NURS 6512 Final Exam Review (Week 7-11)
Heart, Lungs, and Peripheral Vascular (Week 7: Ch. 13, 14, & 15)
• Examination techniques of the Heart, Lungs, and PV systems (See Notes)
• Examination findings of arterial blood flow in infants (339) (345)
o At birth the cutting of the umbilical cord, through which oxygen has been
provided in utero, requires the infant to begin breathing. The onset of
respiration expands the lungs and carries air to the alveoli.
o When pulse is weak, expect cardiac output bay be diminished or peripheral
vasoconstriction may be present. A bounding pulse is associated with a large left-
right shunt produced by a patent ductus arteriosus. In coarctation of the aorta, a
difference is noted in pulse amplitude between the upper extremities or between
the femoral and radial pulses or the femoral pules are absent capillary refill times
in infants and children younger than 2 years of age are raid, less than 1 second. A
prolonged capillary refill time, no longer than 2 seconds, indicates dehydration or
hypovolemic shock.
• Examination findings of the heart and lungs in a patient with illegal drug use (266)
o If an adult- especially young- or an adolescent describes severe, acute chest pain,
ask about drug use, particularly cocaine. Cocaine can cause tachycardia,
hypertension, coronary arterial spasm (with infarction), and pneumothorax (lung
collapse) with severe acute chest pain being the common result.
• Description: shortness of breath (orthopnea, platypnea. Tachypnea, bradypnea) (265)
o Orthopnea- shortness of breath that begins or increases when the patient lies
down; ask whether the patient needs to sleep on more than one pillow and
whether that helps.
o Platypnea- dyspnea increases in the upright posture.
o Tachypnea- increased rate of respirations of breath; abnormally rapid
breathing. (COPD or Pneumonia)
o Bradypnea-breathing more slowly than normal, could mean the body isn’t getting
enough oxygen. (sleep apnea, drug overdose, carbon monoxide poisoning)
o Paroxysmal nocturnal dyspnea- sudden onset of SOB after a period of sleep;
sitting upright is helpful.
• Symptoms associated with intrathoracic infection
o The patient may have any combination of the nonspecific symptoms, such
as fever, dry or productive cough, blood-streaked sputum, shortness of
breath, chest pain, weight loss, fatigue, and anorexia. Physical examination may
reveal abnormal breath sounds.
• Percussion techniques when examining the lungs (273-275)
o Percuss the chest directly or indirectly, comparing sides in three areas. On the
1
,posterior chest, percuss with the patient’s head bent forward and arms folded in front.
On the
2
, lateral chest, percuss with the patient’s arms raised. On the anterior chest, percuss with
the patient in the same position.
• Examination findings when percussing the lungs (274)
o You should hear resonance over all lung areas. Hyperresonance associated with
hyperinflation may indicate emphysema, pneumothorax, or asthma. Dullness or
flatness suggests pneumonia, atelectasis, pleural effusion, pneumothorax, or
asthma. Percuss Tones Heard over the Chest (274)
• Cardiac examination findings for a patient with rheumatic fever (330-331)
o Systemic connective tissue disease occurring after streptococcal pharyngitis or
skin infection. Patho- characterized by a variety of major and minor
manifestations (major: carditis, polyarthritis, chorea, erythema marginatum,
subcutaneous nodules) (minor: previous rheumatic fever, arthralgia, fever,
laboratory, clinical). May result in serious cardiac valvular involvement of mitral
or aortic valve; tricuspid and pulmonic are not often affected. Affected valve
becomes stenotic and regurgitant. Children between 5 and 15 years of age are
most commonly affected. Prevention-adequate treatment for streptococcal
pharyngitis or skin infections-is the best therapy. Subjective Data- fever,
inflamed swollen joints, flat or slightly raised, painless rash with pink margins
with pale centers and a ragged edge (erythema marginatum). Aimless jerky
movements (Sydenham chorea or St. Vitus dance). Small, painless nodules
beneath the skin. Chest pain, palpations, fatigue, or shortness of breath. Objective
Data- characterized by a variety of major and minor manifestations. Murmurs of
mitral regurgitation and aortic insufficiency. Cardiomegaly, friction rub of
pericarditis, or signs of CHF.
• Grading of heart murmurs (311-313)
o Diseased valves, a common cause of murmurs, either do not open or close well.
When the leaflets are thickened and the passage narrowed, forward blood flow is
restricted (stenosis). When valve leaflets, which are intended to fit together
snugly, lose competency and leak, blood flows backwards (regurgitation).
o Characterization of Heart Murmurs (313)
• Evaluation of ECG tracings (298-299)
o An electrocardiogram (ECG) is a graphic recoding of electrical activity during the
cardiac cycle. The ECG records electrical current generated by the movement of
ions in and out of the myocardial cell membranes. The ECG records two basic
events: depolarization, which is the spread of a stimulus through the heart muscle,
and repolarization, which is the return of the stimulated heart muscle to a resting
state. The ECG records electrical activity as specific waves: P-Wave: the spread
of a stimulus through the atria (atrial depolarization). PR interval- the time from
initial stimulation of the atria to initial stimulation of the ventricles, usually 0.12
to 0.20 seconds. QRS complex- the spread of a stimulus through the ventricles
3
Heart, Lungs, and Peripheral Vascular (Week 7: Ch. 13, 14, & 15)
• Examination techniques of the Heart, Lungs, and PV systems (See Notes)
• Examination findings of arterial blood flow in infants (339) (345)
o At birth the cutting of the umbilical cord, through which oxygen has been
provided in utero, requires the infant to begin breathing. The onset of
respiration expands the lungs and carries air to the alveoli.
