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Cardiac HAPS > HAPS--Cardiac Assessment > Flashcards

HAPS--Cardiac Assessment Flashcards

(63 cards)

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1
Q

Apex

A

the tip of the heart located to the left of midline

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2
Q

Base

A

posterior & to the right of the midline

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3
Q

Atrioventricular valves (A/V)

A

Tricuspic

Mitral (bicuspid)

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4
Q

Semilunar valves

A

Pulmonic

Aortic

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5
Q

Systole

A

contraction of the ventricles

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6
Q

S1

A

onset of systole = closure of mitral and tricuspid valves

Louder at the Apex

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7
Q

Diastole

A

relaxation of the ventricle

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8
Q

S2

A

onset of diastole = closure of aortic and pulmonic valves

Louder at the base

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9
Q

Insufficient valve

A

“Leaky”

Does not close completely

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10
Q

Stenotic

A

“Stiff”

Does not open completely

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11
Q

Blood Flow through Heart

A 
R. Atrium >
Tricuspid valve >
Right ventricle >
Pulmonic valve >
Pulmonary artery >
Lungs >
Pumonary veins >
Left atrium > 
Mitral valve > 
Left ventricle>
Aortic valve>
Aorta
> BODY
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12
Q

Coronary Arteries (3 major vessels)

A

Left Anterior Descending artery
Left Circumflex artery
Right Coronary artery

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13
Q

blood supply of coronary arteries?

A

Coronary arteries receive their blood supply from the aorta and supply blood to the myocardium.

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14
Q

Automaticity:

A

Ability of pacemaker cells to initiate an impulse spontaneously and repetitively

The conduction tissue area with the highest rate of automaticity assumes the role of pacemaker, normally the SA node

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15
Q

Contractibility

A

The ability to respond to this impulse with pump action.

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16
Q

Autonomic Nervous System

A

Sympathetic

Parasympathetic

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17
Q

Sympathetic

A

Increase heart rate, speed of conduction and vigor of contraction

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18
Q

Parasympathetic

A

Decrease rate of firing of the SA node, speed of conduction and force of contraction

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19
Q

The Cardiac Assessment

A 
History
B/P Assessment
Inspection
Palpation & pulsation
Auscultation
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20
Q

Preparation for Cardiac Assessment

A

: The client should be sitting up supine at a 30-45 degree angle

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21
Q

INSPECTION

A

General appearance: chest symmetry, skin color, hair pattern (on legs)
Peripheral and Central circulation (pulses)
Aortic pulsations
Capillary Refill
Edema Assessment

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22
Q

Palpate carotid artery

neck vessels

A

Palpate only one carotid artery at a time to avoid compromising arterial blood to brain
Feel amplitude of pulse
Findings should be same bilaterally

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23
Q

Auscultate the Carotids

A

Auscultate each carotid arteries for the presence of a bruit with your bell
This swishing sound indicates turbulence therefore… none should be present
If it is present, the patient is at risk for TIA, CVA.
It is present if the lumen is occluded by ½. After the lumen is 100% occluded, the bruit will disappear.

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24
Q

Observe for JVD

A

Have the client sitting 30 degree
Have them turn face away
Shine light
Pulsations should disappear after 45 degrees or is indicative of heart failure

