Sitting
left lateral decubitus position
25
What does a pulse deficit mean?
The apex of the heart is 120bpm
The ridical heart is 98bpm
There are fewer puleses in the arteries than there are heartbeats
26
When forward **flow is restricted in the heart** is know as
Stenosis
27
Differentiate between murmurs, bruits, heave (lift), and thrill
**Heave (lift)?**
An abnormal sustained, systolic. outward movement of the precordium associated with heart failure
28
Murmurs
Cause high outputv demands increase the speed of blood flow
What stiuations? 4
Fever
Thyrotoxicosis
Anemia
Pregnancy
29
What valves are closing the first heart sound(s1)?
The mitral and tricuspid valves are sounds of S1
30
Deep Vein Thrombosis
a) what it causes?
b) Symptoms
c) Objective factor?
a) Thrombus(clot)
b) Sudden onset of intense
sharp, deep muscle pain
c) **Increased warmth**
swelling
redness
tender to palpation
31
Venous disease
a) Skin change
b) Ulcer
```
a) thick & hardened skin
hemosiderin staining (brown/dark skin color)
```
b) near medial malleolus
irregular shaped
**moderate to large drainage**
32
What sounds can the bell detect?
Murmurs
Bruits
Extra heart sounds
33
where the carotid artery at?
between the trachea and sternomastoid muscle
**- Palpate one carotid artery at a time**
located **on both sides of your neck** that deliver blood to your brain and head
34
What is the PMI?
Point at which the apical impulse is most readily seen or felt
Using one finger pad may need to roll person midway to left to find it
35
What would cause one leg to be colder than the other?
Peripheral artery disease
If the legs and feet aren't getting enough blood flow to operate correctly
36
4 valves of heart
Tricuspid valve
Mitral valve
Pulmonary valve
Aortic valve
37
DVT subjective data? 9
**Leg pain or cramps
Skin changes on arms or legs
Swelling in the calves, legs, or feet**
Swelling with redness or tenderness
Intermittent claudication
Cold, numbness, or pallor in the legs; hair loss
Lymph node enlargement
Medications
Smoking history
38
Effect on the older people
- **Systolic blood pressure increase**/thickening & stiffening of the arteries
- **Left ventricular wall thickness**
- calcification (arteriosclerosis)
- ↑ muscle fatigue
- dyspnea(difficulty brathing)
39
The stroke volume is 60 and the heart rate is 70.
what is the cardiac output?
4200
40
**The cardiac impulse** originates in the a)\_\_\_\_\_\_\_\_node
Then spreads through the b)\_\_\_\_\_\_\_\_\_\_
Then c)\_\_\_\_\_\_\_\_\_\_node
Then the impulse travels to d)\_\_\_\_\_\_\_\_\_\_, then, e)\_\_\_\_\_and then to through f)\_\_\_\_\_
a) SA node(pacemaker)
b) Atria
c)AV node
d) Bundle of His
e) Right and left bundle branches
f) Ventricles
41
Area of Auscultation at the **second ICS and right sternal border**
Aortic
42
Endocardium?
The thin layer of endothelial tissue that lines the inner surface of the heart
43
Differentiate between murmurs, bruits, heave (lift), and thrill
**Murmurs?**
**Just a word used to describe an abnormal sound**
Sound of blood flowing through the heart
44
What the other names for the MITRAL VALVE?
PMI (point of maximal impulse)
Apical pulse
45
The pulmonary veins \_\_\_\_\_\_\_\_\_?
Carry oxygenated blood to the left atrium
46
Aging adult,Peripheral vessels grow more rigid
What is this called?
