Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
FON exam 2
cardiovascular assessment
| Question | Answer |
|---|---|
| location of the heart | lies in the pericardial cavity in the mediastinum under the sternum and between the 2nd and 5th intercostal spaces |
| 2/3 of the heart lies | to the left of the midline of the sternum |
| anatomy of the heart | hollow muscular organ a little larger than your fist |
| main functions of the heart | deliver oxygen and nutrients to body cells, circulate waste products so they can be metabolized and/or removed, maintain perfusion to organs and tissues |
| how to start CV assessment | intro yourself, explain what you need to do, call pt by last name, provide safety and privacy, allow pt to tell you things |
| anterior | front of body |
| posterior | back of body |
| medial | toward the midline of the body |
| lateral | describes something that is further away from the midline than something else |
| intermediate | between two structures |
| inferior | means away from the head, or lower/under |
| superior | means toward the head of the body, or higher/above |
| sternal angle or angle of louis | useful landmark to start counting ribs (2nd rib/2nd ICS) |
| common or concerning symptoms: health Hx | 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 | objective |
| symptom is | subjective |
| assessing cardiac symptoms: chest pain | angina pectoris, coronary artery disease, MI, acute coronary syndrome |
| assessing cardiac symptoms: palpitations | heart skipping, racing, fluttering, pounding |
| assessing cardiac symptoms: SOB | dyspnea, orthopnea, paroxsymal nocturnal dyspnea |
| assessing cardiac symptoms: cough | heart failure, fine crackles and rales |
| assessing cardiac symptoms: edema | dependent edema, congestive heart disease, hypoalbuminemia |
| assessing cardiac symptoms: dependent edema | clears at night when pt is supine |
| assessing cardiac symptoms: fatigue | signals heart is not adequately supplying oxygen |
| assessing cardiac symptoms: cyanosis or pallor | poor oxygenation of body |
| past hx | Heart problems? Heart disease? Murmurs? Congenital heart disease/defect? Rheumatic fever? Hypertension? Elevated cholesterol or triglycerides? Diabetes? |
| family hx | coronary artery disease? HTN? sudden death younger than 60? stroke? diabetes? obesity? |
| lifestyle habits | nutrition (typical diet) smoking alcohol exercise medications: prescribed and over the counter drugs |
| where to start? | Past medical or surgical history is a good place to start assessment. Hypertension-High blood pressure? Has anyone told you of any heart problems? Are you on any medicines for your heart? |
| S & S needing your attention | pain or discomfort in your chest or back? more tired than normal recently? noticed a cough? dizziness or syncope? difficulty with breathing? are you using more pillows at night? why? wake in the middle of the night? Why? |
| orthopnea | dyspnea when lying down - 2 pillow, 3 pillow orthopnea, or sleeps in chair |
| PND | paroxysmal nocturnal dyspnea |
| if they have pain, remember to ask: | where? what does it feel like? does it move or radiate anywhere else? when did it start? pain scale have you had this before? associated symptoms? |
| remember every pt is different! | report pain differently, BUT recent report indicated that about 90% of people report some amount of chest pain if they are having an MI |
| pain scales | basic morning assessment, may use 0-10 may use 1-10 when pt already stated they have pain pt may not be able to put a number on the pain |
| if numeric pain scale is not working | use wong-baker pain scale (faces) |
| physical assessment: edema | any swelling? |
| edema | excess fluid in interstitial tissue rings or shoes too tight? |
| what could edema be from | heart failure, liver failure, low albumin which is essential for maintaining osmotic pressure (keeps fluid where is should be) |
| normal albumin level | 3.5-5 g/dL |
| causes of edema | excessive retention of water and Na |
| if the heart is not pumping well... | the hydrostatic pressure exceeds the osmotic pressure and fluid is nor reabsorbed from interstitial spaces as well |
| 3rd spacing = | 3 spaces for fluid: in the vessels, in the cells, in between (3rd space) |
| pitting edema grading scale | 1+, 2+, 3+, 4+ when charting in the hospital, look for the organizational description for edema |
| 1+ | barely there (2mm) |
| 2+ | indentation less than 4mm , still see contour of ankle |
| 3+ | indentation greater than 6mm, several seconds - obvious |
| 4+ | indentation greater than 8mm, very marked - minutes |
| edema from CV - not only in legs, what if pt is on bed rest? | scrotal edema, sacral edema, DEPENDENT EDEMA (wherever gravity takes the fluid) |
| non-pitting edema | usually not CV but still assess |
| non-pitting edema examples | disorders of the lymphatic system such as lymphedema, pretibial myxedema, periorbital edema, low albumin/leaking of proteins into tissue |
| disorders of the lymphatic system such as lymphedema | a disturbance of the lymphatic circulation that may occur after a radial mastectomy or it can be congenital |
