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Health Assessment > Week 5 Cardiovascular/PV Assessment > Flashcards

Week 5 Cardiovascular/PV Assessment Flashcards

1
Q

What is the precordium

A

the space where the heart sits

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2
Q

What are the three layers of the heart wall and what is the function of each

A
  1. Myocardium - pump
  2. Endocardium - chambers and valves
  3. Pericardium - double walled sac separated by fluids
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3
Q

When performing a cardiac assessment, what are some important questions to ask for history

A
  • chest pain (OLD CART)
  • palpitations
  • dizzy/lightheaded
  • syncope (must lose consciousness)
  • dyspnea
  • orthopnea (how many pillows)
  • +/- cough
  • +/- sweats
  • +/- nausea/vomiting
  • peripheral edema
  • smoking
  • wheeze
  • edema (swelling is worse in evening and bilateral)
  • obesity
  • nocturia
  • indigestion
  • recent viral illness
  • medications
  • alcohol or recreational drugs
  • exercise patterns
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4
Q

When gathering a cardiac assessment, what past medical history questions do you want to know about

A
  • rheumatic fever
  • prior MI
  • angina
  • hypertension
  • diabetes
  • high cholesterol
  • murmurs
  • CAD
  • arrhythmia
  • drug abuse

History of heart surgery to include: cardiac catheterization, bypass, angioplasty, valve repair, stints or dental work

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5
Q

When gathering a cardiac assessment, what family history conditions are we concerned with

A
  • sudden death before age 50
  • heart attacks
  • strokes
  • diabetes
  • hypertension
  • high cholesterol
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6
Q

What are the major risk factors for heart disease

A
  • obesity (BMI > 30)
  • smoking history (any smoking ever)
  • DM
  • hypertension
  • high cholesterol levels
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7
Q

When would you take orthostatic blood pressures

How do you take them? (Time between each)

What result is significant for diastolic and systolic

A
  • check if they’re dizzy
  • Take 5-10 minutes after being supine; take 3 mins after sitting for 3 minutes; take within 3 mins standing
  • drop of more than or equal to 20mmHg systolic and a drop of more or equal to 10mmHg diastolic AND/OR increase of 20 bpm HR
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8
Q

What are you inspecting for during a cardiovascular assessment

A
  • breathlessness or discomfort (diaphoresis, pallor, SOB)
  • precordium for symmetry, pulsations in chest wall, structural deformities
  • skin: edema, cyanosis, nails (cap refill, clubbing)
  • petechiae
  • color (central cyanosis and peripheral)
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9
Q

What is JVD? What is normal?

How would you assess for JVD? What does it mean if its unilateral/bilateral

A
  1. Measurement of right sided heart activity (volume and pressure; cardiac function) because the jugular goes into the RA
  2. Normal = distention can be seen with supine position and goes away as head goes up
  3. Assess: stop at 30-45 degree angle and look for pulsations and fullness
  4. Bilateral JVD = fluid overload; unilateral JVD = right sided heart failure or obstruction
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10
Q

What are heaves

A

lifting from vigorous pulsation

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11
Q

What is meant by the lub (S1) sound

A
  • closure of tricuspid and mitral valve (AV valves)
  • start of systole
  • hear the lub @ the mitral best
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12
Q

What is meant by the dub (s2) sound

A
  • closure of the aortic and pulmonic valves (SL valves)
  • end of systole
  • loudest @ base of heart at aortic and pulmonic valve
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13
Q

What kind of sounds will the bell pick up

A

turbulent blood flow or murmurs

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14
Q

If you identify any abnormal sounds, what should you document

What are some of the abnormal sounds mentioned

A
  • note timing in cycle, location, intensity, frequency

- splitting of S2, S3, S4, murmurs, rubs

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15
Q

What is a splitting of S2

A

aortic valve closes earlier than pulmonic valve during inspiration

can be normal < 40 y.o during inspiration (pathologic = more serious than physiologic)

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16
Q

Explain what an S3 (ventricular gallop) is?

