Print NSG 211 Quiz 3 - Heart and Neck Vessels flashcards

NSG 211 Quiz 3 - Heart and Neck Vessels

front 1 What is the Precordium and where does it lay in the body?	back 1 It's the area on the anterior chest directly overlying the heart and the great vessels. It's located between the lungs in the middle third of the thoracic cage (aka. mediastinum). It extends to from the 2nd to 5th ICS and from the right border of the sternum to the left midclavicular line.
front 2 What are the major anatomic features of the heart? [Hint: 7]	back 2 Pericardium Myocardium Endocardium Atria Ventricles Valves Chordae tendineae.
front 3 What makes up the heart wall?	back 3 Pericardium Myocardium Endocardium
front 4 Describe the Pericardium.	back 4 It's a tough, fibrous, double-walled sac that surrounds and protects the heart. It has 2 layers that contain a few mL of serous pericardial fluid. Ensures a smooth, friction-free contraction of the heart muscle. It's adherent to the great vessels, esophagus, sternum, and pleurae. Anchored to the diaphragm.

front 5 Describe the Myocardium.	back 5 The muscular wall of the heart that does the pumping.
front 6 Describe the Endocardium.	back 6 The thin layer of the endothelial tissue that lines the inner surface of the heart chambers and valves.
front 7 What does the right side of the heart do?	back 7 Pumps blood into the lungs.
front 8 What does the left side of the heart do?	back 8 Pumps blood into the body.

front 9 The heart is considered two pumps; what separates the two?	back 9 An impermeable wall, aka the Septum.
front 10 Describe the Atrium.	back 10 A thin-walled reservoir that holds the blood.
front 11 Describe the Ventricle.	back 11 The thick-walled, muscular pumping chamber.
front 12 Describe the main purpose of the Valves.	back 12 Prevents back flow of blood. Unidirectional (can only open one way). Open and close passively in response to pressure gradients in the moving blood.

front 13 What are the four valves of the heart?	back 13 Two Atrioventricular (AV) valves: Right AV = Tricuspid valve Left AV = Mitral valve (aka bicuspid). Two Semilunar (SL) valves: Pulmonic valve Aortic valve
front 14 Where do the AV valves lie inside the heart chamber?	back 14 They both separate the atria (atriums) and the ventricles.
front 15 The Tricuspid AV lies between...	back 15 The RA and the RV.
front 16 The Mitral AV lies between...	back 16 The LA and the LV.

front 17 Describe the Cardiac cycle of Diastole.	back 17 The AV valves open during the heart's filling phase. Allowing the ventricles to fill with blood.
front 18 Describe the Cardiac cycle of Systole.	back 18 During the pumping phase, the AV valves close to prevent regurgitation of blood back up into the atria. The SL valves open to allow blood to be ejected from the heart. The papillary muscles contract at this time, so that the valve leaflets meet and unite to form a perfect seal without turning inside out.
front 19 Where do the SL valves lie inside the heart chamber?	back 19 Between the ventricles and the arteries.
front 20 The Pulmonic valve is in the...	back 20 Right side of the heart.

front 21 The Aortic valve is in the...	back 21 Left side of the heart.
front 22 Why does a person with abnormally high blood pressure in the left side of the heart have symptoms of pulmonary congestion?	back 22 Because there are no valves between the pulmonary veins and the LA.
front 23 Why does a person with abnormally high blood pressure in the right side of the heart have symptoms in the neck veins and abdomen?	back 23 Because there are no valves between the Vena Cava and the RA.
front 24 List the steps of the direction of blood flow. Starting with the unoxygenated RBCs being drained downstream into the Vena Cava from the Liver...	back 24 Into the RA through the inferior vena cava. Superior vena cava drains venous blood from the head and upper extremities. From the RA, venous blood flows through the Tricuspid (AV) valve to the RV. From RV, venous blood flows through the Pulmonic (SL) valve to the pulmonary artery to be delivered to the lungs. Lungs oxygenate the blood and then the it returns to the heart through the pulmonary veins into the LA. From LA, arterial (oxygenated) blood goes through the Mitral (AV) valve to the LV. LV ejects the blood through the aortic valve into the aorta, which delivers it to the body.

