Term
| Subjective Data Question: 1 |
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Definition
| Do you tire easily or experience fatigue? |
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Term
| Subjective Data Question: 1 - rational |
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Definition
| Fatigue may result from compromised cardiac output. Fatigue related to decreased cardiac output is worse in the evening or as the day progresses. |
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Term
| Subjective Data Question: 2 |
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Definition
| Have you ever had heart surgery or cardiac balloon interventions? |
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Term
| Subjective Data Question: 2 - rational |
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Definition
| Heart surgery may change the heart sounds and indicate prior cardiac compromise. |
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Term
| Subjective Data Question: 3 |
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Definition
| Have you ever had a lipid profile blood test? If so, do you know what your cholesterol levels were? |
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Term
| Subjective Data Question: 3 - rational |
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Definition
| Dyslipidemia presents the greatest risk for developing coronary artery disease and elevated cholesterol levels have been linked to the development of atherosclerosis. |
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Term
| Subjective Data Question: 4 |
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Definition
| Do you take medications or use other treatments for heart disease? How often and why do you take them? |
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Term
| Subjective Data Question: 5 |
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Definition
| Do you monitor your own hear rate or blood pressure? |
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Term
| Cardiovascular Function Assessment: |
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Definition
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Term
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Definition
| Assist client to supine or semi-Flower's position (30-45 degrees), keeping the head and the torso on the same plane. |
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Term
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Definition
| Expose chest while providing privacy. |
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Term
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Definition
| Inspect skin color: "It is within normal limits for race." |
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Term
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Definition
| Inspect for symmetry: "The chest is symmetrical on both sides." |
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Term
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Definition
Inspect for pulsations: "The jugular veins are not fully distended."
Inspect descending aorta for AAA (abdominal aortic aneurysm). |
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Term
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Definition
| Inspect extremities for edema, reduced hair growth, changes in pigmentation, and thick nail growth. |
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Term
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Definition
| Identify and palpate PMI (point of maximal impulse), aka apical impulse. If you cannot palpate the apical impulse, have the pt lean forward because it moves the heart forward. |
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Term
| 8 - The apical impulse is located... |
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Definition
| ...at the 5th intercostal space (ICS), slightly lateral to the midclavicular line (MCL). |
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Term
| 9 - The apical impulse is a result of... |
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Definition
| ...the left ventricle moving outward during systole. |
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Term
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Definition
| Auscultate the apical pulse for one minute. |
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Term
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Definition
| Auscultate the heart by placing stethoscope at all four locations and identifying the sounds heard. |
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Term
| 12 - S1 corresponds with... |
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Definition
| ...each carotid pulsation. |
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Term
| 13 - S1 is the loudest at... |
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Definition
| ...the apex of the heart. |
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Term
| 14 - S2 is the loudest at... |
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Definition
| ...the base of the heart. |
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Term
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Definition
| "Lateral to the sternum on the right, at the 2nd ICS, I'm listening to the aortic valve and it sounds normal (no murmurs or irregular rhythms)." |
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Term
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Definition
| "Lateral to the sternum on the left, at the 2nd ICS, I'm listening to the pulmonary valve." |
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Term
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Definition
| "Below that at the 3rd ICS is Erb's point, which is not a valve location, but just a point where we can also hear heart sounds." |
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Term
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Definition
| "At the 4th ICS, left MCL, I'm listening to the tricuspid valve." |
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Term
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Definition
| "At the 5th ICS, slightly lateral to the MCL, I'm listening to the PMI (aka apical impulse) and the mitral valve." |
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