Health Assessment Flashcards
(182 cards)
1
Q
The completely health interview
A
- Biographical data
- Reason for seeking care (in own words)
- History of current illness/symptoms: PQRSTU-AAA
- Health history (hospitalizations/surgeries, obstetrics, immunization, meds, allergies)
- Family history (sudden death, diabetes, cardiac disease, cancer)
- Review of each system
- Functional assessment (ADLs and IADLs, self esteem, financial, safety at home, occupational, support system, etc.)
2
Q
Subjective assessment (ex: headaches)
A
- Provokes: light, computer
- Quality: sharp, full, stabbing, intermittent
- Region/radiation: one area of head, radiates down neck
- Severity: pain scale
- Timing: what time a day? Frequency, duration
- Understanding: why do you think it happens?
- Associated factors: nauseated, neck pain
- Aggravating factors: what makes it worse? Computer, light
- Alleviating factor: what makes it better? Rest, dark room, acetaminophen
3
Q
Physical assessment
A
- Vital signs: P, temp, RR, BP, pain
- Measurements: wt, ht, circumference of hips, legs, head, etc
- IPPA
Inspection
Palpation
Percussion
Auscultation
4
Q
What parts of your hands do you use for palpation?
A
Fingertips- texture, inflammation, pulses
Back of hand- temp
Ulnar side of hand- vibration (thrill)
Finger and thumb pinching grasp- detect position, shape, consistency of organ
5
Q
The general survey:
A
- Physical appearance (LOC, skin condition, facial feature symmetry)
- Body structure (symmetry, posture, position)
- Mobility (gait, ROM)
- Behavior (facial expression, affect, speech, hygiene and dress)
6
Q
Mental health status check:
A
A: appearance: general presentation, posture, body movement, dress, hygiene
B: behaviour: speech, affect
C: cognition: LOC, orientation, attention and concentration, memory, comprehension and reasoning
T: thinking: process, content, insight and judgement, perception
7
Q
The quick neuro check:
A
- LOC:
- ALERT: awake, responding to questions
- LETHARGIC: not fully alert, drifting into sleep if not talking, drowsy, able to answer questions but seems fuzzy (post op)
- ONTUNDED: sleeping most of time, difficult to arouse. Very drowsy, may answer in one word, mumble, not make a lot of sense
- STUPOR: spontaneously unconscious, drifting in and out, moans or grumbles, only awakes to strong stimulus like pain
- COMA: unconscious, unresponsive to even strong stimuli like pain - ORIENTATION: person, place and time
- MOTOR RESPONSE: equally on both sides? Coordinated?
8
Q
Example of painful stimuli
A
Sternal rub, trap squeeze
Always tell pt what your doing, even when unconscious
9
Q
3 layers of skin:
A
- Epidermis: thinner outer layer, avascular, sheds every 4 weeks
- horny cell layer: dead skin cells that shed constantly and replaced by new ones from basil layer
- basil layer: forms new skin cells (keratin and melanocytes) - Dermis: deep to epidermis, supportive connective layer (collagen)
- blood vessels, nerves, sensory receptors, lymphatic vessels
- epidermal appendages: hair, sweat glands, sebaceous glands - Subcutaneous layer: adipose tissue
- used for energy, insulation, cushion for structures underneath
10
Q
Epidermal appendages:
A
- Hair: keratin
- Arrector Pili: muscle that pulls hair upright (goose bumps)
- Vellus hair: fine hair that covers most of body
- Terminal hair: dark hair (head, eyebrows, axilla, pubic - Sebaceous glands
- Sebum: protective lipid that’s is secreted through hair follicle. Found all over body except for palms and soles of feet. - Swear gland
- Eccrine gland: opens up directly on skin, saline solution known as sweat. Cools us down via evaporation. (matures in infants at 2 months)
- Apocrine gland: becomes active at puberty. Thick, milky substance that mixes with bacteria on skin to cause BO. Mainly located at axilla, naval, genital, breast - Nails: hard plates of protein and keratin
11
Q
Functions of skin
Polly G Plays Tuba In College Without Any Practice
A
- Protection (cushions, minimize injury to organs), physical, chemical, thermal
- Guards the body (1st line of defence)
- Perception (touch, pressure, temp, pain)
- Temperature regulation (sweat, subcutaneous layer)
- Identification (finger prints, facial features unique)
