Term
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Definition
a condition in which the heart rate is less than 60 beats per minute |
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Term
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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 |
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Term
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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 |
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Term
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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 |
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Term
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Definition
the abnormal accumulation of fluid in the interstitial spaces of tissues.Producing swelling. |
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Term
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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 |
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Term
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Definition
is a sustained forceful thrusting of the ventricle during systole.It could be a result of increased workload with ventricular hypertrophy |
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Term
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Definition
pain in the calf with dorsiflexion of the foot, indicating thrombosis |
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Term
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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. |
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Term
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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. |
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Term
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Definition
difficulty breathing laying down, person must assume a more upright position to breath |
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Term
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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 |
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Term
paroxysmal nocturnal dyspnea |
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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. |
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Term
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Definition
rubbing together of inflammed membranes of the pariocardium, as may occur in the pericarditis or after a myocardial infarction, grating sound |
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Term
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Definition
part of the chest wall that overlays the heart and extends down to the epigastrium ( upper middle gastric area |
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Term
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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 |
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Term
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Definition
difference between systolic and dystolic BP, normally 30-50 mmHg |
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Term
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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 |
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Term
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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 |
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Term
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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 |
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Term
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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 |
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Term
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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 |
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Term
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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 |
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Term
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Definition
contraction of the heart, driving blood into pulmonary artery and aorta |
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Term
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Definition
condition in which the heart contracts at a rate greater that 100 beats/ min |
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Term
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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 |
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Term
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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 |
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Term
list characteristics of a chest pain |
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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. |
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Term
elicit a focused health history from a person with chest pains |
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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 |
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Term
list characteristics of palpitations |
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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 |
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Term
Focused health history of palpitations |
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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 |
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Term
List characteristics of dypnea |
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Definition
night sweats, pain, chest pressure, discomfort, ankle edema, diaphoresis, cyanosis. |
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Term
Give a focused health history of Dyspnea |
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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? |
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Term
characteristics of a cough? |
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Definition
sneezing, dyspnea, fever, chills, congested gagging, dry, moist, hackling, barking, sudden gradual , sputum: amount color odor |
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Term
Elicit a focused health history with someone who has a cough |
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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 |
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Term
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Definition
tired, overwhelming sense of exhaution, or a loss of stength or endurace, such as may follow strainious activities |
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Term
elicit a focused health history on someone with fatigue |
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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 |
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Term
peripheral edema characteristics |
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Definition
swelling of the feet and legs, peripherals feeling tight |
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Term
elicit a focused health history on a patient with peripheral edema |
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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 |
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Term
what are the characteristics of leg pain |
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Definition
burning, aching, cramping, stabbing, restless leg syndrom |
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Term
elicit a focuse health history on someone with leg pain |
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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 |
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Term
What 4 things are included in the general assessment of the extremedies |
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Definition
color ease of respirations signs of distress blood pressure ( both upper extremedies in at least 2 places) |
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Term
Inspection of the extremedies includes 8 things |
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Definition
color temperature hair distribution capillary refill skill turgor skin integrity venous pattern nails |
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Term
inspection of extremedies dealing with edema ( the grading scal) |
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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 |
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Term
Inspection of extremedies: Varicose veins |
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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 |
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Term
Inspection of the extremedies: Jugular Venous Pressure |
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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. |
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Term
Evaluation of the chest: inspection of the chest |
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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 |
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Term
Palpation of the extremedies:lymph nodes |
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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 |
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Term
palpations of the extremedies:Homan's test |
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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”) |
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Term
Palpations of the extremedies: peripheral pulses |
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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 |
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Term
What 5 things do you access for peripheral pulses |
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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 |
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Term
Palpation of the apical pulse |
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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 |
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Term
Evaluation of the heart: palpation of the chest: palpate for |
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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 |
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Term
Evaluations of the heart: placed to palpate the chest include |
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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 |
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Term
Evaluation of the heart: how do you relate the chest palpation in relation to the cardiac cycle |
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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 |
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Term
Palpation peripheral pulse locations include: |
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Definition
Locations: Carotid Brachial Radial Femoral Popliteal Dorsalis pedis Posterior tibial |
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Term
palpation across the precordium |
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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. |
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Term
What are the 4 main things to make sure to do when ausculating the chest |
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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 |
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Term
With heart sounds; sound is transmitted in which direction and is heard best over |
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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 |
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Term
