Maryville 612 Exam 2 Advanced Health Assessment Questions and Answers 100% Pass

Maryville 612 Exam 2 Advanced Health Assessment Questions and Answers 100% Pass What is S4 indicative of? In the 2nd phase of ventricular filling, vibration in the valves, papillae, and ventricular walls produce S4. When there is increased resistance to filling because ventricular walls have lost compliance. HTN, CAD or increased stroke volume high output, anemia, pregnancy, and thyrotoxicosis. A loud S4 suggest pathology and deserves additional evaluation. What is the apical PMI? Point of maximal impulse (PMI), the point at which the apical impulses are most readily seen or felt. Usually at the 5th ICS, midclavicular line in adults. 4th ICS medial to nipple in children. What is normal or abnormal in relation to PMI? Normal- 1cm diameter, gentle, brief, not lasting as long as systole. Abnormal- Heave or lift (vigorous apical pulse outside above normal parameters), most often left sternal border, displacement. Thrill- (palpable murmur, vibration) most often at base of heart right or left 2nd ICS. When assessing family history what questions do you ask for CV history? Long QT syndrome. Marfan syndrome-genetic, connective tissue disease MVR/MVP, AR, AD. DM, heart disease, HLD, HTN, obesity, congenital heart disease, morbidity, mortality r/t heart, age at time of illness or death, especially young and middle age relatives. What questions do you ask for patient history in MI? Heart surgery/hospitalization for cardiac evaluation, congenital heart disease, rhythm, acute rheumatic fever, Kawasaki disease. What creates each heart sound? S1-first heart sound (lub), ventricular contraction, closure of the mitral and tricuspid valve (AV valve), beginning of systole, heard best at apex, lower pitch. S2-Second heart sound (dub), aortic and pulmonic valve closure (SL valves), end of systole, best heard at base, higher pitch. S3-Early passive diastole phase that causes distention in the ventricular walls and vibration, ventricular filling phase, best heard in the left lateral recumbent position, Ken-TUCK-y, right after S2. S4-2nd phase of active ventricular filling, vibration in the valves, papillae, and walls produce sound, TEN-nes-see, right before S1. What heart sound are normal and abnormal? Normal S1-S4. Abnormal- pericardial friction rub, clicks, snaps, murmurs: stenosis, regurg, prolapse. What is the correct documentation of abnormal heart sounds? Timing and duration systolic, diastolic, holostystolic, holodiastolic, early late phases, continuous. Pitch (high, med, low). Intensity (grade 1-7). Pattern: crescendo, decrescendo, square or plateau. Quality- harsh, raspy, machine like, vibration, musical, blowing. Location-landmarks, ICS, sternal border, apex, base. Radiation-landmarks, axilla, carotid. Respiratory phase-intensity, quality, and timing. How do you document bounding arterial pulses? Pulse amplitude on a scale from 0-4. 0- Absent, not palpable 1- Diminished, barely palpable 2- Expected 3- Full, increased 4- Bounding, aneurysmal What arterial pulse best assess heart rate? Palpate the arterial pulses (most often radial) to assess the heart rate and rhythm. Infants the brachial, radial, and femoral pulses are easily palpated. What are the steps to a carotid artery exam? Place the bell of the stethoscope over the artery. When listening to the carotid artery, ask the patient to suspend his/her breath for a few heartbeats so that respiratory sounds will not interfere with auscultation. You should hear venous hums and carotid bruits. In a carotid exam what do you do or not do? Do not palpate both sides simultaneously. This can cause a drop in heart rate and blood pressure resulting in a syncope and decreasing blood flow to the brain. Why assess JVD? The activity of the right side of the heart is transmitted back through the jugular veins. What position should the pt. be in to assess JVD, what is abnormal? The patient should be in a supine position using a bed or exam table with an adjustable back. Use a light to illuminate the side of the neck that is being examined. What are the causes of murmurs? Murmurs are caused by some disruption in the flow of blood into, through, or out of the heart. Common causes are diseased valves (stenosis or regurg). Valve insufficiency produce what type of murmur? Regurgitation Describe murmurs? Heart murmurs are relatively prolonged extra sounds heard during systole and diastole. Murmurs are caused by some disruption in the flow of blood into, through, or out of the heart. Stage murmurs for documentation Timing, duration, pitch, intensity, pattern, quality, location, radiation, and respiratory phases. What stethoscope placement is best for heart sounds? 5 Cardiac area Aortic valve area: 2nd right ICS at the right sternal border Pulmonic valve area: 2nd left ICS at the left sternal border 2nd pulmonic area (Erbs point): 3rd left ICS at the left sternal border, S2 is heard best here Tricuspid area: 4th left ICS along the lower left sternal border Mitral area: apex of the heart in the 5th left ICS at the MCL.