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Health Assessment
Cardiovascular system
116
Nursing
10/03/2012

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Term
Bradycardia
Definition
a condition in which the heart rate is less than 60 beats per minute
Term
Bruit
Definition
and abnormal swishing/blowing sound or murmur heard while auscultating the carotid artery, the aorta, an organ, or gland, could result from blood flowing through a narrow or particularly occluded passageway
Term
capillary refill
Definition
a test of blood circulation in the fingers or toes. Pressure is applied to a fingernail or toe nail until normal color is lost. The pressure is then removed and if the circulation is normal, color should return almost immmediatly, within about 2 seconds. The time maybe prolonged due to dehydration, hypothermia, or compromise of circulation
Term
diastole
Definition
The period between the contractions of the atria and the ventricles during which blood enters the relaxed chambers from the systematic circulation of the lungs. Venticular systole begins with the 2nd sound of the heart and ends with the 1st heart sound
Term
edema
Definition
the abnormal accumulation of fluid in the interstitial spaces of tissues.Producing swelling.
Term
ejection click
Definition
a sharp, clicking sound arising from near the heart, could result from forceful openings of the semi-lunar valves due to stenosis normally the opening of the semi-lunar valves is quiet
Term
heaves/lifts
Definition
is a sustained forceful thrusting of the ventricle during systole.It could be a result of increased workload with ventricular hypertrophy
Term
Homan's sign
Definition
pain in the calf with dorsiflexion of the foot, indicating thrombosis
Term
murmur
Definition
a gentle blowing, or swishing sound that can be heard on the chest wall when blood circulates through the cardiac chamber.Relatively prolonged extra sounds heard during systole or diastole. Imagine a sharp turn or rocks in a stream creates a noisy water flow.
Term
opening snap
Definition
Normally the opening of the AV valves is silent . In the presence of stenosis, increasingly higher atrial pressure is required to open the valve. The deformed valve opens with a noise: the opening snap. It is sharp and high pitched with a snapping quality.
Term
Orthopnea
Definition
difficulty breathing laying down, person must assume a more upright position to breath
Term
palpations
Definition
a technique used in a physical exam in which the examiner feels the texture, size, location, and consistancy of certain body parts with their hand
Term
paroxysmal nocturnal dyspnea
Definition
a disorder that is characterized by sudden attacks of respiratory distress that awaken the person, usually after several hours of sleep in a reclining position. This occurs because of an increase fluid central circulation with reclining position.
Term
pericardial friction rub
Definition
rubbing together of inflammed membranes of the pariocardium, as may occur in the pericarditis or after a myocardial infarction, grating sound
Term
precordium
Definition
part of the chest wall that overlays the heart and extends down to the epigastrium ( upper middle gastric area
Term
PMI
Definition
point of maximum impulse-place where the apical pulse is palpated as strongest, often in the 5th intercoastal space, just medial to the left midclavicular line
Term
pulse pressure
Definition
difference between systolic and dystolic BP, normally 30-50 mmHg
Term
pulse deficit
Definition
condition in which a peripheral pulse rate is less than the venticular contraction rate as auscultated at the apex of the heart or seen on an EKG, indicates a lack of peripheral perfussion
Term
S1
Definition
first hard sound in the cardiac cycle, onset of the ventricular systole, closure of the mitral and tricuspid valve, synchronous with the apical pulse, lubb , longer, lower
Term
S2
Definition
second heart sound in the cardiac cycle, closure of the aortic and pulmonary valves, onset of ventricular dystole; second sound louder and shorter than the first
Term
S3
Definition
third sound in the cardiac cycle; normally audible only in children and physically active yound adults, disappears with age; abnormal in adults indicates myocardial failure, weak, low-pitch, dull
Term
S4
Definition
fourth heart sound in cardiac cycle, late in dystole on contraction of the atria; abnormal to hear indicates increased resistance to ventricular filling, as in hypertensive cadiovascular disease,coronary artery disease
Term
sinus arrythmia
Definition
irregular cardiac rythm in which the heart rate usually increases during inspiration and decreases during expiration, common in children and young adults, only significant in elderly
Term
systole
Definition
contraction of the heart, driving blood into pulmonary artery and aorta
Term
tachycardia
Definition
condition in which the heart contracts at a rate greater that 100 beats/ min
Term
thrill
Definition
fine vibrations felt by an examiners hand on a patients body over the site of an anerysm or on the precordium, resulting from turmoil in the flow of blood and indicating the presence of organic murmur of grade 4 or greater intensity
Term
venous hum
Definition
continuous murmur heard on auscultation over the major veins at the base of the neck and around the umbilicus; most audible in neck when patient is anemic, upright and looking contralaterally, also heard in some healthy, young people
Term
list characteristics of a chest pain
Definition
* Angina, an important cardia symptom occurs when the hearts own blood supply cannot keep of the medabolic demand. "clench fist"
-Cardiac
Aortic
Musculoskeletal
Pleural
Gastrointestinal
Pulmonary
Psychoneurotic
NOTE: Chest pain in children and adolescents is seldom due to a cardiac problem.
