Physical Assessment Cardiac/peripheral vascular

Heart extends vertically from....

Heart extends horizontally from...

Upper portion of the heart is called the

Lower portion of the heart is called the..

Anterior chest overlying heart and great vessels is call the

Return blood to right atrium from upper and lower torso

Exits the right ventrical, bifurcates and carries 02 poor blood to the lungs

Return 02 rich blood to the left atrium

transports 02 rich blood from left ventrical to the body

Thin walled chanbers

Receive blood returning to the heart and pump into the ventricles

Thicker-walled chambers

Which ventricle is thicker?

Pump blood out of the heart

Valves between the atria and ventricles

Name the two atrioventricular valves

Separate ventircles from major arteries

Name the two semilunar valves

Direct the flow of blood

Ensure blood only moves in "forward" direction

Valve between the right atrium and right ventricle

Vlave between the left atrium and left ventricle

Separates the left ventricle from the aorta

Separates the right ventricle from the pumonary artery

Achor AV valves to papillary muscles within the ventricles

Ensures that valves do not turn inside out

3 layers of the heart

tough, inextensible, loose-fitting fibroserous sac that attaches to great vessels and surrounds the heart

pericardial fluid secreted by the parietal pericardium and allows for smooth friction-free movement of the heart

Electrical impulse originates in the

Avter electric impulse leaves the SA node, it travels to

SA node normally discharges between how many beats per minute?

After electrical impulse leaves teh AV node, the impulses tranmit to

Results in ventricular contraction

What prevents excessive atrial impulses from reaching the ventricles?

If the SA node fails to dicharge, what heppens?

If SA and AV stop firing, what happens?

Ventricles are relaxed, AV valves are open

high pressure in the ventricles lead to closing of the AV valves....called

first heart shound

End of systole, when the aortic and pulmonic valves close...

Closing of AV and semilunar valves

opening of valves is

S1 is the closing of the AV valves...which valves?

S2 is the closing of what valves?

S1 and S2 normally heard as one sound (separate). But may be heard as 2 if the associated valves close ealier thant he tricuspid. If the aortic valve closes before the pulmonic valve, it's called

Known as diastolic filling sounds or extra filling sounds

Caused by ventricular vibration due to rapid ventricular filling

Heard in early diastole after S2

Known as a ventricular gallp

Sounds like Ken Tuck E

Caused by ventricular vibration but due to ventricular noncompliance during atrial contraction

Blood being forced into stiff ventricles

Heard in late diastole just before the S1

Known as an atrial gallop

Sounds like Ten'nes'see

Can be normal or innocent in many children and some athletes

Caused by CHF, Ischemic heart disease, anemia, restrictive myocardial disease

Can be normal or innocent in childrend and some atheletes

Can be caused by hypertension, CAD, failing left ventricle, Restrictive cardiomyopathy

Quadruple gallop

Cuased by turebulent blood flow, causing swooshing or blowing sounds

Heard over the precordium

Conditions contributing to turbulent blood flow

Valves do not close tightly enough to prevent backlfow

Narrowing, stiffening, thickening, fusion or blockage of one or more of the valves of the heart

vibratory sensation that feels similar to the purring of a cat

a sustained, systolic outward movement of the percordium, associated with heart failure

Most comon heart murmors

Very faint, listener has to be really tuned in; may not be audible in all position...grade this murmur

Quiet, but heard as soon as listener puts stehtoscope on client's chest, grade this mumer

Moderately loud...grade this murmor

Loud with a palpable thrill, grade this murmur

Very loud with thrill, may hera with stethoscope only partly on chest, grade this murmor

Very loud with thrill; may hear w/o stethoscope, grade this murmur

A very faint murmor would be documented as

Amount of blood pumped by the ventricles in a given period of time, usually calculated in one minutes period of time

Determined by stroke volume

CO = SV x HR

Normal adult cardiac output is

Amount of blood pumped from the heart with each contraction

SV from left ventricle is usually

the greater the preload, the greater the

Increased afterload leads to

Uniform, synchronized contraction of the myuocardium

Conditions causing synchronous contractions decrease stroke volume

increased myocardial contractility leads to

Sympathetic and parasympatheic stimulation can impact cardiat output by

Supply neck and head with oxygen and nutrients

Pressure wave closely coincides with S1

Pulse should have a smooth rapid upstroke and more dradual downstroke

Return blood from head and neck to heart by way of the superior vena cave

two set, internal and external veings

assessment is importatn for dtermining hemodynamics of right side of heart

level of jugular venous pressure reflects...

Right sided heart failure causes

Cardiac tamponade

Hypervolemia causes

Chronic constrictuve pericarditis

superior vena cava obstruction causes

Pulmonary embolis causes

Decreased jugular pressure occurs with decreased...

