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Health Assessment > Quiz #3 Heart and Neck Vessels > Flashcards

Quiz #3 Heart and Neck Vessels Flashcards

(75 cards)

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1
Q

S1 sound

A

Occurs with closure of the AV valves- beginning of systole

All over precordium, but loudest at the apex

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2
Q

S2 sound

A

Occurs with closure of the semilunar valves- end of systole.
Heard all over precordium, but loudest at the base.

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3
Q

S3 sound

A

Ventricles are resistant to filling during early filling phase- occurs immediately after S2 when AV valve opens. Can be heard at apex or left lower sternal border.

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4
Q

S4 sound

A

Occurs at the end of diastole when ventricle is resistant to filling. Atria contract and push blood into a noncompliant ventricle- creates vibrations heard as S4.
Could occur in adults older than 40 without cardiovascular disease, especially after exercise.

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5
Q

Causes of heart murmurs

A
  1. Velocity of blood flow increases (flow murmor)
  2. Viscosity of blood decreases (anemia)
  3. Structural valve defects or unusual openings- eg dilated chamber or septal defect
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6
Q

Blood volume during pregnancy

A

increases by 30-40%, most rapid expansion during second trimester

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7
Q

Pulse rate in pregnancy

A

increases by 10-15 bpm

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8
Q

Arterial BP in pregnancy

A

Decreases due to peripheral vasodilation

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9
Q

foramen ovale

A

opening in the atrial septum of a fetus through which oxygenated blood enters the heart

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10
Q

ductus arteriosus

A

Routes oxygenated blood from the pulmonary artery to the aorta.

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11
Q

Heart position in the infant

A

More horizontal— apex is higher. Reaches adult position at age 7 years

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12
Q

Hemodynamic changes in aging

A
  1. Increase in systolic BP due to thickening and stiffening of the arteries (arteriosclerosis).
  2. Increase in pulse wave velocity
  3. Left ventricular wall thickness increases.
  4. Diastolic BP may decrease— pulse pressure increases
  5. No change in resting HR
  6. Cardiac output at rest does not change
  7. Decreased ability to change output with exercise
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13
Q

Dysrhythmias in aging

A

Presence of supraventricular and ventricular dysrhythmias increases with age.
Ectopic beats are common
Tachydysrhythmias are not tolerated well in older people as myocardium is thicker and less compliant

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14
Q

ECG in older adult

A

Prolonged PR interval
Prolonged QT interval
QRS interval unchanged
Left axis deviation due to LV hypertrophy and fibrosis
Increased incidence of bundle branch block

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15
Q

9 modifiable factors for CVD prevention

A
  1. abnormal lipids
  2. hypertension
  3. diabetes
  4. abdominal obesity
  5. psychosocial factors
  6. inadequate consumption of fruits and vegetables
  7. alcohol use
  8. smoking
  9. lack of regular physical activity
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16
Q

Hypertension most common in what group

A
  1. Blacks
  2. American indians
  3. Whites
  4. Hispanics
  5. Asians
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17
Q

Smoking rates

A

decreased, but still 21.2% of men and 17.5% of women

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18
Q

Serum cholesterol highest in what group

A

Mexican-Americans

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19
Q

Risk of CVD in DM

A

2x greater— diabetes damages large blood vessels that nourish brain, heart, and extremities

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20
Q

MI in women

A

less likely to call 911, pain is more of an ache, women report fatigue, difficulty breathing, radiating pain

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21
Q

Subjective Data for Heart and Neck Vessels

A
  1. Chest pain
  2. Dyspnea
  3. Orthopnea
  4. Cough
  5. Fatigue
  6. Cyanosis or pallor
  7. Edema
  8. Nocturia
  9. Past cardiac hx
  10. Family cardiac hx
  11. Patient centered care
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22
Q

Additional subject hx for aging adult

A
  1. Any known heart of lung disease?
  2. Do you take any medications for your illness?
  3. Environment- stairs at home?
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23
Q

Non chest-pain symptoms of angina

A

Diaphoresis, pallor, grayness

Palpitations, dyspnea, nausea, tachycardia, fatigue

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24
Q

Dyspnea characteristics

A

Paroxysmal?
Constant or intermittent?
Recumbent?