o When pulse is weak, expect cardiac output bay be diminished or peripheral
vasoconstriction may be present. A bounding pulse is associated with a large left-
right shunt produced by a patent ductus arteriosus. In coarctation of the aorta, a
difference is noted in pulse amplitude between the upper extremities or between
the femoral and radial pulses or the femoral pules are absent capillary refill times
in infants and children younger than 2 years of age are raid, less than 1 second. A
prolonged capillary refill time, no longer than 2 seconds, indicates dehydration or
hypovolemic shock.
• Examination findings of the heart and lungs in a patient with illegal drug use (266)
o If an adult- especially young- or an adolescent describes severe, acute chest pain,
ask about drug use, particularly cocaine. Cocaine can cause tachycardia,
hypertension, coronary arterial spasm (with infarction), and pneumothorax (lung
collapse) with severe acute chest pain being the common result.
• Description: shortness of breath (orthopnea, platypnea. Tachypnea, bradypnea) (265)
o Orthopnea- shortness of breath that begins or increases when the patient lies
down; ask whether the patient needs to sleep on more than one pillow and
whether that helps.
o Platypnea- dyspnea increases in the upright posture.
o Tachypnea- increased rate of respirations of breath; abnormally rapid
breathing. (COPD or Pneumonia)
o Bradypnea-breathing more slowly than normal, could mean the body isn’t getting
enough oxygen. (sleep apnea, drug overdose, carbon monoxide poisoning)
o Paroxysmal nocturnal dyspnea- sudden onset of SOB after a period of sleep;
sitting upright is helpful.
• Symptoms associated with intrathoracic infection
o The patient may have any combination of the nonspecific symptoms, such
as fever, dry or productive cough, blood-streaked sputum, shortness of
breath, chest pain, weight loss, fatigue, and anorexia. Physical examination may
reveal abnormal breath sounds.
• Percussion techniques when examining the lungs (273-275)
o Percuss the chest directly or indirectly, comparing sides in three areas. On the
1
,posterior chest, percuss with the patient’s head bent forward and arms folded in front.
On the
2
, lateral chest, percuss with the patient’s arms raised. On the anterior chest, percuss with
the patient in the same position.
• Examination findings when percussing the lungs (274)
o You should hear resonance over all lung areas. Hyperresonance associated with
hyperinflation may indicate emphysema, pneumothorax, or asthma. Dullness or
flatness suggests pneumonia, atelectasis, pleural effusion, pneumothorax, or
asthma. Percuss Tones Heard over the Chest (274)
• Cardiac examination findings for a patient with rheumatic fever (330-331)
o Systemic connective tissue disease occurring after streptococcal pharyngitis or
skin infection. Patho- characterized by a variety of major and minor
manifestations (major: carditis, polyarthritis, chorea, erythema marginatum,
subcutaneous nodules) (minor: previous rheumatic fever, arthralgia, fever,
laboratory, clinical). May result in serious cardiac valvular involvement of mitral
or aortic valve; tricuspid and pulmonic are not often affected. Affected valve
becomes stenotic and regurgitant. Children between 5 and 15 years of age are
most commonly affected. Prevention-adequate treatment for streptococcal
pharyngitis or skin infections-is the best therapy. Subjective Data- fever,
inflamed swollen joints, flat or slightly raised, painless rash with pink margins
with pale centers and a ragged edge (erythema marginatum). Aimless jerky
movements (Sydenham chorea or St. Vitus dance). Small, painless nodules
beneath the skin. Chest pain, palpations, fatigue, or shortness of breath. Objective
Data- characterized by a variety of major and minor manifestations. Murmurs of
mitral regurgitation and aortic insufficiency. Cardiomegaly, friction rub of
pericarditis, or signs of CHF.
• Grading of heart murmurs (311-313)
o Diseased valves, a common cause of murmurs, either do not open or close well.
When the leaflets are thickened and the passage narrowed, forward blood flow is
restricted (stenosis). When valve leaflets, which are intended to fit together
snugly, lose competency and leak, blood flows backwards (regurgitation).
o Characterization of Heart Murmurs (313)
• Evaluation of ECG tracings (298-299)
o An electrocardiogram (ECG) is a graphic recoding of electrical activity during the
cardiac cycle. The ECG records electrical current generated by the movement of
ions in and out of the myocardial cell membranes. The ECG records two basic
events: depolarization, which is the spread of a stimulus through the heart muscle,
and repolarization, which is the return of the stimulated heart muscle to a resting
state. The ECG records electrical activity as specific waves: P-Wave: the spread
of a stimulus through the atria (atrial depolarization). PR interval- the time from
initial stimulation of the atria to initial stimulation of the ventricles, usually 0.12
to 0.20 seconds. QRS complex- the spread of a stimulus through the ventricles
3
