S1 is the closure of ?
AV valves.
What may be used to identify which heart sound is S1?
s1 is louder at the apex of heart
What cardiac alterations occurs in the pregnant female?
An increase in cardiac volume and a decrease in blood pressure
What is an appropriate position to have the patient assume when auscultating the heart sounds?
Roll toward the left side
What does NOT increase in the pregnant female?
Blood pressure
A bruit heard while auscultating the carotid artery of a 65-year-old woman is caused by?
Turbulent blood flow through the carotid artery
The semilunar valves separate the:
ventricles from the arteries.
Varicose veins are characterized by:
dilation and tortuosity when the extemities are dependent
In an older adult male, gynocomastia may be secondary to:
a decrease in testosterone, loss of hair
Susan Winer, age 42, comes to the clinic because she has a small lump on her left breast. The nurse investigates Ms. Winer's obstetric history. How is her risk of breast cancer affected by childbearing?
The risk increases if she is childless.
Which inspection finding may be abnormal, while giving a breast exam?
unilateral nipple inversion
How should the nurse position Ms. Winer for palpation of the axilla and breasts?
supine with a pillow under the shoulder of the side being examined and the arm on that side over the head
The nurse palpates Ms. Winer's lymph nodes. Where should the nurse palpate to assess the lateral nodes?
inner aspect of the upper arm
During breast palpation, the nurse finds a small lump. Which characteristic of a lump suggests breast cancer?
irregularity
Nipple discharge of what fluid is associated with breast cancer?
bloody
Stan Green, age 32, is admitted to the hospital with pneumonia secondary to AIDS. When palpating the superficial lymph nodes, which technique should the nurse use?
gently palpate using the pads of the index and middle fingers
Marion Clark, age 70, has metastatic breast cancer. When palpating Ms. Clark's lymph nodes in the affected area, how should the nurse expect them to feel?
hard
Ms. W. has been diagnosed with fibrocystic disease. You know this is significant. Why?
Fibrocystic disease makes it more difficult to examine the breasts.
During your examination of a woman, you notice that her left breast is slightly larger than her right breast. What does this mean?
This finding is not unusual but you should verify that this change is not new.
You are performing a well-child check on a 5-year-old boy. He has no current history that would lead you to suspect illness. His past medical history is unremarkable. He did receive immunizations 1 week ago. What would be considered normal in this situati
Palpable firm, small, shotty, mobile, nontender lymph nodes
S1 heart sound
-created by the closing of the AV valves (tricuspid and mitral)
-Occurs at the beginning of ventricular systole
-Best heard at the apex
-"Lub
S2 Heart sound
-created by the semi-lunar valves closing (aortic and pulmonic)
-Occurs at the end of systole and the beginning of ventricular diastole
-Best heard at the base
"Dub"
-Physiological S2 split
S3 Heart sound
-ventricular filling sound;
-occurs in ventricles are resistant to filling during the early rapid filling phase;
-dull, soft sound, with low pitch.
-Best heard when client lying on left side at apex
S3 heart sound is heard
Right after S2
associated with heart failure
S4 heart sound
-ventricular filling sound;
-occurs at the end of diastole when the ventricle is resistant to filling
-just before s1
-very soft, of very low pitch.
-LA lub dub
S4 is heard
-Just before S1
-Best heard with client lying on left side at apex
-resistance to filling
Pathologic S4
(atrial gallop/S4 gallop) occurs with decrease compliance of the ventricle and systemic overload, including outflow obstruction to the ventricle and systemic hypertension.
Physiologic S4
occurs in adults >40 or 50 y/o with no history of cardiovascular disease.
Physiologic S3
-Can be normal in kids, pregnancy, and young adults;
-disappears when the person sits up.
Murmur
Gentle, blowing, swooshing sound caused by turbulent blood flow or alteration in blood flow.
Characteristics of sounds
FIDT
-Frequency (pitch)
-Intensity (loudness)
-Duration
-Timing
Bruit:
-Blowing/swishing sound.
-Typically signifies plaque build up in artery.
-Sound is blood getting hung up because of plaque
which is louder at the apex of heart
S1 is louder than S2 at the apex (feel the coratid: S1)
S1 characteristics
-S1 coincides with carotid artery pulse
-S1 coincides with R wave on electrocardiogram
Splitting sound:
Lubbs are almost on top of each other but will disappear when holding breath
What does swishing mean when auscultating s2
A heart mummer due to leaky valve
S4 comes before
S1
Heart history questions
-Chest pain (When did it begin, how frequent, point to the pain, any symptoms? Nausea, Jaw pain, arm pain, lower back pain)
-Shortness of Breath
-Dyspnea on Exertion (DOE: when you are doing something)
-Orthopnea (How many pillows do you need to sleep wit
Blood flow through heart
S&I--> RA-->TV-->RV-->PA-->PV-->LA-->MV-->LV-->AV-->A
Systole
A phase during which the ventricles contract and eject blood into the pulmonary and systemic circuits.
Diastole
Phase of the cardiac cycle in which the heart muscle is relaxed.
Physiologic S3 is normal in
Kids, pregnancy, and young adults.
jugular vein distension reasons
To determine right-sided heart failure and the backing up of the superior vena cava, slowing drainage of the jugular veins.indicator of heart failure
pleural friction rub
dry, rubbing, or grating sound, ususally caused by inflammation of pleural surfaces; heard during inspiration or expiration
paroxysmal Nocturnal Dyspnea
sudden awakening from sleeping with shortness of breath
common w/ heart failure
orthopnea
An abnormal condition in which a person must sit or stand to breathe deeply or comfortably.
sequence of cardiac assessment
Five spots: APETM
Listen diaphragm , then re-listen with bell, have them roll over to listen for s3 &s4 . (Pick up lower pitched sounds, murmurs)
Persons at risk for cardiac disease and stroke
Person who participates in smoking, sedentary lifestyle, poor nutrition, elicit drug use, hypertension, women, obese, Type 2 DM
Pulse sites
temor, Brachial, carotid, dorsal pedal, femoral, popliteal, posterior tibial, radial, temporal. The carotid and radial sites are the most common sites for measuring a patient's pulse rate.
