Cardiac A&P
State the route that blood flows through the heart, beginning with the vena cava(s).
Vena Cava --> Right atrium --> Tricuspid (atrioventricular: AV or bicuspid) valve --> Right ventricle --> Pulmonary (semilunar: SL) valve --> Lungs --> Left atrium --> Mitral (AV or bicuspid) valve --> Left ventricle --> Aortic (SL) --> Aortic branch --> body
State at least one question that pertains to the client's present cardiac health condition.
Do you have any problems with your heart now?
Do you have (had) pain in your chest? Follow up with OLDCART & ICE questions
Do you have pain in your upper body (arms, back, neck, jaw, stomach)?
Do you have shortness of breath (air)? AKA dyspnea? Follow up: long, activities, ambulation, pillows or elevation
Notice changes in your skin color (pallor, blueness, greyish)
Do you have swelling in your legs or feet? (long, both, worse as day goes)
Notice any weight changes or clothes not fitting like they use to?
Feelings of fast or skipping heart beats?
Dizziness or fainting occur? (when, anything else)
Do you have a cough? (long, worseness, sound like, activities)
A nurse is inspecting the neck vessels: what is the nurse assessing for a client who needs a focused CV assessment?
Bonus: What is the expected findings?
Neck: noting the jugular veins and carotid arteries.
Client: placed in 35-45 degree angle.
Bonus: Carotid will have pulsations (+2).
Jugular veins won't have distention. If there is full, bulging, or bounding (+3, +4), can indicate right-sided HF
State the auscultation order of the valves and Erb's point.
BONUS: State the valve location.
Aortic - Right 2nd ICS
Pulmonic - Left 2nd ICS
Erb's point - Left 3rd ICS
Tricuspid - Left 4th ICS
Mitral - Left 5th MCL
A nurse palpates a bounding, strong carotid pulse. The nurse this can indicate which heart function condition?
A. Blockage
B. Fluid overload
C. Narrow artery
D. Low blood volume
B. Fluid overload d/t heart failure.
A, C, D, will have a diminished or weak carotid pulse.
What is the pericardium?
Bonus: What are the two major layers called?
Thin sac of layers that surrounds the heart.
The layers are known as parietal and visceral
State at least one question that pertains to the client's present peripheral vascular health condition.
Leg pain or cramping? (OLDCART & ICE)
Skin color changes to arms or legs? (Redness, pigmentation, pallor, blue, or brown discolorations)
Temperature changes
Leg veins bulge or crooked? (treat them)
Leg sores? (present, treatment)
Swelling in legs or arms? (long, one or both, worse or better)
Where is the point of maximum impulse (PMI) palpated?
Apex of the heart, (5th L ICS, MCL) aka at the location of mitral valve. Also known as the apical impulse
When the nurse auscultates "murmurs", what might be the underlying medical diagnosis?
Valvular regurgitation or stenosis.
Regurgitation: backflow d/t restriction of forward flow.
Stenosis: narrowing d/t the valve not opening fully.
A nurse is caring for a client who complains of chest pain. Which intervention is NOT appropriate?
A. Place in a semi-Fowler's position.
B. Notify the rapid response team.
C. Apply telemetry for continuous monitoring.
D. Encourage the usage of the incentive spirometer.
D. Encourage the usage of the incentive spirometer is not appropriate for a client with chest pain.
A-C is appropriate. Along with ensuring patent IV access and applying oxygen via NC.
What are the three layers of the heart wall called?
Epicardium: close to the visceral pericardium
Myocardium: thick, muscular layer
Endocardium: innermost smooth layer, lines the heart chambers, blood vessels, valves.
State at least one question that pertains to the client's past cardiovascular health history.
Been told you have high cholesterol, high triglycerides, or high BP?
Diagnosed with a heart disease, condition, infection, or viral illness?
Do you have diabetes?
A nurse is inspecting the anterior chest for chest movement symmetry and pulsation. What does the nurse expect to find in the PMI (point of maximum impulse) area?