front 25 What are the two phases of the rhythmic cardiac cycle which moves the blood through the heart?	back 25 Diastole Systole
front 26 What occurs during Diastole?	back 26 Ventricles relax and fill with blood. 2/3 of the cardiac cycle.
front 27 What occurs during Systole?	back 27 Heart contacts and blood is pumped from the ventricles and fills the pulmonary and systemic arteries. 1/3 of the cardiac cycle.
front 28 What occurs during the Early or Protodiastolic filling?	back 28 It's the first passive filling phase. The ventricles relax and the AV valves (Tricuspid and Mitral) open silently. The pressure in the atria is higher than in the ventricles, so blood pours in rapidly.

front 29 What occurs during Presystole or Atrial Systole phase?	back 29 Aka "atrial kick." Toward the end of diastole, the atria contract and push the last among of blood into the ventricles. It causes a small rise in left ventricle pressure.
front 30 When does Atrial Systole occur?	back 30 During ventricular diastole.
front 31 Which pressure is higher during the beginning of Systole? What happens because of it?	back 31 Ventricle pressure is higher than the atria pressure. The AV valves swing shut, preventing regurgitation.
front 32 What is the S1 sound and what does it signal?	back 32 The first heart sound. Signals the beginning of systole. The closure of the AV valves.

front 33 Define Isometric contraction.	back 33 A contraction against a closed system (all four valves are closed) works to build up pressure inside the ventricles to a high level.
front 34 How do the Aortic valves open during Systole?	back 34 Briefly all four valves are closed when the ventricular walls contract. Pressure builds in the ventricles until it finally exceeds the pressure in the aorta. Aortic valve opens and blood ejects rapidly.
front 35 How do the Aortic valves close?	back 35 Pressure falls when contents (blood) is emptied from the ventricles. When it falls below the Aorta pressure, some blood flows backwards toward the ventricle. This causes the aortic valve to swing shut.
front 36 What is the S2 sound and what does it signal?	back 36 The closure of the SL valves. Signals the end of systole.

front 37 Define Isometric (or Isovolumic) Relaxation.	back 37 After systole, all four valves are closed and the ventricles relax. The atria are filing up passively with blood delivered from the lungs. Atrial pressure is higher now than the relaxed ventricular pressure. Mitral (AV) valve opens and diastolic filling begins again.
front 38 The first heart sound, the mitral component (M1) closes just before which component?	back 38 The tricuspid component (T1)
front 39 With S2, aortic closure (A2) occurs slightly before which component?	back 39 Pulmonic closure (P2)
front 40 Define S1.	back 40 First heart sound. Loudest at the apex of the heart.

front 41 Define S2.	back 41 Second heart sound. Loudest at the base of the heart.
front 42 Respiration has an affect on cardiac cycle. What occurs during Inspiration on the right side of the heart? [Hint: MoRe to the Right heart, Less to the Left]	back 42 The intrathoriacic pressure is decreased = more blood is pushed into the vena cava. RV stroke volume increases, prolonging RV systole and delays the pulmonic (SL) valve closure.
front 43 Respiration has an affect on cardiac cycle. What occurs during Inspiration on the left side? [Hint: MoRe to the Right heart, Less to the Left]	back 43 A greater amount of blood is sequestered in the lungs during inspiration. Momentary decreased return amount to the left side of the heart = decreasing LV stroke volume. Decreased volume shortens LV systole and allows the aortic (SL) valve to close earlier.
front 44 Respiration has an affect on cardiac cycle. What is the overall significance of the affects of Inspiration on the heart? [Hint: MoRe to the Right heart, Less to the Left]	back 44 When the aortic valve closes earlier than the pulmonic valve significantly, two components are heard separately. Split S2.

