Test 3

angi/o

vessel

aort/o

aorta

arter/o or arteri/o

artery

arther/o

fatty plaque

atri/o

atrium

cardi/o or coron/o

heart

phleb/o or ven/o

vein

thromb/o

blood clot

varic/o

dilated vein

vas/o or vascul/o 

vessel

ventrocul/o

ventricle

cardia

heart condition

stenosis 

narrowing or stricture

brady

slow

endo

in, within

epi

above, upon

peri

around

anatomy of the heart and great vessels

• 2 chambers: atrium and ventricles

• right side: blood from body- from superior and inferior vena cava

• left side: blood from pulmonary vein - to aorta → systemic circulation

• base: top part of heart

• apex: point of heart

• great vessels: pulmonary arteries and aorta

anatomy of pericardium and cardiac muscles

• pericardium: encases heart, shield heart from infection and trauma

• myocardium: thick muscular tissue, contracts → eject blood from ventricles

• endocardium: most innerpart

• coronary arteries: supply blood to the pericardium and cardiac muscles - supply O2

blood flow through the heart

1. superior/ inferior vena cava

2. right atria

3. tricuspid valve

4. right ventricle

5. pulmonary valve → pulmonary arteries

6. lungs

7. pulmonary veins

8. left atria

9. mitral valve

10. left ventricle

11. aortic valve → aorta

12. body

heart valves

• regulate blood flow through heart

• tricuspid valve

  • A/V valve

• pulmonary valve

  • semilunar valve

• mitral valve

  • A/V valve

• aortic valve

  • semilunar valve

electric conduction of the heart

1. SA node: electric impulse originates here. superior aspect of right atrium. also known as the cardiac pacemaker. 60-100 beats per minute. stimulates atrial contraction

2. AV node: impulse then travels here. if SA node fails the AV node can generate 40-60 impulses per minute

3. bundle of His and Purkinje fibers in the myocardium: results in ventricular contraction. if both the SA and AV nodes fail they can create 20-40 impulses per minute 

cardiac cycle

1. systole: first heart sound (S!)

   1. ventricles contract, creating pressure to close the AV valves, preventing backflow of blood

   2. semilunar valves open and blood is ejected into the aorta and pulmonary arteries. when the blood is ejected the pressure in the ventricle decreases and semilunar valves close

   3. the ventricles then relax and diastole starts over

2. diastole: second heart sound (S2) indicates start of diastole

   1. ventricles are relaxed and fill with blood from atria

   2. blood moves when the pressure of blood in the atria becomes hgiher than in the ventricles

   3. at the end of diastole, the ventricles are filled with blood

pulse pressure

• difference between systolic and diastolic blood pressure.

• shows the condition of the blood vessels

  • low/ narrow: poor cardiac output

  • normal: 40-60

  • high/wide: stiff vessels, narrowing/clogged arteries

Mean arterial pressure 

• Average amount of pressure in the arteries walls 

  • low: Poor profusion to the organs

  • normal: 70 to 100

  • high: too much pressure

preload

Volume in the right Atria at the end of diastole 

Afterload

The pressure in the great vessels against which the left ventricle contracts

cardiac output

The amount of blood injected from the left ventricle each minute

If the SA node of the heart is properly functioning, what heart rate should we expect to assess on a client 

60-100 bpm

venous system vs arterial system

1. venous system

   1. veins

   2. low pressure

   3. valves

   4. towards heart

   5. usually unoxegenated

2. arteries

   1. away from heart

   2. usually oxygenated

pulses

• temporal

• carotid

• brachial

• radial

• femoral

• popliteal

• posterior tibial

• dorsalis pedis

arteries

take freshly oxygenated blood from the heart to all body tissues

arterioles

tiny branch of artery

venules

tiny branch of veins

capillaries

fine branching blood vessels that form a network between arterioles and venules

veins

take the deoxygenated blood and waste products from the tissues and return into the heart

thrombosis

formation of a blood clot inside a blood vessel, obstructing flow

bruit

abnormal sound that occurs when blood flows turbently through an artery

thrill

a vibratory resonance heard with your stethoscope

aneurysm 

a ballooned and weakened area in an artery 

which of the following regarding pulse checks is true

carotids should be assessed one at a time

lymphatic system

• lymph fluid from tissues back to blood stream

• regulate fluids in body

• filter pathogens in body

lymph 

pertaining to lymphatics

anatomy

• groups along blood vessels

• filtration before venous system

1. cervical lymph nodes

   1. drain head and neck

2. axillary lymph nodes

   1. drain breast and upper arms

3. epitrochlear lymph nodes

   1. drain hand and lower arms

4. inguinal lymph nodes

   1. drain lower extremities, genitalia, anterior abdominal wall

physiology of lymphatic system

• retrieves excess fluid and plasma proteins from the tissue spaces and returns them to the bloodstream

• defends the body from disease- immune system!!