- Communication (flush when embarrassed, pale when in shock)
- Wound repair (surface wounds)
- Absorption and elimation (UV, meds, limited ability to eliminate metabolic waste)
- Production of vitamin D (UV + cholesterol)
12
Q
Infants skin characteristics:
A
LANUGO: fine hair that covers body, falls out eventually and replaced with Vellus hair
VERNIX: made of sebum and epithelial cells. White substance on newborn. Sebum helps hold water into skin and in utero protects skin from watery environment. Can rub in
MILIA (newborn acne): white bumps on face and nose, goes away eventually
ECCRINE GLANDS not developed and SUBCUT LAYER insufficient, so susceptible to environmental temps
13
Q
Adolescent skin:
A
APOCRINE GLAND: matures and increased secretion (BO starts)
SEBACEOUS GLANDS: becomes more active (more oily skin and acne)
SUBCUTANEOUS: fat deposits increase (especially females and pelvic area)
14
Q
Pregnancy changes in skin
A
LINEA NEGEA: dark line from umbilicus down stomach, from excess hormones. Fades eventually
CHLOSMA: hyperpigmentation on face from excess hormones. Sometimes fades
STIAE GRAVIDARUM: stretch marks; connective tissue becomes fragile from stretching quickly. Not all pregnancies, but expected
15
Q
Older adults skin changes
A
- Decrease: elasticity, subcutaneous layer, muscle tone, sweat and sebaceous glands,
= Dryer, thinner, more relaxed (hanging), more wrinkles - Decrease melanocytes: greying hair
- hair distribution changes (balding, thinning)
- Senile Purpura: the vascular fragility increases. Minor trauma may produce red discolouration
16
Q
Edema 4 point scale:
A
1+: mild pitting, slight indentation, cannot see swelling
2+: moderate pitting, indentation subsides rapidly
3+ deep pitting, remains a short time, limb looks swollen
4+ very deep pitting, indentation last a long time, looks very swollen
17
Q
Pruritis
A
Itching; most common skin concern
18
Q
Blanching:
A
Press down on skin, colour should drain and come back when pressure is taken off. Tells us circulation is good.
If there is not blanching- there is bad circulation in the area
19
Q
Capillary refill
A
Press down on nail, colour should drain and reappear in 1-2 seconds.
If it takes longer than 1-2 seconds= peripheral circulation problem
20
Q
Clubbing
A
Seen with chronic hypoxia; finger top appears bulbus.
Early clubbing sign: nail 180 degree (flat)
21
Q
Danger signs in Pigmented Lesions (ABCDE)
A
Asymmetry Border irregular Colour variations (2+) Diameter greater than 6mm Elevation and evolution (any rapid elevation, formation of new lesion, change over time, sudden itching, burning, bleeding)
22
Q
Annular
A
Circular lesion. Starts in the center and spreads to the periphery.
Ex: Ring warm
23
Q
Confluent
A
Lesions that look like they starting to grow together
Ex: hives (urticaria)
24
Q
Discrete
A
Seperate, distinct
Ex: acne
25
Grouped
Cluster of Lesions, not growing into eachother
| Dermatitis
26
Gyrate
Twisted, snake like
| Parasitic infection
27
Target
Iris; looks like a bullseye
| Lyme disease from tics
28
Linear
In a line
| Scratch
29
Polycyclic
Circular/annular lesions that are growing into each other (confluent)
Psoriasis
Diff from confluent bc lesions are distinct and separate
30
Zosteriform
Linear, but follows a never root
| Shingles
31
Macule
Flat colour change
Less than 1 cm
Freckle
32
Patch
Macule (flat colour change)
Greater than 1 cm
Choloasma, Mongolian spot
33
Papule
Palpable, solid, elevated, circumscribed
Less than 1 cm
Caused by superficial thickening of epidermis
Mole, wart
34
Plaque
Papule, elevation
Greater than 1 cm
Psoriasis
35
Nodule
Solid, elevated, hard or soft, can extend deeper into dermis. Is palpable and moveable
Greater than 1 cm
Fibroma
36
Wheal
Raised and red. Superficial, raised and slightly irregular because of edema
Mosquito bite, uritcaria
37
Tumour
Firm or soft, deeper in dermis, may be benign or malignant
Larger than a few cm
Lipoma, hemangioma
38
Vesicle
Aka blister. Elevated cavity that contains fluid
Less than 1 cm
Chicken pox, shingles
39
Bulla
Elevated lesion that contains clear fluid. Thin walls so ruptures easily
Greater than 1 cm
Friction blister, burns
40
Cyst
Encapsulated sac that contains found, grows into dermis or subcutaneous if larger enough. Tensely elevates skin