Arteriosclerosis
47
**Lymphatic system**
a) What is remove for?
b) What's absorb for?
c) What's produce for?
a) The removal of **excess fluids** from body tissues
b) **Fatty acids** and subsequent transport of fat
c) **Immune cell**s (such as lymphocytes, monocytes, and antibody producing cells called plasma cells)
48
Peripheral Pulse
A pulse that can be palpated over a peripheral artery
49
Where are the Jugular veins at?
a) Internal jugular
b) External jugular
a) lies deep and medial to sternomastoid muscle (usually not visible),
although pulsations may be seen in sternal notch when person is supine
b) vein is more superficial
lies lateral to sternomastoid muscle, above clavicle
50
**Vascular System**
Developmental Competence
Peripheral vessels grow more rigid (arteriosclerosis)
Arterial walls lose elasticity and vasomotor tone
Calcification and plaque buildup (atherosclerosis)
Loss of lymphatic tissue ↓ in numbers & size lymph nodes
51
Differentiate between the carotid artery pulsation and the jugular vein pulsation
## Footnote
**Jugular vein**
Lower, more lateral, under or behind sternomastoid muscle
Two visible waves per cycle
varies with respiratio
Level of pulse drops and disappears as person sits up
52
Why is auscultation in the left lateral decubitus?
The left lateral decubitus position **increases murmu**r of mitral stenosis.
53
Still murmurs?
In children, adolescents, and especially in young athletes have no apparent cause
54
**Lymphatic system**
a) Form a major part of the a)\_\_\_\_\_\_\_\_
b) Conserve b)\_\_\_\_\_\_\_\_ and b)\_\_\_\_\_\_\_\_
c) Without lymphatic drainage, it produce c)\_\_\_\_\_\_\_\_
**a) Immune system defends/**the body against diseases
b) F**luid and plasma proteins/** leak out of the capillaries
c) **Edema/**fluid would build up in interstitial spaces
55
Second heart sound?
**S2 or Dub**
Results from closure of SL valves- can hear S2 over all Precordium, but **loudest at base**
56
Pericardium?
is a tough, fibrous layer that surrounds and protects the heart
57
**Pale, shiny skin and loss of hair** is a consequence of?
Arterial insufficiency
58
Palpate the temperature of both legs and feet use with?
With the backs of your hands
59
What is a Pulse Deficit?
The difference between a radial & Apex of the heart pulse.
60
Stroke volume is the amount of blood ejected by the ventricle **with each heartbeat**
True or false
True
61
Which has thicker walls: arteries or veins?
arteries
62
While assessing an adult client, the nurse detects opening snaps early in diastole during auscultation of the heart. The nurse should refer the client to a physician because this is usually indicative of...
mitral valve stenosis
63
Heart Sounds, what are we listing for? 6
Rate
Rhythm
S1, S2
Splitting
Extra heart sounds
Murmurs
64
Area of auscultation located at the **second ICS and left sternal border**
pulmonic
65
The dorsalis pedis pules
Palpate the dorsum of the foot
66
Stenosis?
Narrow valve-forward flow is restricted
67
Functions of veins
Drain deoxygenated blood and its waste products from tissues and return it to heart
Drain 排出する
68
What is arteriosclerosis?
The build-up of fats, cholesterol, and other substances in and on the artery walls
## Footnote
**Older people**
69
What does pulse deficit indicate?
The volume of blood pumped from the heart may not be sufficient to meet the needs of body's tissues
70
**Diastole**
AV valves a)\_\_\_\_\_\_\_ , ventricles b)\_\_\_\_\_\_\_ and c)\_\_\_\_\_\_\_
This process takes up d)\_\_\_\_\_\_\_ of cardiac cycle
a) Open
b) Relax
c) Fill of the blood
d) 2/3
71
The femoral pulse?
Press deeply below the **inguinal ligament** and about midway between the anterior superior iliac spine and the symphysis pubis
72
Regurgitation?
Incompetent valve-blood flows backward
73
DVT causes?
Prolonged bed rest
History of varicose veins
Trauma
Infection
Cancer
Obesity
74
When you **auscultate the carotid arteries**, what are you assessing for?
Bruits
Blowing or swinging sounds that indicate obstraction duering blood flow
75
During contraction, **apex beats**?
Against chest wall, producing an apical impulse - normally at 5th ICS to the left MCL
5th ICS -5th intercostal spac
MCL-midclavicular line
76
What is known as the PACEMAKER of the heart?
SA node
77
Which of the following is correct about the **LEFT ventricle**?
It pumps blood into the systemic circuitve
78
The direction of blood flow through the heart is best described by which of these?
Right atrium--\> right ventricle --\>pulmonary artery --\>lungs pulmonary vein --\> left atrium --\>left ventricle
79
Types of Heart murmurs (abnormal findings)
Pansystolic
Midsystolic
Diastolic
80
First heart sound?
