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Dillon Ch 14

Assessing the Cardiovascular System

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