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226 exam 3
| Question | Answer |
|---|---|
| cardiovascular system consists of | heart and blood vessels, blood vessels-pulmonary circulation (blood travels from heart to the lungs) and systemic circulation (oxygenated blood travels from the heart to the body's tissues and organs, and deoxygenated blood returns to the heart) |
| precordium | area on anterior chest overlying heart and great vessels |
| mediastinum | heart and great vessels are located between lungs in middle third of thoracic cage |
| heart borders | heart extends from second to fifth intercostal space and from right border of sternum to left midclavicular line |
| apical impulse | PMI. palpable in most people, normally 5th intercostal space midclavicular line. heart rotated so that its right side is anterior and left is posterior |
| heart wall | pericardium-tough fibrous, double walled sac that surrounds and protects heart, two layers that contain a few mL of serous pericardial fluid to ensure friction free movement of muscle |
| myocardium | muscular wall of heart, pumps, where heart attacks occur |
| endocardium | thin layer of endothelial tissue that lines inner surface of heart chambers and valves. smooth blood flow |
| heart chambers | right ventricle-greatest area of anterior surface, pumps oxygen poor blood to lungs, left ventricle- behind right ventricle and forms apex. oxygenated blood through body right atrium-deoxygenated blood from body left atrium-receives oxygenated blood fr |
| left atrium- | .oxygenated blood from lungs/pumps to left ventricle |
| superior and inferior vena cava | returns deoxygenated blood to right side of heart |
| pulmonary artery | leaves right ventricle, bifurcates, and carries deoxygenated blood to lungs |
| pulmonary veins | return oxygenated blood to left side of heart and aorta carries to body |
| aorta | ascends from left ventricle, arches back at level of sternal angle. carrying oxygenated blood from the heart to the rest of the body. |
| right side of heart | pumps blood into lungs, and left side of heart simultaneously pumps blood into body |
| atrium | thin walled reservoir for blood |
| ventricle | thick walled, muscular pumping chamber |
| valves are | unidirectional, can only open one way, prevents backflow of blood. open and close passively in response to pressure gradients in blood |
| tricuspid valve | right AV valve. anchored by chordae tendineae. prevents back flow of blood, right ventricular filling, maintain cardiac output |
| bicuspid/mitral valve | left av valve. ensure that blood moves in the proper direction and prevents backflow |
| AV valves | open during hearts filling/diastole to allow ventricles to fill with blood. av valves close during pumping/systole phase |
| pulmonic valve | SL valve in right side, prevents blood in lungs. ensure the unidirectional flow of blood from the heart to the lungs for oxygenation. |
| aortic valve | sl valve in left side of heart, releases flood flow into aorta. regulating blood flow between the heart and the body |
| SL valves | open during pumping/systole, to allow blood to be ejected from heart |
| direction of heart blood flow | deoxygenated blood drains into vena cavas, venous blood empties into right atrium, goes thru tricuspid valve into RV, venous blood flows thru pulmonic valve to pulmonary artery, PA deliver oxygenated blood to lungs |
| lungs oxygenate blood then... | PV return fresh blood to LA, arterial blood travels thru mitral valve to LV. LV ejects blood thru aortic valve into aorta, aorta delivers oxygenated blood to body |
| to pull my arm | tricuspid, pulmonic, mitral, aortic |
| neck vessels | carotid artery-central artery, close to heart, supplying oxygenated blood to the brain and other parts of the head and neck. jugular veins-empty unoxygenated blood into superior vena cava, give info abt right side of heart, reflects volume change |
| systole | LUB. hearts contraction, blood pumed from ventricles fills pulmonary and systemic arteries. 1/3 of cardiac cycle. ventricular pressure is higher than atrial. closure contributes to first heart sound, left side heart |
