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Dillon Ch 14
Assessing the Cardiovascular System
| Question | Answer |
|---|---|
| Heart sound S1 marks the beginning of | marks the beginning of systole, closing of AV valves (tricuspid and mitral) |
| Where is S1 best heard? | at apex or LLSB (left lateral sternal border) |
| Heart sound S2 marks the end of | marks the end of systole, when the semilunar valves close |
| The split S2 is a normal finding in children, what is it | happens in kids with change in respiration, you can hear each valve (aortic, pulmonic) close separately |
| what are heart murmurs | series of audible, prolonged sounds resulting from turbulence created within vessels |
| murmurs are characterized by | quality---frequency (high/med/low)---intensity (grades 1-6)---duration---configuration---systolic or diastolic ---details pg 449 |
| continuous sounds are heard during both sytole and diastole- name 3 | continuous murmur---venous hum---friction rub |
| what are Korotkoff's sounds | 5 distinct phases of sounds heard when taking bp because cuff partially obstructs blood flow - pg. 453 |
| what is the most common presenting cardiac symptom | chest pain - which may indicate cardiac, respiratory, GI of psychogenic pain |
| what is important to determine when pt presents with chest pain? | determine time of onset---may influence course of tx (admin of thrombolytic agents withint 6 hrs) |
| what are palpitations | when pt has the sense that heart is racing or skipping beats |
| syncope (dizziness) may indicate | may indicate CV problem from decreased cerebral blood flow |
| edema may be seen with | right side heart failure (CHF), vascular disease |
| cardiac assessment can be conducted in 3 positions | supine---sitting---left lateral recumbent |
| it is recommended to assess from the right/left side of pt? | right side of pt to minimize stethescope tube interference |
| What two body stature disorders are associated with cardiac problems | Marfan's syndrome---Klinefelter's syndrome |
| bp > 120/80 may indicate | HTN |
| bp < 100 systolic may indicate | hypovolemia or CHF |
| which are affected by respirations - carotids or jugulars? | jugulars affected by respiratons |
| are carotids affected by position? | no, but jugulars are - normally only visible when client is supine |
| what two cardiac sites can be palpated for pulsation | neck (carotids)and precordium (apex region) |
| We assess the carotid artery for | rate (60-100 bpm)---rhythm (regular, irregular, fluctuating) ---amplitude (0, +1, +2, +3, with +2 normal)---contour---symmetry--elasticity---thrills (abn vibration, check for bruit) |
| if apical impulse not palpable, what should you do | turn pt to left lateral recumbent and try again. ask pt to hold their breath if nec |
| in the neck, we auscultate the carotid and jugular for what | carotid for bruits, jugular for venous hum |
| how is ausculatation intensity graded | Grade 1 (lowest) - Grade 6 (highest) pg. 479 |
| innocent systolic murmurs may be heard in | children, pregnancy |
| where is S1 best heard? | at the apex, while S2 is best heard at the base |
| murmurs above grade 3/6 are usually | usually associated with pathology and are associated with a thrill |
| pts with COPD often have expanded chest wall distance which does what to heart soudns | makes heart sounds more distant |
| what is PMI | point of maximul impulse, best measured at apex |
| if a thrill is felt on palpation, what would you expect to find with auscultation | a murmur |
| an opening snap is | a high pitched sound best heard at apex. Diseased valves allow us to hear them opening as opposed to normal, when we hear them closing |
| what position is best to assess jugular veins | supine - because venous system is a low pressure system |
| what angle of patient's head is best to obtain a JVP (jugular vein pressure) | 30-45 degree angle is best |
| When you palpate the precordium, what are the five areas you palpate? | Apex LLSB Left base Right Base Epigastric |
| What areas do you ausculatate when listening to the heart? | Aortic Area Pulmonic Area Erbs Point Tricuspid Area Mitral Area |
| What changes in blood pressure might you expect from an aging adult? | The systolic blood pressure may gradually decrease due to vascular resistance |
| What is orthostatic hypotension? | A drop in blood pressure with position change. May cause someone to feel dizzy or faint when going from laying down, to sitting, to standing. |
Created by:
MEPN 2013
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