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cardio assess
foundations exam 2
| Question | Answer |
|---|---|
| location of heart | pericardial cavity in the mediastinum under the sternum and between the 2nd and 5th intercostal spaces |
| about 2/3 of the heart lies to the.. | left of the midline of the sternum |
| main functions of the heart | deliver oxygen and nutrients to body cells, circulate wast products so they can be metabolized and/or removed, maintain perfusion to organs and tissues |
| how to start cardiovascular assessment | introduce yourself, explain what you need to do, call patient by last name, provide for safety and privacy, allow patient to tell you things |
| sternal angle or angle of louis | useful landmark to start counting ribs (2nd rib/ 2nd ICS) |
| How to find sternal angle or angle of louis | place fingers at top of sternum or rib cage, move fingers downward until you feel a bony lump |
| Common or concering symptoms when obtaining health history | chest pain or discomfort, pain or discomfort radiating to the neck, left shoulder or arm, and back, arrhythmias: skipped beats, palpitations; dyspnea, cough, edema, nocturia, fatigue, cyanosis, pallor |
| sign is | objectice |
| symptom is | subjective |
| health history assessing cardiac symptoms: chest pain | angina pectoris, coronary artery disease, myocardial infarction, acute coronary syndrome |
| health history assessing cardiac symptoms: palpitations | heart skipping, racing, fluttering, pounding |
| health history assessing cardiac symptoms: shortness of breath | dyspnea, orthopnea, paroxysmal nocturnal dyspnea |
| health history assessing cardiac symptoms: cough | heart failure, fine crackles, and rales |
| health history assessing cardiac symptoms: edema | dependent edema, congestive heart disease, hypoalbuminemia |
| dependent edema | clears at night when patient is supine |
| health history assessing cardiac symptoms: fatigue | signals heart is not adequately supplying oxygen |
| health history assessing cardiac symptoms: cyanosis or pallor | poor oxygenation of body |
| past history to look at when performing cardiovascular assessment | heart problems? heart disease? murmurs? congenital heart disease/defect? rheumatic fever? hypertension? elevated cholesterol or triglycerides? diabetes? |
| family history to look at when performing cardiovascular assessment | coronary artery disease? hypertension? sudden death younger than 60? stroke? diabetes? obesity? |
| lifestyle habits that affect cardiovascular health | nutrition, smoking, alcohol, exercise, medications |
| Where to start cardiovascular assessment | past medical or surgical history (hypertension-high blood pressure? has anyone told you of any heart problems? are you on any medications for you heart?) |
| signs and symptoms needing your attention | pain or discomfort in chest or back? more tired than normal? cough? dizziness or syncope? difficult with breathing? using more pillows at night? why? wake up in middle of night? why? orothopnea or dyspnea when lying down? |
| pain scales | basic morning assessment, may use 1-10, may use 1-10 when patient already said they have pain, patient may nor be able to put a number on the pain-> use wong baker pain scale |
| edema | excess fluid in interstitial tissues |
| 1 liter is equal to (edema) | 1 pound |
| What could edema be? | HF, liver failure, etc or low albumin |
| What is low albumin essential for? | maintaining osmotic pressure (i.e. keeping fluid where it should be) |
| normal albumin level | 3.5-5 g/dl |
| if the reason for edema is heart failure where will fluid accumulate? | in the lungs and periphery |
| Why does fluid accumulate in the lungs and periphery because of heart failure? | if the heart is not pumping well, the hydrostatic pressure exceeds the osmotic pressure, and fluid is not reabsorbed from interstitial spaces as well |
| 3rd spacing | 3 spaces for fluid: in the vessels, in the cells, in-between |
| pitting edema grading scale 1+ | barely there, 2mm |
| pitting edema grading scale 2+ | indentation less than 4mm, still see a contour of the ankle |
| pitting edema grading scale 3+ | indentation greater than 6mm, several seconds- obvious |
| pitting edema grading scale 4+ | indentation greater than 8mm, very marked- minutes |
| dependent edema | wherever gravity takes the fluid; depends on the patient's position in chair or bed |
| edema from cv when pt on bed rest | scrotal edema, sacral edema, dependent edema |
| non pitting edema | disorders of the lymphatic system such as lymphedema, pretibial myexedma, periorbital edema, low albumin, leaking of proteins into tissues, etc |
| lymphedema | a disturbance of the lymphatic circulation that may occur after a radial mastectomy, or it can be congenital |
| pretibial myexedma | swelling over the shins that occurs in some patients with hyperthyroidism |