Lymph system
This system is a separate vessel system. 2 main functions of it are to transport excess fluid from interstitial spaces to the circulatory system & to protect body against infectious organisms.
Location of lymph nodes
head, neck, breast, axilla, inguinal, clavicle and popliteal areas
CRT
Capillary Refill Time
Homan's sign
Pain in the calf when the foot is passively dorsiflexed, can indicate DV
Normal Cardiac findings in children
-Hearts position is more horizontal
-Apex is higher
-Physiologic S3
-venous hum
-innocent heart mumurs
Heart valves
-Atrioventricular (Separates atria and ventricles)
-Tricuspid (right AV)
-mitral (Left AV)
-Semi lunar valve (between ventricles and arteries)
First heart sound occurs with closure of which valve and indicated the beginning of?
Closure of the AV valves (Beginning of systole, mitral proceeds tricuspid "m1 then t1, but usually heard as one)
S2 occurs with the closure of?
Closure of the semi lunar valves. (Signals end of systole. aortic proceeds pulmonic "A2 then P2")
S3 occurs when
The ventricles are resistant to filling during early rapid filling phase
. (Normally a silent event, sometimes causes vibrations that can be heard over chest)
S4 occurs when
At the end of diastole, pre systole. Only when the ventricle is resistant to filling. The atria contracts and pushes blood into a noncompliant ventricle. This creates vibrations that are heard as S4, just before S1
Thrill
A Palpable vibration. It feels like the throat of a purring cat. Signifies turbulent blood flow and accompanies loud murmurs.
lift/ heave
retraction at the apex because of the left ventricle is rotated posteriorly by the enlarged right ventricle
common: hypertension/chronic lung disease
apical impulse
(point of maximal impulse, PMI) pulsation created as the left ventricle rotates against the chest wall during systole.
Location of apical impulse
normally at the 5th left intercostal space in the midclavicular line
Aortic valve area is best heard
Second right interspace
Pulmonic valve area is best heard at
Second left interspace
Tricuspid valve area is best heard at
Left lower sternal border
Mitral valve is best heard at
Fifth interspace around left midclavicular line
Stethoscope should be used in what pattern?
Z pattern to hear sounds produced over precordium
Split S2
normal phenomenon that occurs toward end of inspiration. Inspiration separates timing of two valves closure. hear "t-dup". Only heard in pulmonic valve area "second left interspace
flow of lymph
Drain into two main trunks which empty into the venous system at subclavian veins,: -Right lymphatic duct (empties into right subclavian vein, drains the right side of head, neck, r. arm, r. thorax, r. lung, e. pleura, r. heart, r. liver) - Thoracic duct
Lymph nodes of children
-Relatively large in children
-palpatable even when healthy
-with swelling excessive swelling and hyperplasia occur.
Types of edema
-Bilateral, dependent pitting edema: occurs with heart failure, diabetic neuropathopy, and hepatic cirrhosis.
-Unilateral edema: occlusion of a deep vein, lymphatic distruction.
How to do a breast exam
Use pads of fingers and press down, do little circles, hit every inch, nothing left untouched. Lymph nodes, armpit. (Sitting then lying)
Vertical strip pattern: up and down. don't miss any, cover entire breast,
Risk factors for breast cancer
-No child after 30
-Oral contraceptive use
-High dose radiation to chest
-never breast fed
-obesity
-sedentary lifestyle
Evaluation of lumps
Location
Size
Shape
Consistency
Mobility
Distinctness
Nipple retraction
Overlying skin
Tenderness
Lymphadenopathy
benign breast disease vs. Breast cancer
Benign breast disease: multiple tender masses, swelling, pain, dominant lumps, nipple discharge, infections.
Breast cancer: one unilateral tender mass in one location
Gyncomastia
Due to low levels of testosterone, grow breasts, lose hair.
Location of most breast cancers
Tail of spense
Changes of aging breasts
-Pendulous, flat, and sagging
-nipples may be retracted but can be pulled outward
-more granular, granular ducts feel more prominant and stringy.
BSE timing
Do 4-7th day of period, if irregular: mark it on the calendar, in shower but in front of mirror.
Blood flow through heart and body
Deoxygenated blood: Superior and inferior venae cavae > right atrium > tricuspid valve > right ventricle > pulmonary semilunar valves > pulmonary trunk > Pulmonary arteries > lung tissue(Pulmonary circulation) > Pulmonary veins(oxygenated blood) > left at
Diaphragm
higher pitched sounds
S1
Bell
lower pitched
Bruit
Normal cardiac finding for children
apical pulse may be visible, sinus arrhythmia, increase HR, S3 common , venous hum, innocent murmurs
Aging adult cardiac findings
increased systolic BP, increase workload on heart, increase pulse pressure, decrease HR, diastolic decrease
Abnormal S1 &S2
loud, faint, varying intensity
accented, diminished
extra heart sounds
click- mitral & aortic
Snap- caused by high atrial pressure needed to open valve
structure of the heart
The leaflets of the tricuspid and mitral valves are anchored by __________________ to the _________________, which are embedded in the ventricular floor.
chordae tendinea and papillary muscles
The ability of the heart to contract independently of any signals or stimulation is due to:
automatic
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