Right internal jugular veingg most directly connected to _________ and provides best assessment for pressure changes

5 traditional areas for auscultating heart sounds

the 4 valve sounds are not heard dirctly over the valvues...they

APETM

can hear systolic blood flwo from left ventricle through aortic valve into the aorta

can hear systolic blood flow from right ventricle through pulmonic valve into main pulmonary artery

2nd ICS at right sternal border

2nds or 3rd ICS at left sternal border (base of heart)

3-5th ICS at left sternal border

4th or 5th ICS at lower sternal border

5th ICS near left MCL (apex of heart)

Can hear aortic and pulmonc sounds

Can hear blood flowing from right atria, through tricuspid valve into the right ventricle during diastole

Can hear blood flow through the mitral valve into the left ventricle during diastole

Causes inflammation of all layers of the heart, which leads to impaired contractility and valvular function

Rheumatic carditis caused by

Dyslipidemia highly predictive of development of?

Which clients hsould monitor their own heart rate or BP?

Genetic predisoption for these diseases

If a client can walk one block or climb 2 flights of stairs without symptoms, usually safe for what?

Can you take nitro before intercourse?

what position may decrease cardiac workload in sexual intercourse?

Inability to breath in a supine position (orthopnea) may indicate

If unable to palpate the apical pulse with a client in semi fowlers postion, ask to turn to

what position to auscletate and palpate neck vessels and inspection, plapation and auusclutation of precordium performed in a.......position

Fully distended jugular veins indicates increased...

abbnormal to see protrusion of jugular vein past _____ elevation

Normal CVP __ CM

Distension, buling or protrusion at 45, 60 or 90 may indicate

Clients with COPD amy have elevated venous pressure only during____

An increase in venous pressure during inspiration (kussmaul's sign) amy occur in client's with

When do you auscultate the cartid arteries?

How do you auscultate for any bruits?

When assesing carotid arteris, always do what prior to palpation?

Normal for arteries to be elastic?

What are bruits indicitive of?

If more than 2/3 occluded may not be able to hear

absent on pulse amplitude scale

normal on pule amplitude scale

bounding on pulse amplitude scale

Pulse inequality may indicate what?

Weak pulses may indicate what?

a boudning firm pulse may indicate what?

Loss of elasticity may indicate

may indicate narrowing of artery

Apical may or may not be vislbe...normal?

pulsations of the precordium may be caused by

heaves or lifts...abnormal?

normal amplitude of the apical pulse should feel like a

May not be able to palpate apical pulse in clintss with

where is S1 loudest?

where is s2 loudest

S1 best heard using

S2 best heard using

Systolic pause between

diastolic pause between

S4 may be heard at the end of diastole in well conditioned athletes and adults older than

Walls are thick and strong, contain elastic fibers which allow them to stretch

Lymph drains into

after being filtered, lumph travels to either the

What drains the right side of the body?

What drains the body except the right side

how is lymp returne dto venous system?

Removes excess fluid left behind in interstial spaces

cold, pale, clammy skin of hte extremities caused by

warm skin and brown pigmentation around ankles is a characteristic of

Cramping in legs is indicitive of

associated with arterial disease

heavy aching sendsation aggravated by standing or sitting and relieved with rest is indicitive of

leg pain that wakes you up

who won't experience classic signs of venous or arterial disease?

May only hav e coldness, color change, numbness and ablnormal sensations

Heriditary but also accur with prolonged standing and pregnancy

ulcers on legs

ulcerns on toes feet and lateral ankles

painless ulcers on medial ankle on lower leg

causes of peripheral edema

Enlarged lymph nodes are indicative of

Estrogen increwases a womens risk for

what is prescribed to increase blood flow

Increases blood flow and reduces tissue hypoxia

Topical medicatio that improves blood flow

Helps prevent venous pooling and increases blood return to the heart

Normal documentation for radial pulse

where to palpate the epitrochlear lymph node

abnormal or normal to not be able to palpate the epitrochlear lymph nodes

hair loss of extremeities is normal or abnormal in older clients?

loss of hair on extremeties is suggestive of what?

smooth, even margins
occur at pressure areas asuch as toes and lateral ankle

irregular edges
bleeding, possible bacterial infection
medial ankle

2mm edema

4mm

6mm

8mm

Non pitting edema seen with

local edema caused by

estemic edema caused by

bilateral coolness of the lower extremeties may be due to

nontender movable lymph nodes up to 1-2 cm, normal or abnormal?

Auscultate femoral pulses if

marked by redness, thickening, tenderness along vein
Aching or cramping may accompany walking,
swelling and inflammation also often noted

Risk factors for DVT