WEEK 8- HEART AND VESSELS

Question 1

where do u auscultate the carotid artery

Answer 1

Location
Angle of jaw, midcervical, base of neck

Question 2

what do u wish to not hear when auscultating

Answer 2

BRUIT

Question 3

what is the positioning for the carotid artery

Answer 3

sitting upright

Question 4

what is the positioning for the precordium

Answer 4

supine with head and chest slightly elevated

Question 5

what is the angle your head should be elevated for the jugular venous pulsations

Answer 5

30-45 degrees

Question 6

whats the acronym for auscultating the carotid arteries

Answer 6

AASURR

Question 7

what does AASURR stand for

Answer 7

A- ask patient to tilt head slightly to one side
A- ask patient to hold breath
S- start at the angle of the jaw, mid neck, and at the base of the neck
U- use the bell of the stethoscope
R- remind the client to breathe
R- repeat on the other side

Question 8

how to inspect external jugular venous pulsations

Answer 8

External jugular veins
Location: Over sternomastoid muscle
Present or full

Question 9

how to inspect internal jugular venous pulsations

Answer 9

Internal jugular pulsation
Location: Suprasternal notch or origin of sternomastoid muscle
Diffuse with two visible waves

Question 10

internal jugular characteristics

Answer 10

lower, undulant diffuse with 2 visible waves.
disappears as person sits up

Question 11

carotid pulse

Answer 11

higher, medial to sternomastoid muscle,
-brisk, localized with one wave
-does not vary with R
-unaffected by position

Question 12

cardiovascular system is made up of 2 things

Answer 12

heart and blood vessels

Question 13

the two types of blood vessels

Answer 13

pulmonary and systematic circulation

Question 14

the heart landmarks

Answer 14

• precordium
• mediastinum

Question 15

layers of the heart

Answer 15

pericardium-outer layer
epicardium
myocardium- muscular layer of the heart
endocardium- innermost layer of the heart

Question 16

what are the 4 valves

Answer 16

atrioventricular
- tricuspid
- mitral/bicuspid

semilunar
- pulmonic
- aorta

Question 17

the 2 types of circulation

Answer 17

systematic and pulmonary

Question 18

what are the 2 phases of the cardiac cycle

Answer 18

systole and diastole

Question 19

diastole

Answer 19

• pressure is greater in atria than ventricles
• av valves open
• ventricles fills

atrial kick
- 25% of stroke volume

Question 20

systole

Answer 20

• ventricular pressure greater than atrial
• AV valves close (sound of S1 “lub”
• all 4 valves closed
• pressure builds in ventricles
• SL valves open and ventricles contract
• ventricular pressure falls below aortic
  (SL valves comes sound of S2 “dup”)

Question 21

what is split t-dup

Answer 21

its because the aortic valve closers earlier than pulmonic
- more to the right heart
- less to the left

Question 22

electrical conduction system is made up of

Answer 22

• the cardiac cycle
• abilities of cardiac muscle cells
• the pathway of the electrical conduction system of the heart

Question 23

what is CO

Answer 23

cardiac output is the amount of blood pumped by ventricles during 1 min.

Question 24

whats the measurement for CO

Answer 24

stroke volume x HR= CO

Question 25

developmental considerations - infant and children

Answer 25

- foramen ovale - ductus arteriosus - position of heart in chest apex higher

Question 26

developmental considerations- pregnant women

Answer 26

- increase in blood volume - increase in stroke volume and cardiac output

Question 27

developmental considerations- older adult

Answer 27

- influence in lifestyle - increase in systolic blood pressure - decreased tolerance

Question 28

socioeconomic factors

Answer 28

- high blood pressure - smoking - serum cholesterol - obesity - diabetes

Question 29

subjective data

Answer 29

- chest pain - dyspnea - orthopnea - cough - fatigue - cyanosis - edema - nocturia - cardiac hx - family cardiac hx - personal habits (cardiac risk factors)

Question 30

landmarking the body (the 3 lines)

Answer 30

- midsternal - midclavicular - anterior axillary line

Question 31

precordium (objective exam) inspect

Answer 31

Inspect the anterior chest- can use tangential light

Question 32

precordium (objective exam) palpation

Answer 32

Palpate the apical impulse and pulsations heaves or lifts due to enlarged ventricle d/t overload

Question 33

precordium (objective exam) 3 sites of palpation

Answer 33

Palpate across the precordium 3 locations At 5th ICS at midclavicular line Left Sternal Border Base of Heart Assessing for Thrills

Question 34

precordium- supine, what are you feeling for?

Answer 34

apex, left sternal border, base - normally no pulsations/thrills felt

Question 35

the apical pulse is only palpable in what % of the population

Answer 35

50%

Question 36

where to auscultate the apical pulse

Answer 36

Landmark 5th ICS at left MCL (same location as the mitral valve) Note rate & rhythm

Question 37

auscultatory location for the tricuspid valve

Answer 37

4TH ICS at L sternal border

Question 38

auscultatory location for mitral valve

Answer 38

5TH ICS at left MCL

Question 39

auscultatory location for aortic valve

Answer 39

2ND ICS at R sternal border

Question 40

auscultatory location for pulmonic valve

Answer 40

2ND ICS at L sternal border

Question 41

DEVELOPMENTAL CONSIDERATIONS

Answer 41

Infants Difference in apical, radial pulses HR 100-180 bpm May be in higher range with crying or other activity Murmurs more common in first days Children Position of apical impulse Venous hum Innocent heart murmurs

Question 42

DEVELOPMENTAL CONSIDERATIONS 2

Answer 42

Pregnant women Changes in BP (varies with position) Heart sound changes from increased blood volume and workload Older adult Orthostatic hypotension

Question 43

Abnormal findings

Answer 43

Abnormal pulsations on the precordium Thrill murmur Aortic stenosis Lift (heave) at the sternal border RV hypertrophy Congenital heart defects Patent ductus arteriosus (PDA) Atrial septal defect (ASD) Ventricular septal defect (VSD) Coarctation of the aorta