What sound would it make?

What would aggravate it?

A
  • occurs when ventricles are resistant in early rapid filling phase
  • happens right after S2
  • Not varying with respiration; persists when sitting upright, increases with isotonic exercise (sit ups)
  • sloshing- in
17
Q

What does an S4 sound mean? When does it occur?

A

means the ventricle is noncompliant

S4 comes before S1

18
Q

What are physiologic (normal) reasons for an S3 sound?

What are pathologic (abnormal) reasons?

A

normal: young adults, children, increased heart rate, late pregnancy
abnormal: older adult, hypertension, volume overload (CHF), mitral regurg, high output states (thyroid, anemia)

19
Q

Why does an S4 (atrial gallop) occur and where?

What sound would it make?

What are some conditions that would cause an S4?

A
  • occurs from resistance in the ventricles when filling at end of diastole
  • “a stiff wall”
  • ischemia (aka new MI), aortic stenosis, pulmonary HTN
  • NEVER naturally occurring
20
Q

What causes murmurs (turbulence)?

A
  • increased flow through normal structures (exercise, hyperthyroid)
  • back or regurgitation flow (incompetent valve, deformity or irregularity)
  • flow through defects in valve (partial obstruction or irregularity)
  • flow into dilated chamber
  • blood viscosity decreases (anemia)
  • shunting into abnormal passages (VSD)
  • calcification of aorta (> age 70)
21
Q

When gathering a history for the peripheral vascular system, what are some important symptoms and questions you may ask?

A
  • smoking
  • leg pain/cramps (burning, aching, cramping, stabbing that is aggravated by walking or activity)
  • intermittent claudication (note distance walked until pain occurs; less distance is worse, or if resting doesn’t help, then the problem is significant)
  • pain worse with limb elevation
  • increased pain at night
  • increased pain with cool temperatures (vasoconstriction)
  • skin color changes (red, violet, blue, pale, brown)
  • skin temp changes
  • skin ulceration r/t blood flow
  • swelling in extremities
  • obesity
  • males: changes in sexual function
  • prolonged stasis: pregnancy, bed rest
  • trauma
  • meds (contraceptives, anticoagulants, aspirin)
22
Q

What are some past medical history disorders that you want to know about for peripheral vascular system

A
  • vascular disorders (thrombophlebitis, varicose veins, hx. of claudication)
  • elevated serum cholesterol or lipids; last test results
  • heart disorders (angina, coronary artery disease, heart attacks, heart surgeries)
  • diabetes, hypertension
23
Q

What are some family history conditions that you want to know about when discussing the peripheral vascular system

A
  • heart disease
  • coagulopathy
  • blood dyscrasias
  • PVD/PAD
  • diabetes
  • hypertension
  • high cholesterol
24
Q

What are some things to look at when inspecting for peripheral vascular system?

A
  • color
  • hair distribution
  • nails
  • size
  • skin lesions or ulcerations
  • edema
  • obvious venous patterns
25
Q

What does bilateral edema in extremities and unilateral edema in extremities mean?

A

bilateral = suggests systemic illness (ex; heart disease) or occlusion in large vessel common to both

unilateral = suggests localized problem

26
Q

How do you calculate the pulse deficit?

what do pulse deficits mean

A

subtract apical from radial - the difference is the pulse deficit

The apical pulse will ALWAYS be higher

pulse deficits can indicate poor contractions (HF or Afib)

27
Q

What temp will the skin be if you have arterial problems?

What temp will the skin be if you have venous problems

A

Arterial: cool, pale

Venous: warm, red, purple, swelling and heat

28
Q

How do you perform the Homan’s test

what does a positive Homan’s Sign suggest?

A
  • flex knee and compress the calf (gastrocnemius) against tibia or dorsiflex foot towards tibia; negative = no pain
  • positive Homan’s sign suggests DVT (35% only); false + with tendonitis, muscle injury, lumbosacral disease. If there is a blood clot, it will instigate pain

Health Assessment (11 decks)

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