Auscultation of the heart should be performed in how many different places with which side of the stethescope |
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Definition
Auscultation should be performed in at least the five cardiac areas With the diaphragm Then with the bell |
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Term
The cardiac auscultatory areas are named after |
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Definition
the areas where the valves are best heard |
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Term
assessment of auscultation should proceed in a |
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Definition
orderly systematic manner; from base of heart to apex, or from apex to base of heart |
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Term
what valves are included in the base and apex ares |
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Definition
Base of the heart Aortic area Pulmonic area Apex of the heart Mitral area |
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Term
what are areas to auscultate on the heart (5) |
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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 |
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Term
Auscultation of extremedies: peripheral vessels |
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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 |
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Term
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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 |
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Term
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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 |
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Term
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Definition
S3 Variation during first rapid filling phase during diastole Heard best at apex Sound Ken-tuc-ky S1 S2 S3 |
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Term
Heart Sound S3: abnormalties and normalties |
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Definition
Normal < 30 yoa Pregnancy Abnormal Fluid overload Mitral or tricuspid regurgitation |
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Term
Heart Sound S3: abnormalties and normalties |
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Definition
Normal < 30 yoa Abnormal Hypertension Mitral or tricuspid regurgitation |
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Term
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Definition
front of ear / side of forhead |
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Term
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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 |
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Term
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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 |
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Term
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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 |
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Term
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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 |
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Term
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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 |
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Term
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Definition
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Term
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Definition
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Term
abnormal findings with heave or lifts |
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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. |
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Term
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Definition
Relatively prolonged extra sounds heard during systole or diastole |
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Term
What causes heart murmurs |
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Definition
Increased blood flow across normal valves Forward flow through a closed valve Backward flow through an incompetent valve |
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Term
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Definition
Location Timing (systolic after S2, dystolic after S1) and duration Describe Pitch-High,Medium,Low Character-Blowing,Harsh,Rumbling Intensity |
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Term
Decribe heart murmurs intesity grade |
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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 |
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Term
Vascular sounds are common in which vessels |
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Definition
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Term
what are the two most common vascular sounds |
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Definition
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Term
The diaphram is used to listen to |
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Definition
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Term
The bell is used to listen to |
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Definition
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Term
Arterial vs. Venous insufficiencies with pain |
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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 |
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Term
Arterial vs. venous insufficiencies with the skin |
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Definition
Arterial: cool,cold,hairless,shiny, pallor, elevated, rubor or dangling
Venous: warm,thickened,motted, brown pigmented areas |
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Term
Arterial vs. Venous insufficiencies with pulses |
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Definition
Arterial: often absent Venous: usually present |
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Term
Arterial vs. Venous insufficiencies edema |
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Definition
Arterial: infrequent Venous:frequent |
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Term
What are normal variations seen in the cardiovascular system that deals seen in new borns and infants |
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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 |
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Term
What are normal variations seen in the cardiovascular system that deals seen in children |
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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 |
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Term
What are normal variations seen in the cardiovascular system that deals seen in pregnant women |
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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 |
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Term
What are normal variations seen in the cardiovascular system that deals seen in the elderly |
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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 |
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Term
checklist form heart and neck vessel exam : neck |
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Definition
1.carotid pulse: observe and palpate 2.observe jugular venous pulse 3.estimate jugular venous pressure |
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Term
checklist form heart and neck vessel exam : precordium inspection and palpation |
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Definition
1. describe location of apical pulse 2. note any heave/lift or thrills |
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Term
checklist form heart and neck vessel exam : auscultation |
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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 |
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Term
When does splitting sometime occur |
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Definition
during inspiration the aortic valve closes .06 seconds before the pulmonary valve |
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Term
definition for risk for activity intolerance diagnosis |
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Definition
at risk for experiencing insufficient psychological or physiological energy to endure or complete required or desired daily activities |
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Term
what are the defining/ related to characteristics of the diagnosis risk for activity intolerance |
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Definition
deconditioned status, history of previous intolerance, inexperience with the activity, presence of circulatory problems; presence of respiratory problems. |
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Term
To review relevant history of a patient for a cardiac assessment you as |
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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 |
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Term
What are the four chambers of the heart |
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Definition
Four chambers Right atria Right ventricle Left atria Left ventricle |
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Term
What are the four valves of the heart |
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Definition
Two atrioventricular Tricuspid Mitral Two semiluunar Pulmonic Aortic |
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Term
what is the order of circulation |
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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 |
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Term
What is the systolic cycle |
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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” |
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Term
What is the dystolic cycle |
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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 |
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Term
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Definition
Marking pencil Centimeter ruler Stethoscope with bell and diaphragm Sphygmomanometer |
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Term
Is a bluish discoloration of the hands and feet in a newborn considered normal? |
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Definition
Yes What is this called? Acrocyanosis |
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Term
In what cases might an S3 or S4 be considered normal? |
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Definition
In persons < 30 yoa In pregnancy |
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Term
An extra heart sound that may be heard as a soft blowing sound during systole is called a: |
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Definition
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Term
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Definition
Rapid filling of the ventricles What does it sound like? Ken-tuc-ky |
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Term
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Definition
Rapid filling of the ventricles What does it sound like? Tennessee |
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Term
What valves closing constitute S1 |
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Definition
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Term
What valves closing constitute S2 |
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Definition
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Term
What are the five cardiac areas for auscultation? |
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Definition
Aortic Pulmonic Erb’s Point Tricuspid Mitral |
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