Sebaceous cyst on scalp
41
Pustule
Elevated capsule that contains pus
| Acne
42
Crust
Thickened, dried our exudate left when lesions burst or dry up (vesicles/pustule)
Secondary skin lesion
43
Scale
Dry patch, silver or white, from shedding dead excess keratin cells
Psoriasis, drug interaction, eczema
Secondary skin lesion
44
Fissue
Linear crack with abrupt edges, extends into dermis. Dry or moist
Cut skin, athlete's foot
Secondary skin lesion
45
Erosion
Shallow depression, epidermis layer only, does not bleed (is moist) or scar because it doesn't extend into dermis
Secondary skin lesion
46
Ulcer
Deeper depression, extending into dermis. Irregular shape, may bleed, leaves scar
Ulcer, pressure injury
Secondary skin lesion
47
Excoriation
Self inflicted abrasion. Superficial, sometimes crusted. Scratches from intense itching
Secondary skin lesion
48
Scar
Replacing connective tissue (collagen) with normal tissue after skin lesion is repaired; permanent fibrotic change
Secondary skin lesion
49
Atrophic scar
Depression in skin level from tissue loss; thinning of epidermis
Stretch marks, acne
Secondary skin lesion
50
Lichenification
Thickening of skin with production of tightly pack papules. Caused by prolonged intense itching, looks like moss
Elbows
Secondary skin lesion
51
Keloid (hypertrophic scar)
Elevation of the skin level from excess scar tissue. May increase after healing occurs. Looks smooth and rubbery
Secondary skin lesion
Secondary skin lesion
52
Vascular lesions: hemangiomas
```
Benign proliferation of blood vessels in the dermis
3 types
Port wine stain
Strawberry Mark (immature hemangioma)
Cavernous hemangioma
```
53
Vascular lesions: (hemangioma)
| Port wine stane
flat macular Red, blue, purplish on face or scalp.
Often along cranial nerve
Formed my mature capillaries
Intensifies with exertion, crying, cold, heat.
Formed at birth, does not fade.
54
```
Vascular lesions: (hemangioma)
Strawberry Mark (immature hemangioma)
```
Elevated, bright red area with well defined borers.
About 2-3cm
Does not blanch
Appears at birth or first few months disappear 5 to 7 yrs
55
Vascular lesions: (hemangioma)
| Cavernous hemangioma
Reddish blue, spongy or solid mass of blood vessels.
May be present at birth, can enlarge in first 10 to 15 months.
Does not involute spontaneously
56
Telangiectasia:
appearance of blood vessels on the surface of the skin from permanent dilation
Two types
Spider and star angiomas
Venous lake
57
Telangiectasia: spider and star angiomas
Fiery red, blanches
Star shaped marking with solid center. (Capillary legs spread outwards from center)
Normal; pregnancy, estrogen therapy and chronic liver disease.
58
Telangiectasia: venous lake
Blue purple dilation of venules and capillaries. Caused by backflow/pooling in veins)
Blanches.
Located near varicose veins, lips, face, ears, chest.
59
Purpuric lesions
Blood flowing out of breaks in vessels. Blood pigment stains the skin.
2 types; petechiae and Purpura
60
Purpuric lesion: Petechiae
Tiny punctate (pinpoint) hemorrhages
1-3 mm
Round and discrete.
Dark red, purple, brown. Does not blanches
Caused by bleeding in the superficial capillaries.
May indicate abnormal clotting factors. A
61
Purpuric lesion:: Purpura
Extensive patch of confluent Petechiae and ecchymosis (bruise- bleeding under skin)
Greater than 3 mm. Flat macular hemorrhage
Red to purple
(Senile purpua: capillaries break in response to minor trauma due to decrease vessel wall integrity)
62
```
Frontal bone
Parietal bone
Occipital bone
Temporal bone
Mastoid process
Maxilla
Mandible
Temporomandibular joint
```
Point to bones.
63
```
Masseter
Sternomastoid
Trapezius
Nasolabial fold
Palpebral fissure
```
Point to muscles.
64
```
Salivary glands
Parotid gland
Submandibular gland
Sublingual glands
And temporal artery
```
Point to glands
65
```
Lymph nodes
Posterior auricular and preauricular (x2)
Occipital (x2)
Jugulodigastric
Superficial cervical (2)
Posterior cervical (3)
Deep Cervical chain (5,6)
Submandibular (2)
Submental
```
Point to each node
66
Trachea and thyroid gland
| Describe the structure and thyroids function.
Hyoid bone, thyroid cartilage (Adams apple), thyroid gland straddling trachea.