| what happens when an abnormal amount of protein fluid collected in the tissues of the extremity? | tissue channels increase in size and number, oxygen is reduced through the transport system, a culture medium for bacteria is provided which interferes with healing |
| heart beats (apical pulse) faster than the... | peripheral pulse rate |
| lower radial rate than apical rate | pulse deficit |
| what could cause pulse deficit? | arrythmia/irregular pulse |
| apical pulse-peripheral pulse= | pulse deficit |
| how to report vital sign issues | sbar |
| sbar | situation, background, assessment, recommendation |
| csm | circulation, sensation, movement |
| where to check for dorsalis pedis pulse | top of the foot just lateral to the tendon for the big toe, if not there move laterally and/or up and down a bit |
| What to do if you can't find dorsalis pedis pulse | get doppler |
| how to check capillary refill | press nail for 5 seconds and then release, color should return within 2 seconds (<3 seconds is still normal) |
| causes of prolonged capillary refill time | PVD, hypovolemia, congestive heart failure |
| circulation changes in feet well before... | it changes in the hands |
| When palpating the chest wall use the finger pads to... | palpate for heaves or lifts from abnormal ventricular movements |
| When palpating the chest wall use the ball of the hand to... | palpate for thrills, or turbulence transmitted to the chest wall surface by a damaged heart valve |
| What pulse do you hear with a stethescope? | apical |
| Where should we hear the apical pulse? | over the apex |
| listening to the heart- auscultation | listen in all 4 listening areas for S1 and S2 using the diaphragm and then the bell |
| what does the diaphragm detect? | high pitched sounds like S1, S2, and also S4 and most murmurs |
| What does the bell detect? | low-pitched sounds like S3 and the rumble of mitral stenosis |
| heart sounds aortic and pulmonic spots | lub DUB |
| heart sounds mitral area | LUB dub |
| S1 and S2 | normal heart sounds |
| S3 and S4 | extra heart sounds |
| grading murmurs 1 | the slightest possible murmur, frequently overlooked |
| grading murmurs 2 | slight murmur, should not be missed under optimal conditions |
| grading murmurs 3 | moderate murmur, no palpable thrill |
| grading murmurs 4 | loud murmur with a palpable thrill |
| grading murmurs 5 | very loud murmur with an easily palpable thrill |
| grading murmurs 6 | extremely loud murmur, can be heard with the stethoscope not even touching the chest wall, extremely rare |
| S1 | lub, closure of mitral and tricuspid (atrioventricular valves) |
| where is S1 best heard? | apex |
| S2 | dub, closure of aortic and pulmonic |
| where is S2 best heard? | base |
| Two sets of valves | mitral and tricuspid, aortic and pulmonic |
| S1 is the closure of the atrioventricular valves as... | the ventricular pressures exceed atrial pressures at the beginning of systole |
| Why is S1 normally a single sound? | because mitral and tricuspid valve closure occurs almost simultaneously |
| What is S2 the beginning of? | diastole |
| two phases of the cardiac cycle | diastole and systole |
| What occurs when the heart contracts to pump blood out? | systole |
| What occurs when the heart relaxes after contraction? | diastole |
| S3 | too much blood in atrium (often a sign of heart failure-may be normal in children), ventricle forced to dilate |
| how to hear S3 and S4? | with bell over apex |
| S4 | hear if the ventricle is stiff and noncompliant, as in ventricular hypertrophy due to long-standing hypertension (never normal) |
| what causes murmurs? | valve problems |
| 2 types of valve problems | stenosis and insufficiency |
| stenosis | too tight, obstructing blood flow and you hear the turbulence, valves not opening enough |
| incompetent to regurgitation | valves not closing |
| lab data associated with cv | H and H- hemoglobin, hematocrit |
| hemoglobine | carries O2, 14 plus or minus 2, 16 plus or minus 2 |
| hematocrit | a measure of percentage of total blood volume made up of red blood cells. should be about 40-50 males 42%-52% females 37%-47% |
| low hematocrit | hemodilution, anemia, massive blood loss |
| high hematocrit | hemoconcentration due to blood loss/dehydration |
| normal K+ | 3.5-5 mEq/l |
| what happens when K+ is high or low? | it can kill, usually works with Na- if Na goes up K goes down (ICF) |
| non acute labs (must be fasting) | HDL, cholesterol, LDL |
| HDL | high density lipoproteins, the higher the happier |
| <35 HDL | increased chance CAD |
| >60 HDL | protection from CAD |
| total cholesterol | less than 200 mg/dl, cholesterol/HDL 3:1 ideal |
| LDL | should be less than 100mg/dl |
| troponins I and T elevated | cardiac specific injury |
Created by:
camrynfoster