Assessment
"How many pillows do you sleep on?" helps the RN assess for this
orthopnea
5th ICS MCL
Cause of S1
AV valve closure at the end of diastole (the ventricle has finished filling so the valve closes "lub"), and signals the start of systole, so it coincides with the carotid pulse. You can feel a pulse in sync with S1.
Location of a murmur
a murmur is confined to just heart sounds caused by turbulent blood flow
This occurs to BP in the geriatric population
higher d/t increased systemic vascular resistance caused by plaques blocking and narrowing the arteries
Bell vs diaphragm
low pitched including S3, S4 and murmurs vs high pitched
Differentiate pericardium from myocardium
sac around the heart, muscle of the heart
Cause of S2
closure of SL valves
Cause of a thrill
turbulent flow, likely from a murmur. A thrill is something you palpate and feel- remember "t" for thrill and touch or the "t" in palpate
This occurs to BP in pregnancy
lower d/t vasodilation to reduce systemic vascular resistance
How to palpate carotid arteries
one at a time. arteries are carrying oxygenated blood to the heart and extremities from the aorta
Fill in the blank for blood flow: RA, tricuspid valve, RV, ?, ?
pulmonic (SL) valve to lungs
This assessment should reveal brisk response < 3 sec
capillary refill
Location of a bruit
a bruit can be in any narrowed artery- renal artery, carotid artery, etc caused by turbulent blood flow
Timeframe for which a murmur is normal in an infant
2-3 days after birth
The first thing to assess for when auscultating the heart
Rate and rhythm, then S1/S2, then extra heart sounds
aortic (SL) valve, aorta, systemic circulation
Normal pulse amplitude
2+. Pulses are graded as 0, 1+ weak or thready (eg low volume like dehydration), 2+, 3+ full or bounding (eg anxiety)
What dx to suspect when a pt c/o chest pain, pressure, radiating to the jaw and upper arm, diaphoretic, n/v
MI
Name 3 causes of CVD
obesity, smoking, HLD, HTN, sedentary
How to palpate a normal pulse vs abnormal
30 sec x2 manually or with Dinamap; 60 sec manually
increases it
JVP should be absent when pt is elevated to X degrees
45 degrees. JVP may pulsate when supine- gravity makes it easier (see pic on p 481)- but should disappear when pt is upright
What dx to suspect FIRST when a pt c/o substernal pressure, similar to heartburn
MI
What murmur would you hear at the R 2nd ICS radiating into the neck
aortic stenosis. the base of the heart is higher and leans to the right of the chest. the aorta splits off into the carotids