health assessment exam 2 content

function of arteries

to supply oxygen and essential nutrients to tussies

arteries accessable to examine

temporal and carotid arteries, arteries in arm, arteries in leg

arteries in arm

brachial bifurcates into ulnar and radial

arteries in leg

femoral, popliteal, anterior to dorsal pedis, posterior tibial to plantal arteries

peripheral arterial disease

affects noncoronary vessels and refers to arteries affecting the limbs

function of veins

drain deoxygenated blood and its waste products from tissues and return it to the heart

veins are also called

capacitance vessels because of their ability to stretch

veins accessible for examination

jugular veins, femoral and popliteal, great and small saphenous, perorators

low pressure system

mechanism to keep blood moving by contracting skeletal muscles

low pressure system in legs is called

calf pump or peripheral heart

varicose veins

create incompetent valves leading to increased venous pressure, which further dilates the vein

function fo lymphatic system

conserve fluid and plasma proteins that leak out of capillaries, form major part of immune system to defend body against disease, absorb lipids from intestinal tract

spleen

located in left upper quadrant of abdomen

four functions of spleen

destroy old red blood cells, produce antibodies, store red blood cells, filter microorganisms from blood

tonsils

palatine, adenoid, lingual

located at entrance to respiratory system and gastro tract and respond to local inflammation t

thymus

flat, pink grey gland located in superior mediastinum behind sternum and in front of aorta

vascular system

move blood throughout the body

lymphatic system

move plasma proteins from tissues to blood stream

major part of immune system

palpation of lyphatics

palpate inguinal lymph nodes and epitrochlear lymph nodes

normal findings of inguinal lymph node

can be palpated, less than 1 cm, moveable and non tender

abnormal finding of inguinal lymph nodes

enlarged, tender, or fixed

normal finding of epitrochlear lymph node

no palpable

abnormal finding of epitrochlear lymph node

enlarged and palpable, can be tender

subjective review of systems

leg pain or cramps, skin changes on arms or legs, swelling, lymph node enlargement, medication, smoking history

equipment needed for objective data

paper tape measure, tourniquet or blood pressure cuff, stethoscope, doppler ultrasonic stethoscope

profile sign for clubbing of nail

view finger from side

ulnar pulses and brachial pulses

typically not assessed

modified allen test

provide information about adequacy of collateral circulation

femoral artery

below inguinal ligament, halfway between pubis and anterior superior iliac spines

posterior tibial

between malleolus and achilles tendon

dorsalis pedis

lateral and parallel with extensor tendon of big toe

1+ edema

mild pitting, slight indentation, no perceptible swelling

2+ edema

moderate pitting, indentation subsides rapidly

3+ edema

deep pitting, indentation remains, leg looks swollen

4+ edema

very deep pitting, indentation lasts long time, leg grossly swollen and distorted

doppler ultrasonic prove

use this device to detect a weak peripheral pulse, to measure low blood pressure, or blood pressure in lower extremities

wells score for deep vein thrombosis

clinical model includes 10 catergories focusing on malignancy, mobility limitations, swelling, non varicose veins, history of DVT

scores for DVT

higher the score, greater the risk

0-3

risk factors of coronary artery disease

smoking, diabetes mellitus, dyslipidemia, hypertension

peripheral vascular assessment

cap refill, pulses and amplitude, temp, color changes, hair distribution, edema, ulcers, lyphatic system

cap refill

depress and blanch nail bed, note time for color return

normal is within 1-2 seconds

assess pulse

location, rate, rhythm, amplitude

assess temp

use back of hands to palpate for temperature

hypothermia

if generalized, shock

if localized, peripheral arterial insufficiency and raynauds disease

hyperthermia

if generalized, fever or after exercise

if localized, trauma infection or sunburn

hair distribution should be

symmetrical

normal venous pattern

flat and barely visible

abnormal venous pattern

varicose veins, varicosities

abnormal findings in pulse

weak thready pulse of 1+ or full bounding pulse of 3+, pulses bigeminus, pulses alternans, pulses paraodxus, pulses bisferiens

abnormal finding in arms

raynaud phenomenon, lymphadema

abnormal finding in leg: ulcers

arterial (ischemic) ulcer, venous (stasis) ulcer, neuropathic ulcer

abnormal finding in legs: PVD

superficial varicose veins, deep vein thrombosis

abnormal finding in peripheral artery disease

aneurysms and occlusions

signs of deep vein thrombosis

unilateral swelling, tenderness, extreme pain, warmth and redness of skin

can lead to pulmonary embolism

things to check for in neurovascular check

pain, sensation, skin temp, cap refill, pulses, movement

red flags

unilateral lower extremity pain, pulselessness, unilateral temp change, unilateral edema

costal

ribs sd

precordium

area on anterior chest overlying heart and great vessels

heart has

4 chambers

great vessels

major arteries and veins connected to the heart

2 loops of continous blood vessels

pulmonary and systemic circulation

pericardium

tough, fibrous, double walled sac that surrounds and protects the heart

myocardium

muscular wall of heart

endocardium

thin layer of endothelial tissue that lines inner surface of heart chambers and valves

atrium

thin walled reservoir for holding blood

ventricle

thick walled, muscular pumping chamber

arteries

muscular walled

valves are

unidirectional

open and close passively in response to pressure gradients in moving blood

atrioventricular valves

tricuspid and bicuspid

semilunar valves

aortic and pulmonic

valves open during

diastole

pulmonic valve

semilunar valve in right side of heart

aortic valve

semilunar valve in left side of heart

no valves are present between

vena cava and right atrium

pulmonary veins and left atrium

right side of body is

less oxygenated

left side of the body is

more oxygenated

s1

start of systole, closure of mitral and tricuspid valves

s2

end of systole, closure of aortic and pulmonary valves

gallops and clicks are

ausculatory

thrills are

palpation

heave and lifts

inspection

s3

ventricular gallop, heart with bell of stethescope

s1 s2 s3

s4

reflects strong atrial contraction, heard with bell

s4 s1 s2

murmors

diastolic or systolic

diastolic needs valve replacement

sounds like swooshing or blowing

bruit

swooshing sound over artery

thrill

vibratory sensation felt upon palpation of pericardial

murmor

swooshing sound over heart valve location

subjective data for chest

chest pain, dyspnea, orthopnea, cough, fatigue, skin color, edema, nocturia, past and family cardiac history t

equipment needed for examination

marking pen, small centimeter ruler, stethoscope, alcohol wipe

palpate carotid artery

finding should be bilaterally, only palpate one at a time

auscultate carotid artery

assess for bruits, keep neck in neutral position, apply stethescope at angle of jaw

inspect for jugular vein distention

shine pen light over jugular when patient is in semifowlers

precordium inspect

observe for pulsation, palpate apical impulse

valve areas

second right interspace: aortic valve

second left interspace: pulmonic valve

left lower sternal border: tricuspid valve area

fifth intercostal space around miclavicular: mitarl valve

aortic location

2nd intercostal space, right sternal border

pulmonic location

2nd intercostal space, left sternal border

erbs point

third intercostal space, left sternal border

tricuspid location

fourth intercostal space, left sternal border

mitral location

5th intercostal space, mid clavicualr line

abnormal systolic finidng

ejection click, aortic prosthetic valve sounds, midsystolic click