Assessment
"How many pillows do you sleep on?" helps the RN assess for this
orthopnea
This is the cause of a murmur at the apex that radiates into the axilla
MR.
Where is the apical pulse?
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
This is when to use the bell of the stethoscope
low pitched (ie murmurs) or bruits
This is the cause of a loud murmur to the R sternal border 2nd ICS radiating into the neck
AS
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 pulmonic artery to lungs
This assessment should reveal brisk response < 3 sec
capillary refill
Why do we get this?
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
Fill in the blank for blood flow: LA, mitral valve, LV, ?, ?
aortic (SL) valve, aorta, systemic circulation
Normal pulse amplitude AND the scale
2+. Pulses are graded as 0, 1+ weak or thready (eg low volume like dehydration), 2+, 3+ full or bounding (eg anxiety)
"Ripping" or "tearing" are commonly used words patients use to describe this EMERGENT condition
Name 3 modifiable causes of CVD
obesity, smoking, lipids, BP, sedentary lifestyle
How to palpate a normal pulse vs abnormal
30 sec x2 manually or with Dinamap; 60 sec manually
increases it
JVD is present when supine and should be absent when pt is elevated to this many 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
CHF