• helps fight infection

lymphadenopathy

• swollen lymph nodes usually caused by infection from bacteria or viruses

lymphedema

• tissue swelling caused by accumulation of protein rich fluid

which of the following is a function of the lymphatic system

• Defend the body against diseases

• Return excess fluid and plasma protein to venous system

• Helps the body fight infection

• Nodes act as a filtration system for lymph fluid

review of systems for CV

• present health status

  • medications

  • disease processes

    • HTN, hyperlipidemia, heart disease

• past health history

  • surgeries and hospitalizations

    • open heart surgery- what kind

  • congenital heart defects

  • testing done

    • EKG, stress testing, ultrasounds

• family history

• personal and psychosocial history

  • exercise, stress, hobies

  • diet, alcohol intake

    • DASH diet helps

  • caffeine

    • tachycardia

  • drugs

  • tobacco use

    • vasoconstriction

    • any interest in quitting

• problem based history

  • reported sympoms related to heart

    • chest pain, SOB, cough, nocturia, fatigue, syncope, edema of extremities, pain in legs or cramping, changes in skin, enlarged lymph nodes

inspection of CV

• hand hygiene

• name and DOB

• provide comfort and privacy

• general appearance, skin color, breathing effort

• inspect anterior chest wall for contour, symmetry, and retractions

  • look with pen light from the side

• look for landmarks

palpation technique

• pulsation: finger pads

• thrills: padding at the base of fingers

• heaves/lifts: palm of hand

palpation of CV

• may have to turn patient slightly onto left side

• apical pulse

  • light pulsation

  • location and amplitude

• thrills

  • paplable vibration

  • valve murmur

• heaves or lifts

  • heaves: precordial impulse- cardiac or respiratory disease

• pain

stethoscope use

• diaphragm

  • S1 and S2, S3 and S4

  • high frequencies

• bell

  • murmurs and bruits

  • low frequencies

auscultation CV

• rate and rhythm 

  • regular vs irregular

• S1 (lub) and S2 (dub)

  • S1: begining of systole, when tricuspid and mitral valves close

  • S2: end of systole/beginning of diastole, when aortic and pulmonic valves close

• extra heart sounds

• murmus

tips for hearing heart sounds

1. patient positioning

   1. upright and slightly forward

2. quiet room

3. patient breath holding

4. concentration

APETM

1. aortic valve

2. pulmonic valve

3. erbs point

4. tricuspid valve

5. mitral valve

extra and abnormal heart sounds

1. split S1 and S2

   1. valves do not close at same time

2. S3:

   1. found best with bell at apex

   2. early ventricular gallop due to rapid ventricular filling

   3. children and young adults

3. S4

   1. cardiac apex with heart of bell

   2. late diastolic sound- atrial gallop

   3. decreased stretching of the ventricle/ diastolic dysfunction

   4. children and young adults

4. murmurs

   1. swooshing sound dur to turbulent blood flow

5. pericardiac friction rub

   1. low pitched course rub or grating sound

age considerations CV

1. infants: fetal shunts (usually close within 10-15 hours). HR best auscultated

2. children and young adults: heart rate will slow as child grows and arrythmias are common

3. aging adults: orthostatic hypotension

pregnancy with CV

• blood volume increase by 30-50%, increase stroke volume, cardiac output, and pulse rate

• S3 sound can be heard as a normal variation- resolves usually once baby is delivered

• monitor for increased BP

risk factors for hypertension and CAD

normal vs abnormal CV

red flags CV

• top 5= s/s for MI

1. chest pain or discomfort in men

2. left arm pain, radiates into left jaw

3. elephant sitting on my chest

4. fatigue and SOB in women lasting more than 20 min

5. indigestion, nausea and diaphoresis

6. SOB at rest

7. new murmur

emergent heart conditions

1. cardiogenic shock: Inability of the heart to pump enough blood out of the rest of the body although there is plenty of blood present the heart is not able to squeeze or provide enough cardiac output to perfuse the rest of the body

   1. s/s: Tachypnea, shortness of breath, sudden tachycardia, change in level of consciousness, weak pulses, low blood pressure, diaphoresis, and pale skin