| diastole | ventricles relax, fill with blood, 2/3 car cycle. opening of normal valve is silent, pressure in atria higher than ventricles. first passive filling phase is protodiastolic filling. atria contract at end and push last blood into ventricles(atrial systole) |
| systole pt 2 | when pressure in ventricle exceeds pressure in aorta, aortic valves open and b;ood is ejected, pressure falls after. when pressure falls, some blood flows backward causing aortic valve to close. closing of semilunar valves causes DUB /end of sytole |
| diastole pt 2 | atria have been filling with blood delieverd from lungs, atrial pressure higher than relaxed ventricular pressure |
| cardiac cycle pressure | pressure in right side of heart are much lower than those of left side bc of less energy needed to pump blood to pulmonary circulation |
| components of heart sounds | in first heart sound (S1), mitral compenent closes just before tricuspid component. and S2-aortic closure occurs slightly before pulmonic closure |
| first heart sound | S1, occurs with closure of AV valves and signals beginning of systole, loudest at apex |
| S2 | closure of aortic and pulmonic valves, end of systole and beginning of diastole, best heard at base |
| split S2 heart sound | when aortic valve closes significantly earlier than pulmonary. second heart sound (S2) is heard as two distinct sounds instead of one |
| murmers | blood circulating through normal cardiac chambers and valves usually make no noise, however, some condtitions acreate turbulent blood flow and collision. gentle, blowing, swooshing sound on chest wall |
| conditions affecting murmur | velocity of blood increases. strictural defects in valves. unusual openings in chambers |
| heart conduction | automatically-heart can contract itself, independent of any signals or stimulation from the body. contracts in response to an electrical current. SA node ells initiate electricl impulse-fires 60-100 bpm |
| SA node | located-junction of SVC and right atrium, primary pacemaker-60-100 bpm, impulse spreads thru atria via internodal tracts. bachmanns bundle-rapid conduction to left atrium |
| AV node | located in right atrium near coronary sinus, delays conduction allows ventricular filling. |
| bundle of his | right side of atrial septum, sole muscular connection between atria and ventricles. intrinsic rate-40-60 bpm |
| purkinje fibers | fastest conduction system, backup pacemaker-20-40 bpm |
| conduction sequence | first across to atria to AV node low in atrial septum. there it is delayed slightly so that atria have time to contract before ventricles are stimulated. impulse travels to bundle of his, right and left bundle branches, ventrcles |
| in resting adult heart normally pumps | between 4 and 6 L of blood per minute. this cardiac output equals number of bpm x volume of blood in each systole |
| heart wall and valves | no valves are present between vena cava and right atrium therefore abnormally high pressure in right side of heart shows in neck veins/abdomen. |
| between pulmonary veins and left atrium | abnormally high pressure in left side of heart gives a person symptoms of pulmonary congestion |
| pregnant women | -blood volume decreases by 30 to 40% -most rapid expansion occurs during second trimester -creates an increase in stroke volume and cardiac output and incr. pulse rate of 10-15 bpm -bp drops lowest during second trimester |
| aging adult | hemodynamic changes, isolated systolic hypertension, increased pulse pressure, size of heart doesnt increase, but left ventricular wall thickness increases, hr and co show no changes with age |
| dysrhythmias | increases with age. improper beating of heart. ex-atrium flutters and ventricles speed up |
| CAD | buildup of plaque in heart vessels, increases with age and half of deaths in older people |
| cardiovascular disease | most common underlying cause of death globally. causes-genetics, environmental, and lifestyle factors |
| high bp | systolic bp greater than or equal to 140. diastolic greater or equal to 90. 2-3x more common in women taking oral contraceptives |
| serum cholesterol | ultimate artery clogger, high levels of low density lipoprotein gradually add to lipid cc arteries. low density lipoprotein=BAD=plaque. CAD=death |
| leading cause of death in women | CVD |
| chest pain | symptoms-sweating, ashen gray or pale skin, heart skipping a beat, shortness of breath, nausea. anginal pan gets better with rest. |
