yellow cholesterol deposits seen on the eyelids and are indicative of premature atherosclerosis
a condition caused by bacterial infiltration of the lining of the hearts chambers and has thin red lines or splinter hemorrhages in the nail beds
soft vibratory sensations best assessed with either the fingertips or the palm flattened on the chest
loud blowing sound often associated with narrowing or stricture of carotid artery usually associated with atherosclerosis plaque
Positions for heart exam
Client must sit upright, lean forward sitting upright, supine, and lying left lateral for full examination
When do you hear a S1 sound?
from when AV valves close to when ventricles have been filled
When do you hear S2 sounds?
from when aortic and pulmonic valves close to when ventricles have emptied their Blood
When is systole?
begins when AV valves close and ends when A and P valves close
When is diastole?
begins with closure of A and P valves and ends with closure of AV valves
harsh, blowing sounds caused by disruption of blood flow into heart between chambers of heart
inflammation of pericardial sac. The surfaces of the parietal and visceral layers of the pericardium cant slide smoothly and produce the rubbing or grating sound
Clicks and snaps
heard in clients with valve disease
Left heart failure symptoms
pulmonary issues, Pulmonary edema, crackles, shortness of breath, signs poor tissue perfusion
Right sided symptoms
systemic edema, Peripheral edema, swelling, engorged peripheral vessels, neck vein distention
Why do high heart rates cause low CO?
because the chambers of the heart do not have enough time to fill or empty, decreasing stroke volume
Why is decreased cardiac output signifigant?
CO carried O2 and nutrients to the cells, and carries away waste products. Without O2, cells die
Why is impaired tissue perfusion signifigant?
If CO is good and circulating O2, O2 needs to be able to actually flow through the capillaries of the vascular bed of that structure or region to reach end organs like Kidneys, liver, brain, "gut," heart muscle.
What are nutrients and O2 delivered to the cells via?
why is fluid volume excess/deficit significant?
We need fluid (blood) or we will get dehydrated.
What are signs of dehydration?
Decreased UO, thirst, tenting, low blood pressure, dry skin, fatigue
What is preload
The volume of blood being returned to the right side of the heart from systemic circulation
How is right sided preload measured?
central venous pressure or CVP
How is left sided preload measured?
the pulmonary capillary wedge pressure or PCWP (wedge)
What is afterload?
The amount of resistance the left side of the heart has to overcome in order to eject blood.
aching or feeling fullness. It intensifies with prolonged standing or sitting in one position. Swelling and varicosities in the legs may also be present. Condition is relieved by elevating legs or walking.
swishing sound indicates this, obstruction causing turbulence such as narrowing of the vessel due to the buildup of cholesterol. Increased CO will also cause this.
Do varicosities disappear with elevated legs?
What causes varicosities?
An incompetent valve, a weakness in the vein wall, or an obstruction in a proximal vein
could indicate an obstruction of lymphatic system
sign of O2 deprivation, flattening of the nail and enlargements of the tips of the fingers
Inadequate circulation in arterial system usually due to build up of fatty plaque or calcification of the arterial wall resulting in diminished pulses, cool shiny skin, absence of hair on toes, pallor on elevation, red color when dependent, deep muscle pain, usually in lower limb, ulcers due to arterial insufficiency are usually seen on the toes or areas of trauma of the feet or lateral malleolus. The ulcer is pale in color with well defined edges and no bleeding
Deep Vein Thrombosis
occlusion of deep vein by clot
arterioles in the fingers dvlp spasms, causing intermittent skin pallor or cyanosis and then rubor (red color). Spasms may last from min to hrs occurring bilaterally.
veins that became dilated and have a diminished rate of blood flow and increased IV pressure
inadequate circulation in venous system usually due to incompetent valves in deep veins or blood clot in vein, ulcers are common
bulging or dilation by a weakness in the wall of an artery. It can occur in the aorta and abdominal, renal, or femoral arteries. Can be detected by a characteristic bruit over the artery, deep in abdomen can be difficult to discover.
commonly called stretch marks, silvery shiny irregular markings on the skin. They are seen in obesity, pregnancy, and ascites
rough, grating sound caused by rubbing together of organs or an organ rubbing the peritoneum
Blumbergs Sign (Rebound tenderness)
the experience of sharp stabbing pain as the compressed area returns to a noncompressed state. Occurs in peritoneal irritation and requires immediate medical attention
palpate liver and pt takes a deep breath, if inflammation - will feel a shapr pain on inspiration
midway from umbilicus and superior iliac crest RLQ, painful in appendicitis
hand on pt knee, if hurts when pt raises knee (hip flexion) - appendicitis
liver, gall bladder, duodenum
sigmoid colon, desending colon, L ureter
Red, brown, and Coffee ground puke indicates
What test confirms GI bleeding?
Red stool or emesis indicates
spent less time in digestive tract. Bleeding was close to opening or rapidly going through GI
Maroon, clotted, or red stools indicate
a more rapid bleed and should receive quick attention.
What do you do if you see red in stool or emesis?
Guaic test, check vitals, ask questions, call dr
Correct order of abdominal assessment?
Inspection, auscultation, percussion, palpatation
old blood/ upper GI bleeding
Identify how to identify an increase or decrease in abdominal/peritoneal fluid.
Place pt in lateral position and observe fluid shift.
When is there an increase in abdominal fluid?
cirroisus, CHF, nephrosis, peritonitis, and neoplastic diseases
Normal bowel sounds
Hyperactive bowel sounds
loud, high pitched, rushing, occur more frequently with gastroenteritis or diarrhea
Hypoactive bowel sounds
slow and sluggish, commonly follow abdominal surgery or bowel obstruction
Absent bowel sounds
may be indicative of paralytic ileus
accumulation of fluid in abdomen. Abdomen protrudes, fluid descends with gravity - dullness when percussed,
- abdominal rectus muscle separates allowing abdominal structure to push through and come closer to skin. More common in kids
"incision hernia", incision weakens muscle and abdominal structure move closer to skin
due to weakening in diaphragm that allows portion of stomach to move into thoracic cavity
diminished volume of urine
related to neuro condition
due to consuming too many fluids or diminished bladder capacity
pressure increased during coughing, sneezing, etc
due to spinal cord injury
due to inability to actually reach toilet
inability to retain urine
blood in urine
affects pt spinal cord at T7 or higher, bladder distention causes sympathetic response and can trigger potentially life threatening hypertensive crisis
chronic state where pt cant empty bladder
what does a murmur result from
area on lower back formed by vertebral collumn and last
What lies in the CVA?
kidneys and ureters
rectus abdominus muscle
from pubis to rib cage on both sides on stomach - palpate for kidneys.