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Cardiac (assessment)
Exam 2 - physical assessment
| Question | Answer |
|---|---|
| Where is the PMI located? | Normally found in the 5th interspace 7 – 9 cm lateral to the midsternal line (precise), generally at or just medial to the left midclavicular line |
| What's the normal size of PMI? | Normal PMI may be as large as a quarter, 1-2.5cm |
| PMI > 2.5 cm is evidence of ______ | left ventricular hypertropy or LV enlargement (HTN, aortic stenosis) |
| _____ patients may have the most prominent precordial impulse at a point other than the LV apex | COPDers (may be in xiphoid or epigastric area due to RVH) |
| Where do you listen to assess for split S2? | 2nd left interspace |
| What are the 2 sounds associated with split S2? | Left-sided aortic valve closure, A2. Right-sided pulmonic valve closure, P2. |
| Split S2 is heard during ____ (inspiration/expiration) due to delay in closure of ______ | inspiration, pulmonic valve |
| _____ (stenotic/regurgitant) valves have an abnormally narrowed orifice that obstructs blood flow | stenotic |
| _____ (stenotic/regurgitant) valves fail to fully close, allowing blood to leak backward in a retrograde direction | regurgitant |
| Which murmurs are best heard at and around the cardiac apex? | mitral valve murmurs |
| Which murmurs are best heard at or near the lower left sternal border? | Tricuspid valve murmurs |
| Which murmurs are best heard in the 2nd/3rd interspaces close to the sternum (may also be heard higher or lower)? | Pulmonic valve murmurs |
| Which murmurs are best heard anywhere from the 2nd right interspace to the apex? | Aortic valve murmurs |
| What affect does inspiration have on preload? | Increases |
| What factors influence arterial pressure? | Left ventricular stroke volume; Distensibility of the aorta and the large arteries; Peripheral vascular resistance, particularly at the arteriolar level; and Volume of blood in the arterial system |
| JVP reflects _____ | right atrial pressure (CVP and RVEDP) |
| Jugular venous waveform: what is the "a wave"? When does it occur? | Atrial contraction. Occurs just before S1 in systole |
| Jugular venous waveform: what is the "c wave"? | ventricular contraction when the tricuspid valve bulges |
| Jugular venous waveform: what is the "x wave"? | atrial relaxation |
| Jugular venous waveform: what is the "v wave"? | inflow from the vena cava during ventricular systole will have a 2nd elevation |
| Jugular venous waveform: what is the "y descent"? | ventricular filling when the tricuspid opens & blood passively flows into the right ventricle |
| Unpleasant awareness of heartbeat that can be described as skipping, racing, fluttering, pounding, or stopping is called ______ | palpitations |
| Uncomfortable awareness of breathing inappropriate to a given level of exertion is called ______, and is a common complaint in ____ & _____ patients | dyspnea, cardiac & pulmonary patients |
| Dyspnea that occurs when the patient is lying down and improves when the patient sits up is called ______ | orthopnea |
| Episodes of sudden dyspnea and orthopnea that awaken the patient from sleep is called ______ | Paroxysmal nocturnal dyspnea |
| Can have ___% weight gain before pitting edema occurs | 10% |
| BP classification: what is the BP range in normal BP? | < 120/80 mmHg |
| BP classification: what is the BP range in pre-HTN? | 120-139/80-89 mmHg |
| BP classification: what is the BP range in stage 1 HTN? | 140-159/90-99 mmHg |
| BP classification: what is the BP range in stage 2 HTN? | >160/>100 mmHg |
| BP classification: what is the BP range in patients w/ diabetes or kidney disease? | <130/80 mmHg |
| What is metabolic syndrome? | Cluster of risk factors that create increased risk of CVD and diabetes |
| How high is the HOB during JVP measurement? | 30 degrees |
| What point of the respiratory cycle is JVP measured? | end exhalation |
| What is the distance from sternal angle to center of right atrium? | 4 - 5 cm |
| To calculate JVP, what 2 measurements are added? | Height of the blood column + 5 cm = JVP |
| Is JVP measured in cm H2O or mmHg? | cm H2O |
| Elevated JVP indicates that the patient has _____ (5 diseases) | Acute and chronic left and right heart failure, Tricuspid stenosis, Pulmonary hypertension, Superior vena cava obstruction, & Pericardial disease (ex. tamponade) |
| If JVP is only elevated during exhalation & collapses during inhalation it is due to _____, not heart failure | obstructive lung disease |
| What is the normal carotid pulse upstroke in relation to S1 and S2? | Normal upstroke is brisk, smooth, and follows S1 almost immediately (precedes S2) |
| What type of carotid pulse has a pulse amplitude that varies with respiration? | paradoxical pulse |
| Greater than normal drop in systolic pressure (>10 mmHg) during inspiration is seen with what type of carotid pulse? | paradoxical pulse |
| Which type of carotid pulse is seen with cardiac tamponade, frequently in exacerbations of asthma and COPD, sometimes with constrictive pericarditis? | paradoxical pulse |
| Which type of carotid pulse is described: Rhythm of the pulse remains regular, but the force of the pulse alternates because of alternating strong and weak ventricular contractions? | Pulsus alternans |
| Which type of carotid pulse indicates severe left-sided heart failure? | Pulsus alternans |
| Which type of carotid pulse is usually accompanied by a left-sided S3? | Pulsus alternans |
| Assess the right ventricle by palpating at the ________ | lower left sternal border |
| What is the best position for the patient to be in to assess PMI? | left lateral position |
| What is the duration of PMI? | Normally lasts through the first 2/3 of systole, often less. Should not continue to the second heart sound |
| What is the amplitude of PMI? | brisk, tapping |
Created by:
Thommy413
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