Thryiod regulates: metabolism, heart rate and digestion
67
Head and neck consideration for infants
FONTANELS (soft spots): sutures seperate bone to aid in transition through birth canal
Anterior fontanel: larger, 18 months to close
Poster FONTANELS: smaller, 2 months to close
CAPUT SUCCEDANEUM: swelling and bruising on infants head from birth. Goes away eventually
Lymph vessels help clear
CEPHALHEMATOMA: blood between the parietal bone and periosteum. Will resolve
MOLDING: bones slide over each other to fit through birth canal. Cone shaped head. Will resolve in few days
68
Head and neck consideration for pregnancy
Thyroid gland increases
| Increased vasculature all over body, increase blood volume, sometimes cause increased thyroid gland
69
Head and neck consideration for older adults
Facial bones more prominent
| Lymph nodes may be difficult to palpate
70
Vertigo
Sensation of spinning. Has to do with equilibrium
Subjective vertigo: feel like you are spinning
Objective vertigo: feels like the room is spinning
71
Microcephaly
Unexpectedly small head
| Chromosomal abnormality, fused prematurely, Zika virus
72
Macrocephaly
Unexpectedly large head
Hydrocephalus most common
Tumor, hemorrhage, infection, head trauma
73
Bells palsy
Paralysis of facial never causing muscular weakness on the affected side
Cause unclear, linked to virus
Treatment is wait for it to self resolve
74
What nodes are palpable in healthy people?
Cervical node
75
What does it indicate if a node is enlarged, firm, tender and moveable?
Infection
76
What does it indicate if a node is hard, not tender and fixed?
Cancer
77
How do you palpate a thyroid?
1. Ask them to look up
2. Ask to swallow. Tissue moving up and down is thyroid gland
3. Palpate: anterior approach- use thumbs
Posterior- behind use fingers
Look for difference in symmetry.
78
Function of musculoskeletal system
```
Support
Movement
Protection
RBC
Storage for essential minerals
```
79
How many bones in body?
206
80
What is cartilage?
Specialized form of connective tissue
81
What are joints? What types?
Where two bones articulate
Synovial joints: freely moveable. Fluid lubricates ex knee
Non synovial: immovable or slightly moveable. Ex joints between skull bones, vertebrae
82
Ligaments
Fibrous band connecting bone to bone
83
Bursa
Sac filled with fluids in joints of high impact and lots of movement and friction . Provides cushioning
84
Tendon
Connects muscle to bone
85
Muscle
Contacts move bones
86
Flexion
Bending a limb at a joint
87
Extension
Straightening a limb at the joint
88
Abduction
Moving a limb away from the midline
89
Adduction
Moving a limb towards the midline
90
Pronation
Turning your forearm so palm is down
91
Supination
Turning forearm so palm is up
92
Circumduction
Moving the arm in a circle around the shoulder
93
Inversion
Moving the sole of the feet inwards at the ankle
94
Eversion
Moving the sole of the feet outwards at the ankle
95
Rotation
Moving a body part around a central axis (head)
96
Protraction
Moving a body part forward and parallel with the ground
97
Retraction
Moving a body part backward and parallel to the ground
98
Elevation
Raising a body part
99
Depression
Lowering a body part
100
Temporomandibular joint
```
Hinge joint
Open close
Side to side
Protrusion retraction
Palpate joint and feel for symmetry, should feel smooth.
Audible click is okay if not painful
```
101
Spine
33 vertebrae. Double s curve
7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 3-4 coccygeal
Intervertebral discs: shock absorber
Paravertebral muscles: run alone spine.
Movements: flexion and extension, lateral flexion, rotation, abduction
Inspection anteriorly, posteriorly and lateral sides
Look for scapula, iliac crest and gluteal folds to be on same side. Note all 4 curves. Palpate down spine
102
Cervical spine
7 C vertebrae
Flexion, extension, lateral flexion, rotation
Palpate: sternomastoid, trapezius, paraspinal muscles
Inspect for alignment of head and symmetry of muscles
103
Shoulder
Ball and socket joint
Forward flexion, hyperextension, internal rotation, external rotation, abduction and adduction
Inspect anteriorly and posteriorly
Look for symmetry
104
Elbows
Hinge joint
Bones: humorous, radial and ulna
Olecranon process, medial and lateral epicondyle
Hinge joint: flexion and 0 degree extension
Radioulnar joint: pronation and supination
Inspected flexed and relaxed. Support joint above and below
105
Wrist and carpal joints
Wrist:
Flexion and extension
Ulnar and radial deviation
Mid carpal joint;
Flexion and extension. Some rotation
Metacarpophalangeal and interphalangeal joints
Finger flexion and extension
Abduction (fanning fingers out)
106
Carpal tunnel syndrome?
| Tests?