| evaluating carotid arteries | person can be sitting, but supine with head elevated when assessing jugular veins (assess pressure in right side of heart/efficiency of pumping) |
| bruits | blowing swishing sound indicating blood flow turbulence |
| precordium | inspect anterior chest. apical pulse-pulsation created as left ventricle rotates against chest wall during systole, when visible it occupies the 4th or 5th intercoastal space midclavicular line |
| palpating precordium | palpate across. use four fingers with palmar aspect and gently palpate. percuss-used to outline hearts borders |
| precordium auscultation | 4 valve areas. sound radiates with blood flow direction. listen selectively at one sound at a timebegin with diaphragm |
| valve areas | aortic-only on on left. second right intercostal space pulmonic valve-second left interspace tricuspid valve-left lower sternal border mitral valve-fifth intercostal space at around left midclavicular mline |
| pregnant women heart sounds | palpation of apical pulse-higher and lateral compared with normal position. exagerated splitting of s1 and increased loudness of S1. systolic murmer in 90% soft diastole murmur heard in 19% |
| thrill | palapable vibration-turbulent blood flow |
| lift/heave | forceful thrusting of the ventricle during systole. commonly seen in LVH patients |
| stenosis | valvular defect. a narrowing of the heart valves, which are flaps that control the flow of blood through the heart |
| regurgitation | valve doesnt close properly |
| arteries main function | high speed, oxygenated blood away from the heart. high pressure system, strong, tense with elastic fibers to allow stretch and recoil. arterial flow must haves-efficient heart beat, open lumen, walls stretch on systole and recoil of diastole |
| veins | slower. parallel to arteries. absorb CO2 and waste and carry back to heart. low pressure system. thinner walls=more blood volume |
| venous flow must have | open lumen, contracting of skeletal muscle, intraluminal valves, pressure gradient from breathing, thoracic pressure decreases |
| lymphatics | conserves fluid and plasma proteins that leak out capillaries, major part of immune syste,. can asses in cervical, xillary, linguinal, and epitrochlear |
| lymphatic flow | right lymphatic duct. drains into right side of head and neck, right arm, right thorax, right lung, right side of heart, right upper liver and empties into right subclavia vein. thoracic duct-drains the rst of the body and emptes into left subclavian vein |
| lymph nodes | small, oval clumps of lymphatic tissue, filters out microorganisms, b and t lymphocytes mount immune reponse |
| spleen | destroy old rbc, produce antibodies, store rbc, filter kicroorganisms |
| tonsils | palantine, pharyngeal, and lingual. respond to local inflammation in resp and gi tract |
| thymus | develop T lymphocytes in children, help mature B lymphocytes |
| pregnant women hormonal changes | causes vasodilation, drop in bp, growing uterus obstructs iliac vein and inferior vena cava. incr. venous pressure. dependent edema, varicosities, and hemorrhoids |
| aging adult vessels grow | rigid=arteriosclerosis. incr. systolic BP. enlargemnt of calf veins, loss of lymph tissue |
| inspecting arms | symmetry, color of skin and nail beds, lesions, edema, clubbing. palpate temp, texture, turgor |
| if suspect an arterial problem | raise legs 30 cm, have pt. wag feet for 30 seconds. normal color-pale but still pink, abnormal- elevational pallor, then have patient dangle legs, compare color, not time for color to return to feet-normal 10 sec or less |
| aerterial insufficiency | Dependent rubor is a reddish discoloration of the skin that occurs when a limb is lowered below the level of the heart delayed venous filling |
| doppler probe | magnifies pulsatile sounds from heart/blood vessels, person is supine |
| ankle brachial index | doppler pulse, inflate 20 mmHg above dissapearnce, systolic pressure, right side then left side |
| arterial occlusions | arterial skin/nail changes, weak pulses, intermittent claudation, arterial ulcer, dry, no blood flow |
| peripheral arterial disease | strongly familial. ris factors-smoking, DM, HTN, incr cholestreol, obesity. african americans 2x greater than whites |