| pretibial myxedema | swelling over the shins that occurs in some pts with hyperthyroidism |
| an abnormal amount of protein fluid collects in the tissues of the extremity | stagnant, protein rich fluid causes tissue channels to increase in size and number, reduces oxygen through the transport system, provides a culture medium for bacteria interferes with healing |
| physical assessment: VS and pulses | add more detail to your VS assessment - rate, rhythm, regular or irregular |
| what is the apical pulse and radial pulse rates are different | heart beats (apical rate) faster than the peripheral pulse rate |
| lower radial pulse than apical rate = | pulse deficit, caused by arrhythmia/irreg pulse |
| apical pulse-peripheral pulse = | pulse deficit |
| report VS issues using | SBAR - situation, background, assessment, recommendation |
| dorsalis pedis pulse | check the 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 if still not there, get a doppler |
| when checking dorsalis pedis pulse, might as well check | posterior tibial |
| doppler to find pulses | if not able to find, check equipment, more gel, ask for help |
| capillary refill | this shows checking on the fingers, circulation changes in the feet well before it changes in the hands |
| <2 seconds | best |
| <3 seconds | still considered normal |
| palpating the chest wall (not always done) | using the finger pads, palpate for heaves or lifts from abnormal ventricular movements using ball of hand, palpate for thrills or turbulence transmitted to the chest wall surface by a damaged heart valve |
| where to palpate the chest | aortic, pulmonic, left parasternal, and apical areas |
| apical pulse | one you hear with a stethoscope, technically should be over apex of heart but should at least be on the chest |
| listening to the heart: auscultation | listen in all four areas for S1 and S2 using the diaphragm of the stethoscope, then listen with bell |
| diaphragm is best used for | detecting high-pitched sounds like S1 and S3 and also S4 and murmurs |
| bell is best used for | low-pitched sounds like S3 and the rumble of mitral stenosis |
| S1 and S2 | normal heart beat sounds |
| S1 sound | LUB, closure of the mitral and tricuspid valves at the start of systole |
| S2 sound | DUB, closure of the aortic and pulmonary valves at the end of systole |
| S3 and S4 | extra heart sounds |
| sound of murmur | longer |
| grading murmurs | 1-6 |
| 1 | slightest possible murmur, frequently overlooked |
| 2 | slight murmur, should not be missed under optimal conditions |
| 3 | moderate murmur, no palpable thrill |
| 4 | loud murmur with a palpable thrill |
| 5 | very loud murmur with an easily palpable thrill |
| 6 | extremely loud murmur, can be heard with a stethoscope not even touching the chest wall, EXTREMELY RARE |
| blood flow through hear | RA, RV, pulmonary artery, lungs, LA, LV, aorta |
| valves | mitral and tricuspid valves are a set, aortic and pulmonic valves are a set, WORK AS PAIRS! |
| S1 is the closure of | the atrioventricular valves as the ventricular pressures exceed atrial pressures at the **beginning of systole** |
| S1 is normally | a single sounds because mitral and tricuspid valve close occurs almost simultaneously |
| S2 is | beginning of diastole |
| diastole and systole are | the two phases of the cardiac cycle |
| when do diastole and systole occur | as the heart beats, pumping blood through a system of blood vessels that carry blood to every part of the bod |
| systole occurs when | the heart contracts to pump blood out |
| diastole occurs when | the heart relaxes after contraction |
| S3 is when there is | too much blood in the atrium, ventricle is forced to dilate |
| S3 can be heard with | bell over the apex |
| S3 heard in someone over 40 | pathologic |
| S3 sounds like | sloshing |
| S4 happen if | the ventricle is stiff and non-compliant, as in ventricular hypertrophy due to long standing hypertension |
| S4 can be heard with | bell at the apex |
| is S4 ever normal | no! |
| S4 can be remembered as | a stiff wall |
| stenosed stenotic stenosis | too tight, too small, obstructing blood flow and you hear the turbulence, valves not opening enough |
| incompetent to regurgitation | valves not closing |
| JVD | jugular venous distention |
| laboratory data associated with CV | hemoglobin (Hb, Hgb) 14 plus minus 2 16 plus of minus 2 |
| H and H | hemoglobin and hematocrit |
| lab assessment tools: hematocrit | HCT, a measure of percentage of total blood volume made up of RBCs |
| normal HCT | should be about 40-50, males 42-52% and females 37-47% |
| low HCT | hemodilution, anemia, massive blood loods |
| high HCT | hemoconcentration due to blood loss/dehydration |
| lab assessment tools electrolytes | normal K+ = 3.5-5 mEq/L |
| high or low K+ | can kill |
| K+ usually works with | Na, if Na goes up, K goes down |
| non acute labs = risk assessment | HDL, the higher the happier |
| <35 HDL | increased chance of CAD |
| >60 HDL | protection from CAD |
| total cholesterol | less than 200 mg/dL |
| ideal cholesterol to HDL ratio | 3:1 |
| LDL should be | less than 100 mg/dL |
| EKG monitoring is | another tool for assessment |
Created by:
leh195