Term
elicit a focused health history from a person with chest pains
Definition
- any chest pain or tightness
ONSET:
when did it start?How long have you had it this time?Had this type of pain before?how often?
LOCATION:
where did the pain start? does the pain radiate to any other spot?
CHARACTER:
How would you describe it? crushing, stabbing,burning? note if they clench their fist
PAIN BROUGHT ON BY:
activity-rest, emotional upset, after eating, during sexual intercoarse; with cold weather?
ANY ASSOCIATED SYMPTOMS:
sweating, ashen gray or pale skin, heart skips a beat, shortness of breath, naseau/ vomiting, racing heart?
-PAIN :
made worse by moving arm or neck, breathing/ lying flat
-pain relieved by what
Term
list characteristics of palpitations
Definition
a pounding or racing of the heart, normal emotional responces and heart disorders. Some people may complain of pouding heart, skipping a beat, could be associated with chest pain
Term
Focused health history of palpitations
Definition
- any chest pain or tightness
ONSET:
when did it start?How long have you had it this time?Had this type of pain before?how often?
LOCATION:
where did the pain start? does the pain radiate to any other spot?
CHARACTER:
How would you describe it? crushing, stabbing,burning? note if they clench their fist
PAIN BROUGHT ON BY:
activity-rest, emotional upset, after eating, during sexual intercoarse; with cold weather?
ANY ASSOCIATED SYMPTOMS:
sweating, ashen gray or pale skin, heart skips a beat, shortness of breath, naseau/ vomiting, racing heart?
-PAIN :
made worse by moving arm or neck, breathing/ lying flat
-pain relieved by what
Term
List characteristics of dypnea
Definition
night sweats, pain, chest pressure, discomfort, ankle edema, diaphoresis, cyanosis.
Term
Give a focused health history of Dyspnea
Definition
Any shortness of breath?
-what type of activity and how much brings on shortness of breath? How much activity brought it on 6 months ago?
-ONSET: does the shortness of breath come on unexpectedly?
-DURATION: constant or does it come and go
-seem to be affected by position: lying down
-awaken you from sleep at night?
Term
characteristics of a cough?
Definition
sneezing, dyspnea, fever, chills, congested gagging, dry, moist, hackling, barking, sudden gradual , sputum: amount color odor
Term
Elicit a focused health history with someone who has a cough
Definition
Do you have a cough
-Duration: how long have you had it
-freuquency: is it related to time of day
-type: dry, hackling, course, dry, congested?
-do you cough up mucous: color, odor?, blood?
-associated with: activity, position, anxiety, talking
- does any activity make it better or worse
-what medication are you taking
Term
Fatigue characteristics
Definition
tired, overwhelming sense of exhaution, or a loss of stength or endurace, such as may follow strainious activities
Term
elicit a focused health history on someone with fatigue
Definition
Do you seem to tire easily? Able to keep up with your family or coworkers?
ONSET: when did your fatigue start? sudden or gradual? Has any recent changes occured in energy level
-is your fatigue related to a time of day: morning, evening, afternoon
Term
peripheral edema characteristics
Definition
swelling of the feet and legs, peripherals feeling tight
Term
elicit a focused health history on a patient with peripheral edema
Definition
swelling in one or both legs?when did this swelling start?
-what time of day is it the worst?
-is the swelling come and go or constant?
-what seems to bring it on: trauma, standing all day, sitting
-what relieves it?