| aneurysms | arterial skin/nail changes, weak pulses, thrill, bruit. an excessive localized enlargement of an artery caused by a weakening of the artery wall. |
| raymaud phenomenon | blood vessels overreact to cold or stress, impairs blood flow |
| chronic arterial | intermittent cramping, tingling, cold, chronic, calf, loer leg, dorsum foot, pain after activity relieved with rest, cool pale skn, thick toenails, atrophied muscle, shiny thin dry skin, necrotic ulcers |
| chronic venous | aching, fullness, chronic, calf lower leg, chronic, pain incr at end of day, worse with sitting/standing, better with elevation or walking, edema, varicose veins, brown skiin, warm, weeping ulcers at ankles |
| A third heart sound (or S3) | due to the vibration of ventricles that resist early, rapid filling |
| A fourth heart sound (or S4) | due to the vibration of noncompliant ventricles when the atria contract and push blood into them |
| The cardiac impulse originates in the | sinoatrial node and spreads through the atria and to the atrioventricular node, where it is delayed. Then the impulse travels to the bundle of His, the right and left bundle branches, and then to the ventricle |
| ventral abdominal | 4 layers of large, flat muscles, protective |
| mesenteries | double layer of parietal peritoneum, track of lymph tissues and nerves |
| solid viscera | like the liver and kidneys, are dense organs with primarily metabolic functions. dont have fluctuation of air fluid |
| hollow viscera | such as the stomach and intestines, are tubular structures with lumens that store and transport substances |
| abdomen aging adult | fat redistributed to abdomen and hips, salivation decreases, delayed esophageal emptying, incr risk of gallstones, liver decr by 25%, 12-19% report constipation, dysphagia |
| lactase | digestive enzyme necessary for absorption of carbohydrate lactose, high in blacks and native americans |
| visceral abdominal pain | internal organ, generalized, dull |
| parietal abdominal pain | peritoneal inflammation, localized, sharp |
| liver pain | RUQ |
| esophagus pain | behind lower sternum |
| ulcer | shoulder |
| gallbladder | RUQ |
| appendix | RLQ |
| pancreas | midscapular |
| kidney | flank pain |
| small intestine pain | diffuse |
| colon | colicky pain and bloating |
| hematemesis | the vomiting of blood, or vomit that resembles coffee grounds, originating from the upper gastrointestinal (GI) tract and requiring immediate medical attention |
| vomiting center is in | brain |
| melena | black tarry stool |
| order for abdomen | inspect, auscultate, percuss, palpate |
| touching abdomen | increases peristalsis |
| types of contours | flat, scaphoid (goes in), rounded protuberant (rlly big) |
| symmetric abdominal distension | obesity, air/gas, ascites-taunt skin, bulging flanks, everted umbilicus, pregnancy |
| asymmetric abdominal distention | feces, tumor |
| hernias | protrusion of abdominal viscera thru abdominal muscle wall. |
| stride | common skin change, silvery white, linear, jagged marks |
| what may be seen in thin people | aorta pulsations in epigastric or peristalsis wave |
| normal bowel sounds | high pitched, gurgling, cascading sounds at irregular intervals (5-30) times per min, normoactive |
| hyperactive bowel sounds | loud, high pitched, rushing, tinkling sounds. borborygmus (hyperperistalsis, stomach growling) |
| hypoactive bowel sounds | decreased frequency of sounds |
| auscultate technique bowel sounds | diaphragm not too firm, start RLQ, listen for 5 min before saying no bowel sounds |
| auscultating vascular sounds | firmer pressure with diaphragm, use bell for vascular sounds |
| percuss bowels | 3 areas in each quadrant, normal-predominant tympany |
| percussing costovertebral angle tenderness | place hand over 12th rib, thump hand with fist |
| palpating abdomen | first 4 fingers, rotary motion, light palpation-1cm, deep palpation-5-8 cm, lift fingers and move clockwise, overall impression of skin, not organs, painful areas last, mild tenderness over sigmoid colon |
| use what for obese | bimanual technique, involves the simultaneous use of both hands to perform a task |
