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cardiac assessment

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how are pulses rated?
0-4. 0=absent, 1 weak, 2 normal, 3 full, 4 bounding.
how do you measure pulse pressure?
the difference between systole and diastole should be no more than 1/3 of the systolic pressure
where is ventricular diastole heard best?
at the base of the heart (so up at the top)
during ventricular diastole what happens to the valves?
the aortic and pulmonic are closed (so the ventricle can fill) and the tricuspid and mitral are open.
what is the atrial kick?
it is 25% of cardiac output, it happens near the end of diastole.
when do the mitral and tricuspid valves close?
when pressure in the ventricles is too much. (thus is stops filling, and then aortic and pulmonic open to allow it to leave)
what is stroke volume?
amount of blood ejected with each contraction. the normal is 60-100 ml (same as pulse rate!)
the closure of the aortic and pulmonic valves begins what?
diastole
what is cardiac output? How do you measure it?
amount of blood ejected each minute. CO= SV X HR.
preload
volume of blood in ventricles at the end of diastole (usually expressed as a pressure)
Afterload
reflects end systolic volume (end systolic pressure)
what might you expect to find in children?
and s3 sound. innocent murmers, a horizontal heart (apex at 4th ICS)
what might be present in pregnant clients?
mammary souffle murmer
what might be present in older clients?
ausculatory gap.
what is the #1 killer of women?
CAD
How do heart problems effect african americans?
early onset and greater severity of CAD, black women have a greater incidence than white women of CAD
How do heart problems affect asians?
they have lower incidence of hypertension and hyperlipidemia
how do hart problems affect native americans?
they have twice the mortality rate under the age of 35 than other nationalities
how do cardiac problems affect white people?
we have the highest incidence of CAD
what sympotms spell heart trouble?
dyspnea, cough, snycope, fatigue, changes in extremities, edema, palpatations, chest pain.
when it comes to respirations and positioning and waves, describe the difference between carotid and jugular
carotid has one wave, it is not affected by position or breathing. The jugular has 3 waves, it IS affected by positioning and breathing.
when you compresse the jugular at the clavical what happens?
wave dissapears
when you compress the jugular at the jaw what happens?
wave is more prominate at subclavicular area
what would an accentuated s1 sound indicate?
anemia, hypertension, or exercise
what would an accentuated s2 sound indicate?
systemic hypertension
what would an ejection sound (or click) represent?
aortic/pulmonic stenosis
what would an opneing snap mean?
mitral/tricuspid stenosis
a "normal" s3 indicates what?
it is normal in children and some young adults, but it is abnormal in adults and means heart failure
what does a normal s4 indicate?
hypertention,...may be normal in athletes
what does a pericardial friction rub indicate
acute MI!!!! occurs in both systole and diastole
bruits and venus hums,..can you acclude them?
you can occlude a venous hum, but not a bruit
what are the 4 sites for lymph nodes?
cervical, axillary, epitrochlear, inguinal
what is patency, and what test could you use to assess this?
patency is normal refil, you could use the allen test to assess it on the radial and ulnar arteries before you go and puncter them.
what is teh ankle brachial index?
it assesses circulation at the feet. Use a doppler to measure blood pressure at the poteriaor tibialis or dorsalis pedias. Then compaire that pressure that one one obtained at the brachial artery. Devide the systolic pressure at the ankel, by the one at the brachial site. Normal would be 1 or greater. .8-.9 is minimal disease, .8-.4 is moderate disease, .4-0 is severe disease. *so obviously you want thsi number to be HIGH.
what is the manual compression test?
it is used if the client has varicosities. You are assessing for valve compliance. With the client standing compress the distal portion of the vein, then the proximal portion of the vein. if the valves are complient then you will not feel any backflow, if they are incompliant you will feel a wave pulsation with your lower hand when pressing on the proximal section.
what should you do for arterial insufficiancy?
put feet DOWN.

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