front 45 Describe the Third Heart Sound (S3).	back 45 Diastole normally is quiet, but in some conditions ventricular filling creates a vibration that could be heard because the ventricles are resistant to filling during protodiastole. Occurs after S2 when AV valves open and atrial blood first pours into the ventricles.
front 46 Describe the Fourth Heart Sound (S4).	back 46 Occurs at the end of diastole (at presystole) when the ventricles resist filling. The atria contract, pushing blood into a noncompliant ventricle, creating vibrations that could be heard. Occurs just before S1.
front 47 Define a Murmur.	back 47 Normally blood circulation through the cardiac chambers and valves is quiet. Some conditions create turbulent blood flow and collision currents. Like nosey water flow over a pile of stones or a sharp turn in the stream.
front 48 What are the conditions of a murmur?	back 48 Velocity of blood increases (flow murmur). Ex. In exercise or thyrotoxicosis. Viscosity of blood decreases. Ex. In anemia. Structural defects in the valve or an unusual opening in the chambers. Ex. Narrowed valve, incompetent valve; or dilated chamber, wall defect.

front 49 Describe Chest Pain.	back 49 Angina. May also have pulmonary, musculoskeletal, or GI origin.
front 50 Describe Angina.	back 50 Severe chest pain. Occurs when the heart's own blood supply can't keep up with metabolic demand. Feels like a squeezing "clenched fist."
front 51 What other symptoms have an anginal equivalent when there's an absence of chest pain?	back 51 Diaphoresis (excessive sweating) Cold sweats Pallor Grayness Palpitations Dyspnea (SOB) Nausea Tachycardia Fatigue
front 52 What is DOE mean?	back 52 Dyspnea on exertion.

front 53 Define Orthopnea.	back 53 The need to assume a more upright position to breathe. Note the exact number of pillows used.
front 54 Define Edema.	back 54 Dependent when caused by heart failure.
front 55 Describe Cardiac Edema.	back 55 Is worse at evening and better in the morning after elevating legs all night. Bilateral, but unilateral swelling has a local vein cause.
front 56 What is CAD?	back 56 Coronary artery disease.

front 57 Define the abnormal pulsation, Heave or Lift.	back 57 A sustained forceful thrusting of the ventricle during systole. Occurs with ventricular hypertrophy as a result of increased workload.
front 58 Where is a RV heave seen?	back 58 At the sternal border.
front 59 Where is a LV heave seen?	back 59 At the apex.
front 60 Where is the aortic valve auscultated?	back 60 At the 2nd, right ICS.

front 61 Where is the pulmonic valve auscultated?	back 61 At the 2nd, left ICS.
front 62 Where is the tricuspid valve auscultated?	back 62 Left, 5th ICS near the sternal border.
front 63 Where is the mitral valve auscultated?	back 63 Left, 5th ICS at MC line.
front 64 Where is the Erb's point auscultated?	back 64 Left, 3rd ICS near sternal border.

front 65 Do all murmurs indicate a heart disease? Why or why not?	back 65 No, an innocent murmur or systolic murmur may occur with a normal heart. But a diastolic alway indicates heart disease.
front 66 Describe a Grade 1 Murmur.	back 66 Barely audible, heard only in a quiet room, with difficulty.
front 67 Describe a Grade 2 Murmur.	back 67 Clearly audible, but faint.
front 68 Describe a Grade 3 Murmur.	back 68 Moderately loud, easy to hear.

front 69 Describe a Grade 4 Murmur.	back 69 Loud, associated with a thrill palpable on the chest wall.
front 70 Describe a Grade 5 Murmur.	back 70 Very loud, heard with one corner of stethoscope lifted off of the chest wall.
front 71 Describe a Grade 6 Murmur.	back 71 Loudest, still heard with entire stethoscope lifted just off the chest wall.
front 72 Define Sinus Arrhythmia. When is it normal?	back 72 Rhythm varies with the person's breathing, increasing at the peak of inspiration and slowing with expiration. Normal in young adults and children.