Visible gentle pulsations.
If the client is obese or very muscular the pulsation of PMI might not be visible.
Very thin walled clients (peds) there might be more visible pulsation of the PMI
A nurse notes a S4 gallop upon auscultation. What may this indicate?
Heart disease and valve malfunction: ventricular hypertrophy, acute MI, angina, ventricular aneurysm. This is due to the association with active atrial contractions causing late ventricular filling.
"TE Nuh See" S4, S1, S2 (Tennessee)
A nurse notes an ulcer on the client's medial ankle. Which of the following findings indicates that it is a venous ulcer? (select all that apply)
A. Irregular or flat wound border with a pink ulcer wound.
B. Foot is cool with hair loss.
C. Pain occurs while at rest and absent pedal pulses.
D. Leg edema and ankle discoloration.
A. Irregular or flat wound border with a pink ulcer wound
D. Leg edema and ankle discoloration. Additional findings of venous = no pain at rest, there are pedal pulses present.
B & C are arterial ulcer findings, along with regular, even, wound border with a pale wound ulcer; usually located at the end of the toes.
When does systole occur?
Ventricular contraction d/t ventricle contract to expel blood into aorta and pulmonary arteries.
Begins with closure of "lub" S1 (AV valves) and closure of "dub" S2 (SL valves)
S1 --> SILENT systole --> S2
State at least one question that pertains to the client's family history when it comes to cardiovascular assessment.
Immediate family have hypertension?
Cardiovascular problems?
Sudden death at a young age?
What is the typical rate of blood return when assessing for capillary refill?
Less than 3 seconds.
A nurse notes a S3 gallop upon auscultation. What may this indicate?
Ventricles reached its elastic limit, causing blood flow to slow down from the atrium. Medical diagnosis may be: systolic or diastolic ventricular dysfunction, ischemic heart disease, tricuspid, mitral, or aortic regurgitation, volume overload, hypertension. Poor prognosis if client also has HF.
"Ken Tuc KY" S1, S2, S3 (Kentucky)
Which of the following leads to increased risk for CV complications?
A. Drinking 4 ounces of red wine weekly.
B. Does not smoke or vape or chew tobacco.
C. Ingests 3,500 mg of salt daily.
D. Cardiovascular training of 150 minutes per week.
C. Ingests 3,500 mg of salt daily. Max salt intake should be 3g or 3,000 mg daily
When does diastole occur?
Ventricular relaxation d/t the ventricles relaxing and refilling.
Begins: Closure of "dub" S2 (SL) and ends with closure of "lub" S1 (AV)
S2 --> SILENT diastole --> S1
State at least one question that pertains to the client's behavior when assessing for cardiac health conditions.
Describe your diet, past 24 hours (salt, fat-saturated/unsaturated, protein, carbohydrates).
Smoke, vape, or chew tobacco? (how much, years)
Alcoholic beverages (daily, weekly, last drink)?
The nurse is caring for a client who had a femoral-popliteal bypass and is unable to to palpate the following pulses, dorsalis pedis and posterior tibial. What is the nurse's next course of action?
Obtain the doppler, to auscultate. Then mark with a permanent marker the sites for future assessment.
A student nurse asks "which valves close during the 'dub' sound?" What would be the most appropriate response?
Aortic and pulmonic valve closure.
S1 "lub" is the closure of mitral and tricuspid valves", best auscultated at the PMI.
The nurse is assessing a client's heart sounds and has difficulty auscultating the first heart sound, S1. Which nursing response is most appropriate?
A. Listen at the base of the heart.
B. Listen only for higher pitched sounds.
C. Ask the client to lay on the left side.
D. Ask the client to hold their breath for 15 seconds.
C. Ask the client to lay on the left side.
Laying on the left alllows the sounds to be more audible for auscultation. S1 is low pitches and best heard at the apex (not the bases). S2 is higher pitched, better at the base
Holding the breath is good to distinguish between a cardiac or lung friction rub.