Punching on nerves
1. Phalen's test: posterior side of hands against eachother with finger tips pointing down. Numbness tingling or pain indicates positive
2. Tinel's test: percussion by tapping on mid wrist with palm side up. If there is symptoms, send for imaging.
107
Hips
Ball and socket (more stable than shoulder, femur deeper in socket)
Bones: iliac crest (ASIS, PSIS), ischial tuberosity, greater trochanter
Flexion with straight leg (90), with bent knee (120), extension, abduction, adduction, internal rotation, external rotation
108
Knees
```
Hinge joint
Articulation- femur tibia and patella
Flexion, extension (0) or hyperextension (15)
Assess for symmetry:
Quad muscles
lateral and medial condyles of tibia
Lateral and medial condyles of femur
```
109
Condyle vs epicondyle?
Condyle: round and smooth. Forms articulation with another bone
Epicondyle: rough, provides sites for muscle attachment
110
Ankle and foot joints
Tibiotalar joint: hinge joint
Dorsiflexion and plantar flexion
Medial and lateral malleolus
Subtalar joint:
Inversion and eversion
111
Name 4 hinge joints
Temporomandibular
Elbow
Knee
Tibiotalar
112
Name 2 ball and socket joints
Shoulder
| Hip
113
MSK consideration for infants and children
1. Hip dysplasia: dislocation of hip. Can happen at birth and go unnoticed bc they don't weight bear until 10 to 14 months.
Check leg lengths and ROM at every appointment until they start weight bearing.
2. Growing pains: non inflammatory bone pain. Common between 3 to 12 years old. Occurs more commonly in evening and night.
114
MSK consideration for pregnancy
1. Increased joint mobility: increase hormones laxin and estrogen (2 to 3 trimester)
2. Lumbar lordosis: from increased joint mobility + weight of baby makes you lean back = low back pain
115
MSK consideration:
1. Loss of bone density: osteoporosis
2. Muscle mass decreases
3. Cerebral column shortens: decreased height
4. Postural change: kyphosis in thoracic back (hump back)
116
Describe what arteries, veins and lymphatic vessels do:
Arteries: originate in the aorta or its branches. Transport oxygenated blood from the blood to the systemic circulation.
Exception is pulmonary artery: RV to lungs to oxygenate
Veins: carries deoxygenated blood and waste from systemic circulation to right atrium via superior and inferior vena cava
Exception is pulmonary vein: lungs to LA
Lymphatic vessels: retrieves excess fluid from tissue (leaks out at capillaries) space and returns to blood system.
117
Describe the pressure of arteries vs veins?
Arteries are high pressure
Veins are low pressure
Blood flows from hight to low
118
Which do we have more of? Arteries or veins?
More veins, closer to surface
Less arteries
119
Describe the walls of a vein:
Thinner and larger in diameter than arteries, can dilate to hold more blood.
Have elastic and muscle fibers, but less than arteries.
120
Describe the walls of an artery
Thicker and more tough than veins. More elastic and muscle fibers.
Elastic fibers allow walls to stretch with systole
Muscle fibers control the blood flow to tissues by dilating
121
Describe venous flow
1. Skeletal muscle pump: muscles contract to squeeze blood towards heart (calf pump)
2. Pressure gradient: inspiration causes thoracic pressure to decrease (RA) and abdominal pressure in increase (vena cava). Blood flows from high to low pressure
3. Intraluminal valves: unidirectional flow. Each cables has semilunar pockets that open towards the heart and close tightly when filled. Prevents backflow
122
What arteries are accessible during an exam?
```
Temporal
Carotid
Brachial
Radial
Ulnar
Femoral
Popletal
Dorsalis pedis
Posterior tibial
```
123
What veins are accessible during an exam?
```
External juglar
Internal jugular
Superficial arm
Deep arm
Femoral
Popliteal
Great saphenous
Small saphenous
Perforators (connecting veins)
```
124
What causes varicose veins?
Incompetent valves. The lumen of the vein is too wide, so the valve cusps cannot approximate.
Result is backflow and blood not returning efficiently. At risk for venous pooling.
125
Where is the temporal artery?
Palpated in front of ear
126
Where is the carotid artery. What is the significances?
Palpated in groove between sternomastoid and trachea.
| It is the central artery (closest to heart). Timing closely coincides with ventricular systole.