**S1 OR Lub**
Results from closure of AV valves
Can hear S1 over all Precordium, **but loudest at apex**
81
The heart lies in the __________ **cavity** in the mediastinum under the sternum and between the second and fifth intercostal spaces
Pericardial
82
Which layer forms the bulk of the heart and is the layer that contract?
Myocarium
83
Heart extends from a)\_\_\_\_\_ to a)\_\_\_\_\_\_\_intercostal cartilages
From b)\_\_\_\_\_ to c)\_\_\_\_\_
a) 2nd to 5th
b) right sternal border (RSB)
c) left midclavicular line (MCL)
84
Major risk factors for heart disease & stroke
HTN
Smoking
High cholesterol
Obesity
Diet
Sedentary lifestyle
Stress
DM
85
What is Raynaud's Syndrome?
Fingers showing cyanosis
86
Differentiate between the carotid artery pulsation and the jugular vein pulsation
Carotid?
Higher and medial to muscle
Brisk, localized
One wave per cycle, palpable
No pressure change
Unaffected by position change
87
\_\_\_\_\_\_\_\_\_\_ is the period of ventricular **contraction**
Systole
88
What is the spasm?
Involuntary contractions of a muscle, typically harmless and temporary, but can be painful.
けいれん
89
Apical Pulse
A pulse that can be ausculated over the apex of the heart
90
Area of auscultation located in the **apex** and assessing the left ventricle, fourth to fifth ICS at the left midclavicular line
Maital
91
Neck Vessels: Inspection
Position
Position person supine anywhere from a **30- to a 45-degree** angle
92
Older people/Electrical irritability enhanced
What does it mean?
Increase fibrosis and sclerosis in the heart valves
fibrosis/thickening or scarring of the tissue
sclerosis/stiffening of a tissue
93
Capillary refill time more than 3 seconds
What this indicate?
Arterial insufficiency
94
What part of the autonomic nervous system will stimulate the SA node to increase heart rate & the force of contraction?
Sympathetic
Responsible for your **“fight or flight”**
95
What is a major difference between arteries and veins?
Veins have valves
96
What are the **Great Vessels**?
Major arteries and veins connected to heart
Aorta
Pulmonary trunk
Pulmonary veins
Superior vena cava
Inferior vena cava
97
Characteristics of heart sounds 4
Frequency (pitch): high, medium or low
Intensity (loudness): S1 loudest at the apex, S2 loudest at the base
Duration: very short for heart sounds; silent periods are longer
Timing: systole and diastole
98
What is the main cause of **venous ulcers**?
or **venous insufficiency?**
The veins have one-way valves that keep blood flowing up toward the heart
When these valves become weak or the veins become scarred and blocked
Blood can flow backward and pool in the legs
99
Pitting vs. non-pitting edema
## Footnote
**Non- pitting?**
Lymphedema. When it is extremely difficult for lymph fluid to drain as it should, it is often due to a blockage.
## Footnote
**cancer treatment**
100
**The P-wave** phase of an ECG represents?
when the SA node creates an action potential that depolarizes the atria.
Depolarize reduce or remove the polarization of
101
The **semilunar valves** are located?
At the exit of each ventricle at the beginning of the great vessels
102
Which ABNORMAL conditions may affect the location of the apical impulse?
CARDIAC ENLARGEMENT
103
What is arterial ischemia?
An injury to the brain or spinal cord
**Caused by a lack of oxygen to the area affected**
Results from obstruction of blood flow by blood clots
Narrowed or damaged arteries or both
104
Cardiac output?
Volume of blood pumped from a heart **_per minute_**. Adult heart normally pumps between 4 to 6 L of blood throughout the body/minute.
CO = SV X HR
105
Which sound is louder? S1 or S2?
**S2 is louder** because the larger valves are the Aortic and Pulmonic
106
Raynaud’s syndrome?