-is swelling associated with pain, heat, redness
Term
what are the characteristics of leg pain
Definition
burning, aching, cramping, stabbing, restless leg syndrom
Term
elicit a focuse health history on someone with leg pain
Definition
describe the type of pain:burning, sching, cramping, stabbing
- is it aggrivated by activity walking
-is it worsened with elevation, worse with cool temperatures
-does the pain wake you up at night
- any recent change in exercise
-what relieves this pain: dangling, walking, rubbing, is it associated with any skin changes?
-is it associated with any change in sexual function ( males)
-any history of vascular problems: heart problems, diabetes, obesity, pregnancy, smoking, bedrest, prolonged standing
Term
What 4 things are included in the general assessment of the extremedies
Definition
color
ease of respirations
signs of distress
blood pressure ( both upper extremedies in at least 2 places)
Term
Inspection of the extremedies includes
8 things
Definition
color
temperature
hair distribution
capillary refill
skill turgor
skin integrity
venous pattern
nails
Term
inspection of extremedies dealing with edema ( the grading scal)
Definition
1+ slightly pitting(2mm) disappears rapidly
2+ a little deeper(4mm) disappears within 10-15 sec
3+ noticeable deep(6mm) may last more than a minute
4+ very deep (8mm), lasts as long as 2-5 minutes
Term
Inspection of extremedies: Varicose veins
Definition
-dialated and swolen
-evaluate veins incompetance:
Trendelenburg test
person is supine
Lift the leg above the level of the heart until the veins empty
Then lower the leg quickly
An incompetent system will allow rapid filling of the veins
Term
Inspection of the extremedies: Jugular Venous Pressure
Definition
Jugular Venous Pressure
Place person in supine position
Gradually raise the head of the bed until jugular venous pulsations are noted
To ensure they are not carotid pulsations, palpate the carotid pulse on the opposite side while you observe the pulsations
Place your cm ruler with its zero point at the sternal angle
Extend the level of the JVP horizontally until it intersects with the cm ruler
Record the cm height of the the JVP
Should not be > 2 cm.
Term
Evaluation of the chest: inspection of the chest
Definition
*contour ( smoothness)
*heaves or lifts- sustained forceful thrusting of the ventricle during systole ( abnormal finding)
*pulsations- you may or may not see the apical pulse, the pulsation created as the left ventricle rotates against the chest wallduring systole
Term
Palpation of the extremedies:lymph nodes
Definition
Lymph Nodes
Epitrochlear- inside of arm right; above and beyond medial condyle of the humorus ;above elbow; usually not palpable
Inguinal- lower abdomen surrounding the pubic region; it is not unusual to find palpable nodes that are small ( 1cm or less), movable, and non tender
Term
palpations of the extremedies:Homan's test
Definition
Homan’s sign
Dorsiflexion of the foot with the knee slightly bent
Positive sign is calf pain
This is usually an abnormal sign indicating thrombosis (“blood clot”)
Term
Palpations of the extremedies: peripheral pulses
Definition
- makes sure to palpate simentaneously so you can compare the right with the left EXCEPTIONS: carotid!! ( to avoid comprimising arterial blood to the brain). Normally the contour is smooth with a rapid upstroke and slower downstroke, normal strength is 2+, should be the same bilaterally
Term
What 5 things do you access for peripheral pulses
Definition
* rate (not at all sites)
*rythm (regular, irregular, regularly irregular)
*Contour (smooth)
*Amplitude (strength)-
0=absent
1=thready weak
2=easily felt (normal)
3=bounding
symmetry with both sides

Term
Palpation of the apical pulse
Definition
usually called the point of maximal impulse, should occupy only one intercoastal space, the fourth or fifth and should be medial to the midclavicular line, size is normally 1-2 cm
amplitude normally a short gentle tap
Term
Evaluation of the heart: palpation of the chest: palpate for
Definition
Thrills- a palpable vibration feels like the throat of a purring cat( abnormal)
Pulsations- normal
PMI (Point of Maximal Impulse)- usually the 5th intercoastal space where the apical pulse is the loudest
Term
Evaluations of the heart: placed to palpate the chest include
Definition
Areas SB=sternal border; RIC=right intercoastal space
Aortic
2nd RICS @ SB
Pulmonic
2nd LICS @ SB
Right ventricle
3rd-5th LICS @ SB
Apical
5th LICS @ MCL
Normal location of PMI in an adult
Term
Evaluation of the heart: how do you relate the chest palpation in relation to the cardiac cycle
Definition
Palpation of the Chest
Simultaneously palpating the carotid artery will allow you to describe the chest palpation in relation to the cardiac cycle
Carotid pulsation and S1 are practically synchronous
Term
Palpation peripheral pulse locations include:
Definition
Locations:
Carotid
Brachial
Radial
Femoral
Popliteal
Dorsalis pedis
Posterior tibial
Term
palpation across the precordium
Definition
using the palmar aspects of the four fingers, gentle palpate the apex, the left sternal border and the base, searching for anyother pulsations ( none should be present). use the carotid artery pulsation as a guide.