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25
Measuring JVP
Place one ruler vertically at the sternal angle. Locate the pulsation and place another ruler at the level of the pulsation. Line up the two rulers as a T. Measure JVP at the level where the horizontal ruler intersects the vertical ruler. Ideally the measurement should be less than 2 cm
26
Palpation
Palpate over the valve areas for thrills Thrills are vibratory sensations caused by the heart and felt on the body surface Thrills are indicative of turbulent blood flow Check for thrills over the apex, base, and left sternal border
27
Auscultation with use of diaphragm side
used for high pitched sounds S1 and S2 Murmurs
28
auscultation with use of bell side
low pitched sounds S3 and S4 Murmurs Bruits
29
Auscultation
``` Begin with diaphragm end piece and use following routine Note rate and rhythm Identify S1 and S2 Assess S1 and S2 separately Listen for extra heart sounds Listen for murmurs ```
30
ORIGIN OF HEART SOUNDS
S-1 =T + M closure S-2 = A + P closure (lub-dub sound)
31
S - 1 (lub)
Onset of Systole Closure (shutting) of mitral and tricuspid valves Loudest at apex Indication is normal
32
S -2 (dub)
Heard at end of systole…Onset of diastole Closure (shutting) of aortic and pulmonic valves Heard best at aortic area, base Indication is normal
33
Abnormal Heart Sounds
S 3 S 4 Murmurs = blowing or swooshing sound Friction Rubs = inflammation of pericardium like sand paper rubbing
34
S3
loudest at APEX additional sound “KENTUCKY” Can be physiologic (normal) or pathologic (abnormal). Physiologic S3 is heard in children and young adults May last to age 40 in women. Also called a ventricular gallop indicates decreased compliance of ventricles and indicative of heart failure
35
MURMURS - TLC
TIMING LOCATION CHARACTER
36
TIMING: (murmurs)
Systolic or Diastolic?
37
LOCATION (Murmurs)
Heard best over which area
38
CHARACTER (murmurs)
QUALITY blowing, musical, harsh, rumbling LOUDNESS Graded on 6 point scale
39
Murmurs
Sound produced by turbulence of abnormal blood flow through a valve When listening for murmurs: Determine the timing in the cardiac cycle Do they occur in systole? (heard between S1 and S2) Do they occur in diastole? (heard between S2 and S1)
40
MURMURS- Main Causes
Stenotic valve Regurgitant or insufficient valve Abnormal passage between heart chambers
41
Murmurs - Grading
``` Grade 1: very faint Grade 2: quiet but clearly heard Grade 3: moderately - loud no thrill Grade 4: loud - may have thrill Grade 5: very loud - thrill present Grade 6: heard with stethoscope off chest with a thrill ```
42
PERICARDIAL FRICTION RUB
Produced by inflammation (Pericarditis) Heard best at apex and along left sternal border Lean patient forward Sounds like sand paper rubbing together
43
Infants
Heart rate may range from 100 to 180 beats per minute immediately after birth Infants normally have wide fluctuations with activity, from 170 bpm or more with crying or being active to 70 to 90 bpm with sleeping
44
Arterial Insufficiency
``` Intermittent Claudicating Capillary refill > 3 sec Absent or faint pedal pulses Thick toenails Cool skin Pain with ambulation Shiny skin Scant hair ```
45
Venous Insufficiency
``` Swelling in legs (graded from +1-+4) Warm skin temperature Dependent cyanosis Brown discoloration of the skin Chronic leg pain when in dependent position ```
46
The inspection for central/peripheral circulation
Capillary Refill: should be less than 2 seconds Clubbing: Is it present? Pulses: How would you grade them?
47
Pulsations
``` Temporal Carotid PMI Brachial Radial Ulnar Femoral Popliteal Posterior Tibial Dorsalis Pedis Dopplers can be utilized as well ```
48
Pulse Assessment
``` Scale for pulse assessment +0 = absent or not discernible +1 = thready, weak, difficult to feel +2 = normal, detected readily +3 = increased +4 = bounding ```
49
legs inspection for central/peripheral circulation
``` Skin color Hair distribution Size (swelling or atrophy) Lesions or ulcers Temperature Edema ```
50
Edema
unilateral or bilateral Firmly depress skin for 5 seconds and release Normally, your finger should leave no indentation Scale Present vs absent Pitting vs non-pitting
51
What does high pressure in the left side of the heart indicate?
symptoms of pulmonary congestion
52
What does high pressure in the right side of the heart indicate?
distended neck veins and abdomen
53
Where is the aortic valve
2nd right intercostal
54
Where is pulmonic valve
2nd left intercostal space
55
where is tricuspid valve
left lower sternal border
56
where is mitral valve
fifth interspace at around left midclavicular line
57
Where is Erb's point
3rd left intercostal space under the pulmonic valve
58
What happens at Erb's point
This is where a murmur would be heard
59
S3 (ventricular gallop)
-occurs with heart failure and volume overload
60
S4 (atrial gallop)
occurs with CAD
61
What does a systolic murmur indicate
may occur with healthy heart of with heart disease
62
What does diastolic murmur indicate
always indicates heart disease
63
S3 and S4 murmur of mitral stenosis may be only heard on what side?
left side

Cardiac HAPS (2 decks)

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