* *White,** due to arteriospasm and resulting deficit in **supply**
* *Blue**, due to slight relaxation of the spasm that allows a slow trickle of blood through the capillaries and increased oxygen extraction of hemoglobin
* *Red** (rubor), due to return of blood into the dilated capillary bed or reactive hyperemia
107
**Arterial disease**
a) Skin change
b) Ulcer
a) Pale, shiny, loss of hair
Diminished or absent pulses
b) Tips of toes, foot, or lateral malleolus
Rounded, smooth, looks “punched out”, minimal drainage
Due to lack of arterial blood flow supplying **the area of the wound**
108
Earliest sign of heart failure
Auscultation of S3 Heart sounds
109
Systole
AV valves a)\_\_\_\_\_\_\_\_\_, ventricles b)\_\_\_\_\_\_\_\_\_,
Pumps blood into c)\_\_\_\_\_\_\_\_\_ and c)\_\_\_\_\_\_\_\_\_
This takes up d)\_\_\_\_\_\_\_\_\_,of cardiac cycle
a) close
b) contract
c) pulmonary and systemic arteries
d) 1/3
110
Auscultate bruit with the a)\_\_\_\_\_\_\_ of stethoscope as a b)\_\_\_\_\_\_\_ pitch sound
a) bell
b) low
**When listening over the carotid vessels, ask the patient to suspend breathing for a** **few heartbeats so that respiratory sounds do not interfere with auscultation**
111
The difference between the **systolic and diastolic** pressure is
Pulse pressure
112
Lymphatic system
Only superficial nodes are palpable
113
Arterial disease factor?
-Arteriosclerosis
Arterioembolism
-Smoking
DM/Diabetes mellitus
HTN
high chol
Obesity
114
Lymphatic system
During circulation of the blood, more fluid leaves a)\_\_\_\_\_\_\_\_ than b)\_\_\_\_\_\_\_\_ can absorb.
a) capillaries
b) veins
115
Differentiate between murmurs, bruits, heave (lift), and thrill
**Bruits?**
Also called vascular murmur
Blowing vascular sounds
116
Where is S1 heard beset?
Apex
117
What are cardiac thrills?
**A palpable murmur**
Rushing vibration
Vibratory sensations felt on the skin
118
Physical Examination/palpation
**Apical impulse
Heaves (lift)
Thrills**
119
What subjective dates we want to get?
**Chest pain
Dyspnea
Edema
Nocturia**
Orthopnea
Cough
Fatigue
Cyanosis or pallor
Personal cardiac history
Family cardiac history
120
Auscultation position of heart valves
A,P,T,M
**A: Second intercostal space**
Right sternal border
Aortic area
P: Second intercostal space
Left sternal border
Pulmonic area
T: Third intercostal space
Left sternal border
Second pulmonic area
M: Fifth intercostal space
Left midclavicular line
Apex, Mitral area
121
Define claudication
Condition with cramping pain
Commonly in the legs
Caused by too little blood flow
Often indicates peripheral artery disease
122
- During contraction, a)\_\_\_\_\_\_\_\_\_\_ beats against chest wall
- Producing an b)\_\_\_\_\_\_\_\_\_\_
- Normally at b)\_\_\_\_\_to the b)\_\_\_\_\_
a) apex
b) apical impulse
c) fifth ICS/intercostal cartilages
c) left MCL/left midclavicular line
123
Systolic pressure?
Diastolic pressure?
Maximum pressure felt on artery during **left ventricular contraction**
Resting pressure that blood exerts constantly **between each contraction**
124
What is the major health problem resulting from a pulse deficit?
A. Bradycardia
B. Activity intolerance
C. Decreased cardiac output
D. Impaired tissue perfusion
Decreased cardiac output
125
Why do we get nocturia with heart failure?
-Urinating frequently at night
- A weak heart can't pump blood efficiently, causing fluids to build up in the body
- The kidneys work to rid the body of excess fluid
- Causing large amounts of urine production and frequent urination
126
First--Palpate the radial pulse
Second--If cannot obtain then feel brachial pulse
127
What should the nurse do when a pulse deficit is suspected?
Ask another health care provider to count the radial pulse while the nurse counts the apical pulse.
128
What are the 7 arterial pulses?
neck (carotid artery)
the wrist (radial artery)
behind the knee (popliteal artery)
the groin (femoral artery)
inside the elbow (brachial artery)
the foot (dorsalis pedis and posterior tibial artery)
the abdomen (abdominal aorta)