Term
What are the 4 main things to make sure to do when ausculating the chest
Definition
Auscultation of the Chest
Make sure room is warm
Make sure stethoscope is warm
Take time to isolate each sound and each pause in the cycle
Avoid “jumping the stethoscope from one site to another
“Inch” the end piece along the route
Term
With heart sounds; sound is transmitted in which direction and is heard best over
Definition
Sound is transmitted in the direction of blood flow
Specific sounds are heard best over areas where the blood flows after it passes through a valve
Term
Auscultation of the heart should be performed in how many different places with which side of the stethescope
Definition
Auscultation should be performed in at least the five cardiac areas
With the diaphragm
Then with the bell
Term
The cardiac auscultatory areas are named after
Definition
the areas where the valves are best heard
Term
assessment of auscultation should proceed in a
Definition
orderly systematic manner; from base of heart to apex, or from apex to base of heart
Term
what valves are included in the base and apex ares
Definition
Base of the heart
Aortic area
Pulmonic area
Apex of the heart
Mitral area
Term
what are areas to auscultate on the heart (5)
Definition
Aortic
2nd RICS @ RSB
Pulmonic
2nd LICS @ LSB
Erb’s point (second pulmonic)
3rd LICS @ LSB
Tricuspid

ALL PEOPLE ENJOY THEIR MEALS
4th or 5th LICS @ LSB
Mitral
5th LICS in LMCL
Term
Auscultation of extremedies: peripheral vessels
Definition
Carotid arteries
Listen for bruits
Bruit: Low-pitched bowing sound over a peripheral vessel
Usually indicates a narrowed vessel
Jugular veins
Listen for a venous hum
Venous hum: low to medium-pitched soft hum heard throughout the cycle
Common in normal children and has no pathological significance
*Others will be done with the abdominal examination
Abdominal aorta: bruits
Renal and ileac arteries: bruits
Umbilicus: venous hum
Indicates portal hypertension
Term
Heart sounds S1:
Definition
S1
Closure of mitral and tricuspid valves at the beginning of systole
Heard loudest at the apex
Mitral area
Almost synchronous with carotid pulsation
May be “split”
Tricuspid area on inhalation
Term
Heart Sound S2:
Definition
S2
Closure of aortic and pulmonic valves at the beginning of diastole
Heard loudest at the base
Upper precordium
May have a physiologic split
Pulmonic area on inhalation
Term
Heart sound S3:
Definition
S3
Variation during first rapid filling phase during diastole
Heard best at apex
Sound
Ken-tuc-ky
S1 S2 S3
Term
Heart Sound S3: abnormalties and normalties
Definition
Normal
< 30 yoa
Pregnancy
Abnormal
Fluid overload
Mitral or tricuspid regurgitation
Term
Heart Sound S3: abnormalties and normalties
Definition
Normal
< 30 yoa
Abnormal
Hypertension
Mitral or tricuspid regurgitation
Term
temporal pulse location
Definition
front of ear / side of forhead
Term
carotid pulse location
Definition
is located in the groove between the trachea and the sternomastoid muscle, medial to and along side that muscle; smooth rapid upstroke, and downstroke more gradual
Term
femoral pulse
Definition
located just below the inguinal ligament halfway between the pubis and anterior posterior iliac spine, if person is obese ask them to bend legs like a frog
Term
popliteal pulse
Definition
is more of a diffuse pulse and can be difficult to locate, with your leg extended but relaxed, anchor your thumbs on the knee and curl your fingers around into popliteal fossa. Press fingers hard to compress the artery against the bone. almost impossible to palpate
Term
posterior tibial pulse
Definition
curve your fingers around the medial malleolus. You should feel the pulse right behind it in the groove between the malleous and the archilles tendon. Try passive dorsiflex to make it easier
Term
doralis pedis pulse
Definition
requires a very light touch. Normally it is just lateral to and parellel with the extensor tendon of the big toe. Sometime they can be difficult to find in older adults <45
Term
radial pulse
Definition
thumb side of wrist
Term
brachial pulse
Definition
anticubital fossa
Term
abnormal findings with heave or lifts
Definition
a sustained forceful thrusting of the ventricle during systole. It occurs with ventricular hypertrophy as a result of increased workload. A right ventricular heave is seen at the sternal border; a left ventricular heave is seen at the apex.