| abnormal abdomen | reliable sign of peritoneal inflammation, rebound tenderness. tenderness .5-2 in from ileum in RLQ often associated with inflammation of appendix-Mcburneys point |
| palpating organs | position self on right side, left hand lifting up behind 11 and 12 ribs, right hand push deeply under right costal margin, deep breath, feel edge of liver bump, if they have pain and cant breathe they have positive murphys sign indicating large gallbladde |
| enlarged liver | hepatomegaly |
| palpating spleen | not palpable unless 3x normal size, left hand pushing up behind 11 and 12 rib,palpate wt right hand, nothing firm |
| enlarged spleen | splenomegaly |
| palpating kidneys | duck bill-bimanual deep palpation in flanks, left hand pushes upward, right had palpates deeply upon inspiration, left kidney 1 cm higher |
| palpating aorta | finger/thumb palpates pulse, slightly left of midline, note width normal-2.5-4 cm wide |
| musculoskeletal function | support, movement, protection, production, storage |
| bones | hard, rigid, dense connective tissue that continually turn over and remodel |
| joints | location where two or more ones meet, functional unit |
| fibrous joints | fibrous tissue, immovable |
| cartilaginous joints | fibrocartilaginous discs, slightly moveanle |
| synovial joints | enclosed joint cavity of cartilage and synovial fluid, freely moveable |
| ligaments | fibrous bands that connect bone to bone and strangthen joints |
| bursa | enclosed sac with synovial fluid located in areas of potential friction |
| skeletal muscle | bundle of muscle fibers that contract to produce movement |
| tendon | fibrous cord that attaches muscle to bone |
| flexion | creates small angle |
| circumduction | a circular, cone-shaped movement of a limb or body part formed by the sequential combination of flexion, extension, abduction, and adduction |
| protraction | a movement in which a body part moves forward or away from the midline of the body |
| epiphyses | growth plate, last closure at around 20 years old |
| pregnant women musculoskeletal | increased laxity of ligaments of joints, progressive lordosis, anteriror flexioon of neck and slumping of shoulders |
| osteoporosis | not normal, but common with aging |
| rheumatoid arthritis | inflammation, body attacking itself, movement helps pain, symmetric, attacks all joints, autoimmune |
| osteoarthritis | one joint, not very long, a common joint disease that causes pain, stiffness, and loss of mobility. It occurs when the cartilage that cushions the ends of bones wears down over time |
| knee is only stabilized by | ligaments |
| a screening exam | insepct and palpate joints integrated with each bidy region, observation of rom during gait, posture, sitting in chair, age specific screenings |
| a complete exam | articular disease, MS symptoms, or adl probles |
| synovial membrane normally | not palpable |
| 0/5 | no muscle contraction |
| 1/5 | no ROM, little muscle contraction |
| 2/5 | cannot do active ROM |
| 3/5 | okay with gravity |
| 4/5 | had to take a liittle resistanc off |
| 5/5 | normal |
| TMJ | vertical movement, protraction and retraction, lateral movement. 2 finger tips over joint, tests CN 5 |
| vertebral discs and joints | flexion, extension, abduction or lateral bending, rotation |
| cervical spine ROM | flexion-chin to chest hyperextension-lift chin toward ceiling lateral bending-touch ear to shoulder rotation-touch chin to shoulder. tests CN 11 |
| spine rom | flexion-bend torward-alignment lateral bending-bend sideways hyperextensiono-bend backward rotation-twist shoulders while nurse holds pelvis |
| shoulder | can do most things. glenohumeral joint-flexion, extension, abduction, adduction, internal and external rotation, subacromial bursa |
| rotator cuff | supraspinatus, infraspinatus, teres minor, subscapularis. landmarks-acromion process greater tubercle, coracoid process |
| shoulder | flexion and extension-arms at side and elbows extended move both arms forward then back, abduction/adduction-with arms at sides and elbows extended raise arms in coronal pane, touch palms, internal rotation-rotate arms internally behind back as high as p |
| shoulder rom | tests CN 11, muscle strength-elevate shoulders flex forward, abduct all against resistance |
