Health Assessment test 1

Rapid heart rate- over 100 bpm

Slow heart rate-less than 60 bpm

SA node

When it is started by any cardiac cell other than the SA node

Backflow, stenosis

No. Skeletal muscles get bigger with exercise. An enlarged heart would be bad, bigger is not better! An enlarged heart has to work horder.

Low sodium, low fat diet
Exercise
Maintaining a healthy weight

It causes fluid buildup in the lungs

Equal to the size of your clenched fist

Pericardium

Slightly towards the back

The ventricles extend to the left and toward the anterior chest wall

5th intercostal space, midclavicular line

Precordium

the top

the bottom

a cone

Unoxygenated Blood: Superior Vena Cava --> R Atrium--> Tricuspid Valve--> R ventricle --> Pulmonic Valve--> Pulmonary Artery to Lungs (gets oxygenated)
Oxygenated Blood: Pulmonary Veins--> L Atrium--> Mitral Valve--> L Ventricle--> Aortic Valve--> Aorta--> Body

Pericarditis

Bruit

Diastole (fillin and chillin)
Bottom number of BP

2 main coronary arteries- LCA & RCA

During Diastole- when coronary cascular resistance is minimized

60

Diastole: ventricles relax and fill with blood (filln and chillin)
when left ventricle is filling with blood
takes up 2/3 of cardiac cycle
Systole: ventricles contract, pump blood into pulmonart and systemic arteries
only takes up 1/3 of cardiac cycle

Closing of mitral & tricuspid valves (AV valves)-- lub is heard-- ventricular systole takes place

Closing of aortic & pulmonic valves (semilunar valves)--dub is heard--diastole is taking place

The opening and closing of the heart valves

They are heard due to improper opening or closing of the valves

at the apex of the heart

at the base of the heart

Ventricular filling creates vibrations that can be heard over chest. Occurs when ventricles are resistant to filling during early rapid filling phase-- heard after S2 (low pitched at apex)

Occurs at the end of diastole when ventricle is resistant to filling, non-compliant and creates vibrations- sound just before S1 atrial gallop

Frequency (pitch): high or low
Intensity (loudness): loud or soft
Duration =: very short hear sounds or longer periods of silence
Timing: systole or diastole

Sinoatrial (SA) Node
It initiates an electrical impulse

SA node
AV node
Bundle of HIS
Purjinke Fibers

electrical impulses of the heart

repolarization of ventricles

the conduction stimulus of the heart spreading through the bundle of HIS

SA to AV- atrial stimulation

impulses traveling through the heart

Cardiac output (CO) is the volume of blood in liters ejected by the heart each minute
The average CO for adults is 4-7 liters/minute
CO= HR X SV

number of times ventricles contract each minute

The amount of blood ejected by the left ventricle during each systole

inverse relationship

Degree of stretch of myocardial fibers at end of diastole. The more the heart is filled (within limits, ie, not over-filled), the more forcefully it contracts

Pressure or resistance the ventricles must overcome to pump out blood. The amount of resistance is directly related to arterial blood pressure and the diameter of the vessels.

Personal and family history
Diet history: 24 hour sample
Socioeconomic status- ability to purchase proper foods, medicines
Cigarette smoking: # packs/day and also # of years smoked
Physical activity/inactivity- 30 minutes daily of light to moderate exercise recommended by american heart association
Obesity- associated with HTN, hyperlipidemia, and diabetes and all contribute to CV disease
Current health problems- describe health concerns

Pleurisy, pulmonary embolus, hiatal hernia, and anxiety

They all cause chest pain or discomfort, a symptom of cardiac disease

Onset? (when did it start?)
Duration? (how long have you had it?)
Frequency? (how often does it come?)
Precipitating factors?
Location?
Radiation?
Quality? (throbbing, burning, etc)
Intensity? (rate on pain scale)

Also note any associated symptoms- dyspnea, diaphoresis, nausea, vomiting
Dyspnea can occur with either cardiac or pulmonary disease
Dyspnea on Exertion (DOE)- early symptom of heart failure
Orthopnea- advanced heart disease
Any SOB?
Recent increase in fatigue? Inability to complete usual activities? Presence of cough?

client has been recumbent for several hours, increase in venous return leads to pulmonary congestion, seen in CHF

Resulting from decreased cardiac output is usually worse in evening. Ask patient if they can perform same activities as a year ago.

Palpitations are a fluttering or unpleasant awareness of heartbeat.
Besides cardiac causes, other causes of palpitations are fatigue, caffeine, nicotine, & alcohol

Transient loss of consciousness, decrease in perfusion to brain, due to cardiac and/or neurological causes

A sudden increase in weight can be a result of accumulation of fluid in interstitial spaces, known as edema

Extremity pain- cramping sensation of legs/buttocks associated with walking related to decrease in arterial tissue perfusion

Build, skin color, LOC, presence of SOB, DOE

chronic oxygen deprivation

When one gets dizzy on fast movements of elevation changes, a sudden drop in BP when rising to sit or stand

assess skin changes
vascular changes
clubbing
capillary filling
edema

color and temperature
look for symmetry in skin color, temp, and cyanosis?