Term
What are heart murmurs
Definition
Relatively prolonged extra sounds heard during systole or diastole
Term
What causes heart murmurs
Definition
Increased blood flow across normal valves
Forward flow through a closed valve
Backward flow through an incompetent valve
Term
Describe heart murmurs
Definition
Location
Timing (systolic after S2, dystolic after S1) and duration
Describe
Pitch-High,Medium,Low
Character-Blowing,Harsh,Rumbling
Intensity
Term
Decribe heart murmurs intesity grade
Definition
Intensity: Grade
I Very faint
Hardly heard
II Faint
Clearly audible but quiet
III Moderately loud
IV Loud
Associated with thrill
V Very loud
Thrill easily palpated
VI Very loud
Visible heave or lift
Heard with stethoscope not in contact with chest
Term
Vascular sounds are common in which vessels
Definition
carotid, jugular, aorta
Term
what are the two most common vascular sounds
Definition
bruits
venous hums
Term
The diaphram is used to listen to
Definition
high pitched sounds
Term
The bell is used to listen to
Definition
low pitched sounds
Term
Arterial vs. Venous insufficiencies with pain
Definition
arterial: after exercise ; sharp stabbing;worse with activity; lowering feet reduces pain

Venous: with prolonged sitting/standing aching, heavy helped by activity;raising feet and legs reduces pain
Term
Arterial vs. venous insufficiencies with the skin
Definition
Arterial: cool,cold,hairless,shiny, pallor, elevated, rubor or dangling

Venous: warm,thickened,motted, brown pigmented areas
Term
Arterial vs. Venous insufficiencies with pulses
Definition
Arterial: often absent
Venous: usually present
Term
Arterial vs. Venous insufficiencies
edema
Definition
Arterial: infrequent
Venous:frequent
Term
What are normal variations seen in the cardiovascular system that deals seen in new borns and infants
Definition
HR very fast
Skin and mucous membranes should be uniformly pink
Acrocyanosis is normal
Bluish coloration of hands and feet
Disappears within a few days after birth
Apical impulse usually in 4th or 5th LICS just medial to the LMCL
Murmurs are frequent in the newborn in the first 48 hours
Term
What are normal variations seen in the cardiovascular system that deals seen in children
Definition
Sinus arrhythmia is a physiologic event in childhood
Heart rate varies in a cyclic pattern, usually faster on inhalation and slower on exhalation
Venous hum is common in children
Caused by turbulent blood flow in the internal jugular veins
Watch for squatting
Term
What are normal variations seen in the cardiovascular system that deals seen in pregnant women
Definition
Pulse rate gradually increases throughout
At term is 10-15 bpm faster
BP gradually falls in the first 16-20 weeks then rise to pre-pregnant levels at term
May hear an audible S4
Grade II systolic ejection murmurs are heard in 90% of pregnant women
Dependent edema is the norm
Decreased venous return
Term
What are normal variations seen in the cardiovascular system that deals seen in the elderly
Definition
S4 is more common in the elderly
Soft murmurs are not uncommon
Dorsalis pedis and posterior tibial pulses are more difficult to find
Heart rate does not respond as readily to exercise
Systolic blood pressure may increase
Term
checklist form heart and neck vessel exam : neck
Definition
1.carotid pulse: observe and palpate
2.observe jugular venous pulse
3.estimate jugular venous pressure
Term
checklist form heart and neck vessel exam : precordium inspection and palpation
Definition
1. describe location of apical pulse
2. note any heave/lift or thrills
Term
checklist form heart and neck vessel exam : auscultation
Definition
1. identify the 5 anatomic areas to listen
2. note rate and rythm of heart beat
3. identify S1,S2 and note any variations
4. listen in systole and dystole for any extra heart sound variations
5. listen in systole and systole for any murmurs
6. repeat sequence with bell
7. listen at the apex with person in left lateral position
8. listen at the base with person in sitting position

Term
When does splitting sometime occur
Definition
during inspiration the aortic valve closes .06 seconds before the pulmonary valve
Term
definition for risk for activity intolerance diagnosis
Definition
at risk for experiencing insufficient psychological or physiological energy to endure or complete required or desired daily activities
Term
what are the defining/ related to characteristics of the diagnosis risk for activity intolerance
Definition
deconditioned status, history of previous intolerance, inexperience with the activity, presence of circulatory problems; presence of respiratory problems.