127
Where does jugular veins carry blood?
| Where are they found?
External jugular vein: lateral, deeper and smaller than internal. Branches of superior vena cava, goes lateral and under clavicle and crosses in front of sternomastoid
Internal jugular vein: larger, branches of vena cava, goes under clavicle and deep to sternomastoid. Medial to external jugular, lateral to carotid artery.
They carry deoxygenated blood into the superior vena cava.
128
What happens when the right side of the heart is backed up?
| Jugular veins
When the right side of the heart fails to pump efficiently, the pressure if the right atrium increases and volume of blood increases.
There is no valve between the RA and superior vena cava, so it backs up into the vena cava, which backs up into the jugular veins.
Resulting in the jugular vein distension (bulging)
129
Describe how the arteries supply the arm. And pulse sites
BRACHIOCEPHLIC a. Breaks into COMMON CAROTID (head) and SUBCLAVIAN.
Subclavian travels down inside upper arm and becomes BRACHIAL artery (pulse site and major blood supply to arm)
Brachial artery divides into ULNAR and RADIAL artery (pulse sites)
Ulnar and radial arteries create deep and superficial PALMAR ARCH
130
Describe how arteries supply the leg. And pulse sites
The FEMORAL artery (major blood supply, pulse site above ischial tuberosity) passes deep to inguinal ligament on anterior medial side of thigh. Cross to posterior aspect of leg and becomes POPLITEAL artery (pulse site behind knee).
Popliteal divides into ANTERIOR TIBIAL artery and POSTERIOR TIBIAL artery below knee on posterior lower leg.
Anterior tibial travels to anterior part of lower leg (through tibia and fibula) travels down to dorsum of foot and becomes DORSALIS PEDIS artery.
Posterior tibial travels down leg towards medial side, behind medial malleolus (pulse site), and becomes PLANTAR arteries.
131
What is ischemia?
Deficiency in oxygenated blood supply from arteries due to obstruction of the blood vessel.
May only be apparent during exercise bc of increased oxygen demand
132
What are the 3 types of veins in the leg?
1. Deep veins- femoral and popliteal. Run along arteties
2. Superficial veins- great and Small saphenous
3. Perforators- connecting veins. Connect deep to superficial
133
Describe veins in the leg.
FEMORAL vein runs deep on medial aspect of anterior thigh (lateral to great saphenous). Cross knee on medial side and becomes POPLITEAL vein. Under back of SMALL SAPHENOUS vein ascends down back of leg behind lateral malleolus and onto the lateral dorsum of foot.
The GREAT SAPHENOUS vein ascends down medial thigh (medial to femoral). Cross knee on medial side and descends across medial malleolus (can see it) onto medial dorsum of foot.
134
Name 3 functions of the lymphatic system.
1. Return fluid back to venous site (artery is high pressure, vein is low. So at capillary site, there is leaking)
2. Immune response: a. Phagocytosis of pathogens via neutrophils and monocytes. B. Exposed to lymphocytes in lymph nodes which mount an antigen specific response.
3. Absorbs lipids from GI tract and deposits back into venous system (lipid soluble fats)
135
Describe the 2 major trunks of the lymphatic system
1. Right lymphatic duct: drains to right subclavian vein
- right side of: head, arm, lung, heart, thorax, and right upper liver
2. Thoracic duct: drains the rest of body to to left subclavian vein
136
What are lymph nodes?
Small oval clusters of lymphatic tissue located at intervals along the lymph vessels
They filter fluid before it returns to the blood stream. It filters out potentially harmful microorganisms.
Lymphocytes mount antigen specific immune response.
137
```
Identify and describe lymph nodes:
Cervical nodes
Axillary nodes
Epitrochlear node
Inguinal nodes
```
Cervical nodes: drains head and neck
- pre and post auricular, occipital, superior cervical and posterior cervical, deep cervical chain, supraclavical, jugulodigastric, submandibular, submental
Axillary nodes: drains breast and upper arm
- Lateral axillary: above armpit on inner upper arm
- Superficial central axillary: middle of armpit, closer to chest side
Epitrochlear node: drains hand and lower arm
- Antecubital fossa (inside elbow)
Inguinal nodes: drain groin and external genitalia, most lymph nodes in lower body, and anterior abdominal wall.
upper and lower lnguinal nodes located on medial upper thigh, lateral to groin.
138
Peripheral vascular and lymphatic system considerations for infants and children.