lack of oxygen

Presence (absent or not)
Amplitude (1+ - 4+ quality)
Rhythm (regular or irregular)
Rate (beats/minute)
Equality (same both sides)

systolic drops slightly or stays the same
diastolic increases slightly

narrowed carotid arteries

Inspection
Palpation
Percussion
Auscultation

Inspection- side to side, at right angle and downward over precordium where vibrations are virible
Point of maximal intensity (PMI)-located at 5th intercostal (IC) space at midclavicular line (MCL)- mitral area
Pulmonic area-2nd L intercostal space (best place to hear valves)
Aortic area-2nd R intercostal space

fingers and most sensitive part of palm of hand to detect any precordial motion or thrills
Palpate apical impulse

A palpable vibration, may signify a lud murmur

no

estimate heart size, most accurately done by chest x-ray

anterior percussion has little usefullness with female breast tissue, or in obese persons, or a person with a very muscular chest

Note change from resonance over lung to dullness over heart

Note location & strength of apical impulse

When listening to 1st and 2nd heart sounds and high frequency murmurs

lub-dub

Severe myocardial depression, may be seen with an MI, aortic stenosis, or other causes

For low frequency gallops and murmurs

First letter of the alphabet
A
Apex
LUB
closing of semilunar valves

Second letter of the alphabet
B
Base
Dub
closing of atrioventricular valves

Gallops-rapid, passive filling phase during diastole into noncompliant ventricle
Lub Dub Dee
common in children and young adults
considered pathologic over age 30
best heard at apex with bell of stethoscope

pathologic, may be heard with advancing age because of stiffened ventricle
De Lub Dub
Indicates impaired compliance or volume oferload
Best heard at apex with bell of stethoscope

Blowing, swooshing sound that occurs with turbulent blood flow in the heart or greater vessels

Classified according to their timing and cardiac cycle

Can be systolic or diastolic

Innocent between S1 and S2 commonly heard in children and adults under 30

Configuration of murmurs: Crescendo- Decrescendo

Note if murmur increases on inspiration or expiration

no valve disease or pathological cause

gets louder

tapering off

Grade 1: faint
2: soft
3: moderately loud
4: loud with thrill
5: very loud, stethoscope partially off chest
6: stethoscope off chest, thrill

They are a scratching, scraping sound, high pitched, extends through systole and diastole
Best heard at 3rd ICS, diaphragm
They result from inflammation of the pericardial membrane

Diaphragm

Bell

Bell and Diaphragm work equally well for medium pitched sounds

Early systole, stiff, deformed valve, high pitch, apex, diaphragm

Immediately after S2 stenotic mitral or tricuspid valve leaflets recoil abruptly during diastole

Apex

Base

Supine, left side lying and sitting, leaning forward

Listen R. 2nd ICS close to sternum (aortic area)
Listen L. 2nd ICS close to sternum (pulmonic area)
Listen L. 3rd ICS close to sternum (Erb's point)
Listen L. 5th ICS close to sternum (tricuspid area)
Listen L. 5th ICS medial MCL (mirtal area)

Aortic
Pulmonic
Erb's Point

Tricuspid
Mitral Area

S4, S1, S2, S3

Leg pain
History of DVT?
Arm/leg skin changes, varicose veins
Edema
Medications

Intermitten (comes and goes)
usually in a calf, a partial blockage of blood flow (during exercise)

Skin including color and hair distribution
Jugular vein distension

brown discoloration occurs with chronic venous stasis

Pulses
Tenderness
Temperature
Edema

A unilateral cold foot or leg or sudden drop in temp as you move down the legsindicates arterial insufficiency

carotid, brachial, radial, femoral, popliteal, posterior tibialis & dorsalis pedis
To feel any pulse, you have to push it up against bone
1+ = thready, weak pulse

Rhythm is coupled, every other beat comes early or normal
Beat followed by premature beat
Force of premature beat is decreased because of shortened cardiac filling time

Rhythm is regular, but force varies with alternating beats of large and small amplitude- from heart failure

Check for pretibial edema, how high does it go up?
1+= mild pitting, slight indentation
2+= moderate pitting, indentation subsides rapidly
3+= deep pitting, indentation remains short time, leg looks swollen
4+= very deep pitting, very swollen

occlude radial & ulnar arteries, pt. opens and closed fist, let go quick while you are occluding radial artery and if hand turns pink, ulnar is intact

Relatively uncommon occlusive disease of small and medium arteries and veins
Fibrosis and scarring that binds artery, vein and nerve together
Found in young males, who smoke
When they stop smoking, goes away in most people

Vasoplasm-arterioles and arteries upper and lower extremities-usually unilaterally, however with Raynaud's-bilateral
Vasoplasm-cutaneous vessels constricted and blanching of extremities occurs
Painful
Intermitten
Aggravated by cold
*more common in women

Thrombus formation- can lead to pulmonary embolus, a life threatening complication
Defective valves-venous insufficiency or varicose veins, not life threatening
Deep Venous Thrombophlebitis (DVT)-risk clot formation-embolus-pulmonary embolus

Thrombus formation. Nurses teach patients to do leg exercises in bed and get OOB as quickly as possible

weak pulse alternates with strong pulse, despite regular heart rhythm
It is seen with severly depressed cardiac function

Auscultate carotid arteries

Neck Vessels
Precordium
Inspection and palpation of peripheral system with auscultation of the carotids