Term
To review relevant history of a patient for a cardiac assessment you as
Definition
Personal habits
Smoking
Diet
Exercise
Alcohol intake
Personal and family history
Diabetes
Hypertension
CAD
Hyperlipidemia

Chest Pain
Fatigue
Dizziness
Syncope
Fainting; transient loss of consciousness
Diaphoresis
Profuse sweating
Palpitations°
Dyspnea-
Interference with ADL
Orthopnea
# of pillows
Cough
Edema
Numbness or pain in the extremities
Term
What are the four chambers of the heart
Definition
Four chambers
Right atria
Right ventricle
Left atria
Left ventricle
Term
What are the four valves of the heart
Definition
Two atrioventricular
Tricuspid
Mitral
Two semiluunar
Pulmonic
Aortic
Term
what is the order of circulation
Definition
Superior and Inferior vena cava
Right atrium Tricuspid valve Right ventricle Pulmonic valve Pulmonary arteries Lungs Pulmonary veins Left atrium Mitral valve Left ventricle Aortic valve Aorta Head and Body
Term
What is the systolic cycle
Definition
Systole
Ventricles contract and atria relax
Pressure in the ventricles rises
Mitral and tricuspid valves are forced closed to prevent backflow into the atria
This closure produces the first heart sound: S1: “lubb”
When the pressure in the ventricles is > than that in the aorta and pulmonary arteries the aortic and pulmonic valves open
Blood is ejected
Right ventricle to lungs
Left ventricle to aorta
When ventricles are almost empty
Pressure in ventricles becomes < than that in the aorta and pulmonary arteries
Aortic and pulmonic valves close producing the second heart sound: S2: “dubb”

Term
What is the dystolic cycle
Definition
Atria contract and ventricles relax
As ventricular pressure falls below atrial pressure
Mitral and tricuspid valves open to allow the blood collected in the atria to refill the relaxed ventricles
Blood flows in a relatively passive manner
Right atria to right ventricle
Left atria to left ventricle
This passive filling sometimes produces a third heart sound: S3
Then the atria contract to eject the remaining blood
This can sometimes be heard as a fourth heart sound :S4
Term
equipment needed
Definition
Marking pencil
Centimeter ruler
Stethoscope with bell and diaphragm
Sphygmomanometer
Term
Is a bluish discoloration of the hands and feet in a newborn considered normal?
Definition
Yes
What is this called?
Acrocyanosis
Term
In what cases might an S3 or S4 be considered normal?
Definition
In persons < 30 yoa
In pregnancy
Term
An extra heart sound that may be heard as a soft blowing sound during systole is called a:
Definition
a murmur
Term
What creates S3?
Definition
Rapid filling of the ventricles
What does it sound like?
Ken-tuc-ky
Term
What creates S4?
Definition
Rapid filling of the ventricles
What does it sound like?
Tennessee
Term
What valves closing constitute S1
Definition
Mitral and Tricuspid
Term
What valves closing constitute S2
Definition
pulmonic and aortic
Term
What are the five cardiac areas for auscultation?
Definition
Aortic
Pulmonic
Erb’s Point
Tricuspid
Mitral