nursing 344 - all the stuff i missed

lub (s1)

• av valves (mitral and tricuspid) close

• systole begins

where is lub loudest?

apex

dub (s2)

• sl valves (pulmonic and aortic) close

• diastole starts

where is dub loudest?

base

s3

• lub-dub-dub

• ventricular gallop

• early diastole

what does s3 sound like?

sounds like kentucky

when is s3 normal?

• children + teens

• up to 40

s4

• lub-lub-dub

• atrial gallop

• late diastole

what does s4 sound like?

tennessee

who is s4 heard in?

• normal sound in athletes

• some older clients after exercise

murmur #1

increased blood velocity = decreased blood viscosity

murmur #2

structural valve defects (septal defects)

murmur #3

valve malfunction (stenosis/regurgitation)

murmur #4

abnormal chamber openings

murmur types

• systolic murmur

• diastolic murmur

systolic murmur

• after s1, before s2

• lub-SWOOSH-dub

diastolic murmur

• after s2, before s1

• lub-dub-SWOOSH

• always pathological

jugular venous distension

• elevated right side heart pressure

• seen in heart failure

• head of bed elevation

myocardial infarction

• irreversible heart damage due to myocardial ischemia

• can result into necrosis

• pain radiates

agina

• pain predictable due to too much exertion

• relieved by rest or nitroglycerin

stroke

• blockage of blood vessel that supplies to brain

• necrosis

breast cancer - risk factors

• alcohol

• lack of exercise

• weight gain

• hormone replacement therapy

breast cancer - physical exam

• skin dimpling

• nipple retraction + lumps

• often four in upper outer quadrant

wbc

5,000-10,000 mm³

hemoglobin

• female: 12-16

• male: 14-18

hematocrit

• female: 37-47%

• male: 42-52%

platelets

150,000-400,000 mm³

types of diseases

• leukopenia = decreased wbc = immunosuppression

• thrombocytopenia = low platelets

• pancytopenia = all levels in cbc low

leukorrhea

• discharge during pregnancy

• candidiasis common in pregnancy due to glycogen levels raised

sti - subjective data

ask partners if they had:

• gonorrhea

• herpes

• hiv/aids

• chlamydia

• warts/syphilis

sti - objective data

• herpes simplex - type 2 or HPV warts

• syphilitic chancres

• males exam includes looking penis for discharge or lesions

health promotion for sti

• encourage use of condoms

• verify if patient got Gardasil vaccine

prostate cancer

• more common in black men

• screening begins at 45

prostate assessment

• digital rectal exam

• check in warm shower once a month

• should be non-tender, smooth, rubbery