front 73 Normal heart rate.	back 73 50-100 beats per minute
front 74 Define Congestive Heart Failure (CHF).	back 74 The cardiac output is inadequate causing blood to not effectively pump through the pulmonic or aortic valves.
front 75 What are the two types of CHF?	back 75 Left CHF Right CHF
front 76 What is the Objective (O) and Subjective (S) findings of Left Ventricular Failure?	back 76 Objective Patient c/o Fatigue & Dyspnea. Subjective S3 may be present. Rales/Crackles may be present on exam.

front 77 How does Right Sided HF look like?	back 77 Increase in the Jugular Vein Pressure Dependent peripheral edema Weight gain S3 may be auscultated on exam.
front 78 What causes Myocardial Infraction (MI)?	back 78 Caused by ischemia (lack of oxygen) to the myocardium resulting in infarction (death) of the cells.
front 79 What are the subjective findings of MI in males?	back 79 c/o crushing chest pain With pain and numbness down the left arm. Diaphoretic Dyspneic Pain does not improve with rest.
front 80 What are the subjective findings of MI in females?	back 80 c/o fatigue Abdominal bloating/discomfort Jaw pain Dizziness

front 81 What are objective of MI?	back 81 Weak, thready pulse. Heart sounds may be distant. Hypotension may be present. Cyanosis may be present. Irregular heart rhythm (Dysrhythmia).
front 82 Define Pericarditis.	back 82 Inflammation of either the parietal & visceral layers of the pericardium or the outer myocardium (Wilson & Giddens, 2009). Can be a result of an MI, cardiac surgery, infections, etc.
front 83 What are the subjective and objective findings of Pericarditis?	back 83 O: Pt. c/o chest pain. S: Friction rub auscultated.
front 84 Define the Congenital Heart Defect: Patent Ductus Arteriosus (PDA).	back 84 Persistence (non-closure) of the channel joining between the L pulmonary artery to the aorta.

front 85 What are the O and S findings of PDA?	back 85 S: None O: Blood pressure has a wide pulse pressure and bounding peripheral pulses from rapid runoff of blood into low-resistant pulmonary bed during diastole. The continues murmur heard in systole and diastole is called "machinery murmur." Holosystolic & holodiastolic murmur auscultated.
front 86 Describe Atrial Septal Defect (ASD).	back 86 Abnormal opening in the atrial septum (open communication between atria), resulting usually in left-to-right shunting, which causes a large increase in pulmonary blood flow.
front 87 What are the S and O findings of ASD?	back 87 S: Defect well tolerated. Children and young adults have mild fatigue and DOE. May have weight gain as shunt increase. O: Systolic murmur (II-III/VI), ejection, medium pitch, best heard at base in 2nd, left ICS. Murmur not caused by shunt, but by increased blood flow through pulmonic valve. Sternal lift often present. S2 w/fixed split, with P2 louder than A2.
front 88 Describe Ventricular Septal Defect (VSD).	back 88 Abnormal opening in septum between ventricles, usually sub-aortic area. The size and exact position vary. Blood shunting through ventricular septum from left-to-right.

front 89

What are the S and O findings of VSD?

back 89

S: In infants with large defects:
- Poor growth
- Slow weight gain
- CHF (severe condition)
- Feeding problems
- DOE
- Frequent respiratory infections
O: May have a loud, harsh holosystolic murmur with small shunt.
- Best heard at the left sternal border and may be accompanied by thrill.
- With a large shunt (defect), a soft diastolic murmur.
- Heard at the apex (mitral flow murmur) due to increased blood flow through mitral valve.

front 90

Define Claudication distance.

back 90

The number of blocks walked or stairs climbed to produce pain.

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NSG 211 Quiz 3 - Heart and Neck Vessels