   2. causes: Systolic dysfunction, diastolic dysfunction, dysrhythmias, structural defects; most often seen myocardial infarctions 

2. hypertensive emergency/urgency: When very high blood pressure is capable of impairing one or more of the organ systems such as brain eyes heart aorta kidneys etc

   1. MAP is most indicative sign

conditions and common medical diagnoses

• Hypertension (increased BP)

• hyperlipidemia (increased lipids, high cholesterol)

• valvular heart disease (Heart valve that does not close or open completely causing murmurs or abnormal heart sounds)

• myocardial infarction (Decreased sensation of blood flow into a portion of the myocardium causing coronary artery blockage)

• pericarditis (Inflammation of the pericardium causing a cardiac friction rub)

• heart failure (Heart muscle can't pump as much blood as it should causing blood to blow back up)

heart failure

1. left sided

   1. Left ventricle cannot pump sufficient blood forward causing blood to back up into the left atrium and eventually into the pulmonary capillaries causing pulmonary edema 

      1. Dyspnea, shortness of breath, decreased oxygen, tachypnea, cough, crackles, cyanosis 

2. Right sided 

   1. Failure of the right ventricle to pump blood into the pulmonary arteries causing back flow of blood into the inferior and superior vena cava 

      1. risk factors: HTN, CAD, DM

      2. Blood pulls in the body, deepened edema, ascites, enlarged liver and spleen, JVD, and increased weight 

3. both

   1. all symptoms

common nursing diagnoses CV

1. decreased cardiac output

2. risk for decreased cardiac tissue perfusion

3. excess fluid volume

documentation CV

During auscultation where is the best area for the nurse to listen for S3 and S4 heart sounds

5th ICS at the left MCL

review of systems PV

• pain

• edema

  • where

• lumps

• changes to the skin

  • color, wounds

• erectile dysfunction in males

• personal history of hypertension and hyperlipidemia

• family cardiac and PV history

inspection PV

• appearance of extremities

  • skin integrity, color

• nail bed

  • color and angle

• note asymmetry

• jugulat vein distention (JVD)

  • Reflects right atrial pressure

  • Lie in supine position with head 30 to 45 degrees

auscultation PV

• Carotid bruits: bell of stethoscope to listen for turbulent blood flow. Have them take a small breath in and hold it while you listen

• hear a bruit = abnormal

palpation PV

1. temporal

2. carotid

   1. one at a time

3. brachial

4. radial

5. popliteal

6. femoral

7. dorsalis pedis

8. posterior tibial

carotids assessment sequence

1. inspect

2. auscultate

3. palpate

modified allen test

Used to measure how well blood flows into a patient's hand 

normal vs abnormal PV

red flags PV

• pain with or without walking (resolved with the other)

• asymmetry

• color changes

• muscle atrophy

• changes in pulse force and rhythm

• absent pulse

  • confirm with doppler

conditions and common medical diagnoses

1. peripheral arterial disease

2. peripheral venous disease

3. raynaud’s syndrome

   1. due to vasospasm

4. deep vein thrombosis

peripheral artery vs peripheral vascular diease

common nursing diagnoses PV

• ineffective peripheral tissue perfusion

• risk for peripheral neurovascular dysfunction

• activity intolerance

documentation PV

When assessing for JVD what is the best position to place the patient in

Supine position elevate head to around 30 to 45 degrees slightly tilt chin and look away from the side you are assessing

review of systems lymphatic

• edema

  • new or all of the time

• enlarged lymph nodes

  • OLD CARTS

inspections and palpation lymphatic  

• inspect skin 

  • color, edema, skin integrity

  • one limb or both

• epitrochlear lymph node- elbow

  • size

  • consistency

  • mobility

  • tenderness

  • warmth

measure lymphatics

• leg circumfrence

normal vs abnormal lymphatics

red flags lymphatics

• asymmetry

common medical diagnoses lymphatics

• lymphedema

• lymphadenopathy

lymphedema vs lymphadenopathy

common nursing diagnoses lymphatics

• acute pain

• risk for peripheral neurovascular dysfunction

• activity intolerance

• impaired skin integrity

documentation lymphatics

Inspection of a person's right hand shows a red swollen area. to further assess for infection, you would palpate the

epitrochlear node

Esophag/o

esophagus

gastr/o

stomach

pylor/o

pylorus

duoden/o

small intestine

enter/o

intestine

jejun/o

jejunum

ile/o

ileum

append/o

appendix

appendic/o

appendix