1. Larger lymph nodes: lymph nodes may be palpable when healthy. Lymph tissue grows faster than the rest of the body. As long as it is not tender or fixed it's no concern
139
Peripheral vascular and lymphatic system considerations: pregnancy
1. Drop in BP: hormonal changes cause vasodilation. Expecting in 2 to 3 trimester
2. Edema in lower legs, varicose veins and hemorrhoids. Fetus growing = pressure on lower legs and vessels = edema and increased risk of varicose veins (especially 3rd trimester)
140
Peripheral vascular and lymphatic system considerations: older adults
1. Arteriosclerosis: vessels become less elastic so a greater pressure is needed from the heart to push blood through. There BP increases
2. Atherosclerosis: build up of fatty plaque
3. Enlargement of calf veins
4. Loss of lymphatic tissue (may not be able to palpate when sick)
141
What would you think if you saw unilateral edema?
| Bilateral edema?
Unilateral- peripheral circulation problem (DVT)
Bilateral- systemic problem (heart or kidneys)
142
How is pulse graded on 4 point scale?
3+ increased, bounding (after exercise)
2+ normal
1+ weak, threads
0 absent, not palpable
143
Name 2 types of peripheral vascular disease
1. Deep vein thrombosis DVT
| 2. Peripheral artery disease PAD
144
What is DVT?
Deep vein thrombosis: a clot that is usually in the legs.
Acute, unilateral pain and swelling
Asymmetry of calves >1 cm indicates DVT
145
What would happen if there was a DVT clot in the thigh?
The blood would move into the legs via the artery, but not be able to drain due to the blockage.
So below the blockage site there would be blood pooling, which would cause inflammation, redness and heat.
146
What are some risk factors for DVT?
```
Old age
Immobility
Clot disorder
Damage to vein walls
Etc
```
147
What is Homans sign?
Flex patients knee and dorsiflex foot to stretch the gastrocnemius which compresses posterior tibial vein.
If there is pain that is a positive sign.
148
Describe peripheral artery disease (PAD)
narrowed arteries reduce blood flow to limbs. Not enough blood reaches extremities (usually legs) to keep up with demand.
Usually caused by atherosclerosis.
149
What would happen if any artery was blocked at the thigh?
Since the lower leg is not receiving oxygenated blood, it would look pale, cool.
Difficult to find a pulse
Capillary refill would take more than 2 seconds
150
How can PAD lead to amputation of a foot?
```
Decreased circulation
Chronic hypoxia
Decrease wound healing (especially ulcers)
Gangrene
Amputation
```
151
What is the precordium?
The area of the chest where the heart sits
From the 2nd to 5th intercostal space
From the right sternal border to left midclavicular line
152
What is the apex of heart?
```
Bottom of the heart
5th intercostal space at the midclavicular line
PMI site (point of maximal impulse)
```
153
What's the base of the heart
Top of heart
| 2nd intercostal space by sternal border
154
What would happen if there was increased pressure in the left atrium?
There is no valve between the pulmonary veins and left atrium.
If pressure was higher than pulm vein, blood would backup into the lungs
Causing pulmonary congestion or heart failure.
155
What is the hearts function?
Pumps oxygenated blood into arterial system
| Pumps deoxygenated blood from venous system into lungs to be re oxygenated
156
What are the layer of the heart.
Pericardium- sac that holds heart
Epicardium- outer layer
Myocardium- muscular middle layer
Endocaridum- inner lining
157
Describe the chambers of the heart.
Atrium; 2 receiving chambers
1. Right atrium: receives deoxygenated blood from vena cavas, pumps to right ventricle
2. Left atrium: receives oxygenated blood from pulmonary veins, pump to right ventricle.
Ventricles: 2 distributing chambers
1. Right ventricle: receives deoxygenated blood from RA, pumps to pulmonary artery
2. Left ventricle: receives oxygenated blood from LA, pumps to aorta for systemic circulation
158
Describe the AV valves of the heart
Atria-ventricle
1. Tricuspid valve: RA to RV
2. Mitral valve: LA to LV
159
Describe the semilunar valves (SL)