| elbow | joints-humerus, radius, ulna. flexion/extension-biceps and brachioradialis and triceps and brachialis. olecron bursa. landmarks-medial and lateral epicondyles. radioulnar joint-pronation and supination |
| olecranon bursitis | an inflammation of the bursa, a fluid-filled sac located at the tip of the elbow |
| wrist and carpals | radiocarpal joint-distal radius and 8 carpal bones, flexion, extension, and lateral movements. midcarpal jpint-between 2 rows of carpal bones |
| palpating wrist and hand | use 2 thumbs on dorsum to palpate wrist joints. palpate IPs using thumb and index fingers |
| wrist and hand rom | flexion/extension-bend hand up, bend hand down at wrist, bend fingers up and down at mcp, radial/ulnar deviation-move palm outward and in abduction/adduction-spread fingers apart and make fist |
| bouchard nodes | bony enlargements that develop on the middle joints (proximal interphalangeal joints) of the fingers. |
| heberden nodes | bony lumps or outgrowths that appear on the finger joints closest to the fingertips, known as the distal interphalangeal (DIP) joints |
| deformities of rheumatoid arthritis | swan neck and boutonniere, ulnar deviation |
| hip | joint-acetabulum/head of femur. flexion, extension, abduction, adduction, internal/external rotation. |
| hip muscles | anterior flexor, posterior extensorm adductor and abductor muscle. 3 bursa, landmarks-anterior superior illiac spine, illiac crest, ischial tuberosity |
| hip ROM | flexion/extension-raise each leg with knee extended. bend each knee up to the chest with other leg straight. internal/external rotation-flex knee and hip up to 90 degrees then swing foot inward then outward. abduction/ad-swing leg lateral then medial. |
| hip rom continued | hyperextension-standing, swing leg straight back |
| knee | joint-femur, tibia, patella. flexion/extension, largest joint and bursa. cruciate ligaments-criscross within knee. collateral ligaments-medial/lateral stability |
| knee landmarks | quadriceps muscle merge into one tendon that encloses oateella extending down medial and lateral epicondyles of tibia and fmeur |
| palpating knee | supine or wt knees flexed/dangling. start high on anterior thigh, use thumb and fingers in grasping fashion. palpate tibiofemoral joint, check for crepitus |
| knee ROM | flexion/extension-bend each knee then straighten each knee. check knee during ambulation. muscle strength-flexion/extension agaiinst resistance with hand on lowe leg/ankle |
| osgood-schlatter disease | a painful condition that affects the growth plate (epiphysis) below the kneecap (patella). It is caused by repetitive stress on the patellar tendon, which pulls on the growth plate |
| mild joint effusion | excessive accumulation of fluid within a joint cavity. It is a common condition that can affect any joint, but is most frequently seen in the knee. |
| ankle and foot | tibiotalar joint, tibia, fibula, talus-flexion (dorsiflexion), extension-plantar flexion) landmarks-medial malleolus, lateral malleolus, calcaneous |
| palpating ankle and foot | weight bearin should fall in middle of foot from heel to 2nd/3rd toes. palpate wt 2 thumbs over joint spaces, palpate MTP joints. palpate IPs in htumb and fingers. |
| ankle and foot ROM | plantar lfexion/dorsiflexion-point toes toward floor then toward nose. eversion/inversion-turn soles of feet out then in. flexion/extension-flex then straighten toes |
| ankle and foot muscle strength tests | dorsiflexion and plantar flexion against resistance |
| gout | a form of inflammatory arthritis caused by the accumulation of uric acid crystals in the joints |
| hallux valgus | a common foot deformity where the big toe deviates towards the other toes, forming a prominent bump (bunion) on the inside of the foot. |
| hammertoes | a deformity of the toes where the middle joint of the toe bends upwards, resembling a hammer |
| The metatarsophalangeal (MTP) joint | connects the bones of the foot (metatarsals) to the first bones of the toe (proximal phalanges). |
| interphalangeal (IP) joints are | located between the bones of the toes themselves (phalanges), with proximal interphalangeal (PIP) joints between the first and second phalanges and distal interphalangeal (DIP) joints between the second and third phalanges. |
Created by:
cwehner125