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25
Paroxysmal noctural dyspnea (PND)
Occurs with heart failure. Lying down increases volume of intrathoracic blood- weakened heart can't accomodate increased load- person awakes after 2 hrs with feeling of needing fresh air
26
Hemoptysis can signal
mitral stenosis, pulmonary embolism
27
Fatigue that is worse in the evenings due to
decreased CO
28
Fatigue all day or worse in the morning due to
anxiety or depression
29
Cyanosis or pallor occurs with
MI or low CO due to decreased tissue perfusion
30
Cardiac edema characteristics
Worse in the evening, better in AM after elevating legs. Bilateral.
31
Nocturia
recumbency at night causes fluid resorption and excretion- occurs with heart failure in pt who ambulates during the day
32
Risk factors for CAD (7)
1. high cholesterol 2. hypertension 3. blood sugar above 100mg/dL or DM 4. obesity 5. smoking 6. inactivity 7. hormone replacement therapy in postmenopausal women
33
Patient centered care for Heart and Neck Vessels (5)
1. Nutrition 2. Smoking 3. Alcohol 4. Exercise 5. Drugs
34
Objective data for the neck vessels
1. Palpate carotid 2. Auscultate the carotid 3. Inspect jugular venous pulse 4. Estimate jugular venous pressure
35
How much blood does the heart pump per minute?
4-6L in a resting adult
36
Carotid sinus hypersensitivity
Pressure over the carotid sinus leads to decreased HR, decreased BP, cerebral ischemia. Occurs in older adults with hypertension or occlusion of the carotid artery.
37
Normal carotid pulse contour
brisk upstroke, slower downstroke, moderate strength. Same bilaterally.
38
Carotid bruit indicates
turbulence from local vascular cause, atherosclerotic disease. Increases risk of TIA and stroke. Also occurs in 5% of those age 45-80 with no significant carotid disease
39
Where to auscultate the thyroid
1. angle of the jaw 2. midcervical area 3. base of the neck
40
Carotid bruit is audible when
Lumen is occluded by 1/2 to 2/3, When lumen is completely occluded, bruit disappears— absence of bruit does not indicate absence of carotid lesion
41
On what side do you assess the central venous pressure?
right side
42
What do you look for when assessing jugular venous pressure?
Top of the external jugular vein overlying the sternomastoid muscle pulsation of the internal jugular vein in the sternal notch
43
Unilateral distention of external jugular veins caused by
local cause- kinking or aneurysm
44
full distended external jugular veins above 45 degrees caused by
increased CVP with heart failure
45
Normal jugular venous pulsation
2cm or less above the sternal angle.
46
Elevated jugular venous pressure
pulsation >3cm above sternal angle. May indicate heart failure, cardiac tamponade, constrictive pericarditis
47
If venous pressure is elevated, perform what test?
abdominojugular test Watch level of jugular pulsation while pushing into right abdomen, pushing blood out of splanchnic vessels. If does not elevate CVP, jugular veins rise then back to normal. If heart failure, jugular veins elevate >4cm and stay as long as you push.
48
Objective data: the precordium (4 steps)
1. Inspect the anterior chest 2. Palpate the apical impulse 3. Palpate across the precordium 4. Auscultation
49
apical impulse
pulsation created as the left ventricle rotates against the chest wall during systole occupies 4th or 5th intercostal space at the midclavicular line easier to see in children/thinner chest walls
50
heave or lift
sustained forceful thrusting of the ventricle during systole occurs with ventricular hypertrophy due to increased workload
51
palpating the apical impulse
use one finger pad, ask pt to exhale and hold it, may need to rotate the person to the left. 4th or 5th interspace @ midclavicular line
52
Apical impulse in cardiac enlargement
left ventricular dilation displaces impulse down and to the left, increases size to more than one interspace.
53
Apical impulse with left ventricular hypertrophy
Sustained impulse with increased force and duration but no change in location
54
Apical impulse in pulmonary emphysema
not palpable due to overriding lungs
55
Palpating precordium
use palmar aspects of four fingers to palpate apex, left sternal border, and the base, looking for pulsations.
56
Thrill
palpable vibrations like a purring cat. Indicates turbulent blood flow- look for murmurs.
57
Valve areas for Auscultation
aortic valve area- second right interspace pulmonic valve area- second left interspace tricuspid valve area- left lower sternal border mitral valve area- fifth interspace at midclavicular line
58
Auscultation pattern for heart
from base to the apex in zigzag formation
59
premature beat
isolated beat is early, or pattern of early beats
60
irregularly irregular
no pattern- beats come rapidly and randomly (eg afib)
61
sinus arrythmia
occurs regularly in young adults and children rhythm varies with breathing- increases at inspiration and decreases with expiration
62
pulse deficit
auscultate apical beat and radial pulse simultaneously. subtract radial from apical to determine deficit. signifies weak contraction of the ventricles as in afib, premature beats, heart failure
63
Split S1
normal but rare
64
split s2
increased on inspiration, normal
65
midsystolic click
most common extra sound in systole, signals mitral valve prolapse
66
pathologic S3
ventricular gallop- occurs with heart failure and volume overload
67
pathologic s4
atrial gallop- occurs with CAD
68
Describing murmurs
1. Timing 2. Loudness (Grade 1-6) 3. Pitch 4. Pattern 5. Quality 6. Location 7. Radiation 8. Posture
69
Murmur of mitral stenosis
low-pitched and rumbling
70
murmur of aortic stenosis
harsh
71
innocent murmur
no valvular or other pathologic cause. Normally soft, midsystolic, short, heard at 2nd or 3rd left intercostal space. Disappears with sitting.
72
functional murmur
caused by increased blood flow in the heart- anemia, fever, pregnancy, hyperthyroidism
73
soft diastolic murmur of aortic regurgitation heard
when the pt is leaning forward in the sitting position
74
Objective data for heart and neck in the older adult
Gradual rise in SBP common Some adults experience orthostatic hypotension Caution in palpating carotid- could cause HR slowing or compromise circulation when atherosclerosis present Chest increases in AP diameter- more difficult to palpate apical impise and hear split S2. S4 occurs with no cardiac disease Systolic murmurs common Occasional premature ectopic beats common
75
S3 in older adult
associated with heart failure and always abnormal over age 35.

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