1. Pulmonary semilunar valve: RV to pulmonary artery
| 2. Aortic semilunar valve: LV to aortic artery
160
Explain how blood flows through the heart
```
DEOXYGENATED
1. Superior and inferior vena cava
2. Right atrium
3. Tricuspid valve (AV)
4. Right ventricle
5. Pulmonic valve (SL)
6. Pulmonary artery to lungs
OXYGENATED
7. Lungs to pulmonary vein
8. Left atrium
9. Mitral valve
10. Left ventricle
11. Aortic valve (SL)
12. Systemic circulation.
```
161
Describe pulmonary to system circulation
Oxygenated blood leaves heart via aorta and branches of to supply tissue and capillaries with oxygen
Oxygenated blood goes into capillaries from arteries and deoxygenated blood comes out into veins
Veins being blood back up to heart via superior and inferior vena cava
162
Describe the cardiac cycle
1. Diastole
A. Protodiastolic filling (passive filling): AV valves open and blood pours into ventricles. Heart is relaxed
B. Pre-systole/atrial systole/atrial kick (active filling): at the end of diastole, atriums contract to squeeze last bit of blood into ventricles
2. Systole:
AV valves close= S1
For short period all 4 valves are closed while pressure builds.
SL valves open once pressure is high enough.
Blood from RV pumps into lungs, LV pumps into systemic.
Semilunar valves close= S2
163
What are expected heart sounds?
1. S1: occurs when AV valves close
Loudest at apex
2. S2: occurs when SL valves close
Loudest at base
164
What causes a split S2?
Lup-T-Dup
The aortic SL valve closes slightly before the pulmonic SL valve.
165
What causes an S3 sound
Lup dup dup
Ventricular resistant to filling. Can indicated ventricular gallop (early sign of heart failure)
May be physiological in infant, children and pregnant women when lying down
Heard during protodiastole
166
What is am S4 sound?
Ventricles resisting to filling
May be normal in older people when exercising, but not at rest
Atrial gallop- indicates cardiamyopathies
Heard during pre-systole phase before S1
167
What does murmur mean?
Turbulent blood flow (hear a blowing or swooshing sound)
168
What are conditions that may cause a murmur;
Increased velocity of blood (exercise)
Decreased viscosity of blood (anemia)
Structural defects in valves or unusual openings in chambers.
169
What would cause a bruit sound on an artery?
Turbulent flow.
Artery should be quiet
Caused by atherosclerosis
170
Electrical conduction of the heart;
1. SA node pacemaker
2. AV node
3. Bundle of His
4. Right and left bundle branches
171
Cardiac output vs stroke volume
CO is amount of blood being pumped by heart in 1 min
(4 to 6 L in adults)
SV is amount of blood being ejected from the heart in 1 cycle
(Would be less than CO)
CO= SV X HR
172
Preload and after load
Preload: the length the ventricle must stretch to fill just before contraction
After load: the pressure the ventricles must generate to open the semilunar valves and eject blood
173
Cardiac considerations for infants
1. Foramen ovale: hole between atriums.
Lungs are fluid filled and higher pressure than RV. So blood can't freely flow, instead a hole between atriums allows blood to bypass lungs.
Closes in 1st hr
2. Ductus arteriosus: a duct between the pulmonary artery headed to the lungs and the aorta artery for systemic circulation. 2nd way fetal blood bypasses the lungs
Closes in 10 to 15 hrs
174
Where is a infants heart located?
More horizontal than adults
PMI at 4th intercostal
Until about age 7
175
Cardiovascular consideration in pregnancy
1. Increased blood volume (30 to 40%)
2. Pulse rate increases: due to increasing CO and SV
3. BP drops slightly due to vasodilation (2-3 trimester)
176
Cardiovascular considerations in older adults
1. Systolic BP increases (less elastic vessels)
2. Left ventricle wall thickens (harder to push blood out of heart)
3. Increased arrhythmias, hypertension, heart failure and cardiovascular disease
177
What is orthopnea?
The need to assume an upright position to be able to breathe.
Could be related to pulmonary congestion
178
Nocturia
Peeing frequently at night
| Can be sign of CHF
179
How do you displace the heart towards the chest wall
Roll on to left side
180
Describe the Z pattern to auscultate the heart
1. Aortic area (2nd right intercostal space, against sternum) S2 loudest
2. Pulmonic space (2nd intercostal left space, beside sternum)
3. Erbs point (3rd intercostal left space, near sternum)
4. Tricuspid area (5th intercostal left space. By sternum
5. Mitral area (5th intercostal left space. Midclavicular line) S1 loudest
181
How would you assess a cardiac murmur
```
Timing: systole or diastole
Loudness
Pitch: high or low
Pattern
Quality: musical, blowing, rumbling, harsh
Location
Radiation
Posture
```
182
6 grades of murmur
1. Barely audible.
2. Clearly audible. But faint
3. Moderately loud. Easy to hear
4. Loud. Associated with thrill
5. Very loud. Can hear with one corner of stethoscope off chest
6. Loudest. Can hear with stethoscope off chest
