Study Guide. Nursing Assessment 126. The Cardiovascular System (126.3) This Study Guide contains:

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1 Study Guide Nursing Assessment 126 The Cardiovascular System (126.3) This Study Guide contains: Brief Description, Objectives, Discussion Questions, Pre-view and Post-view Tests, Answer Keys and Glossary for this program. Institutions that have purchased the program from Educational Media Distributors have permission to duplicate any of the contents of this Study Guide for teaching purposes.

2 Program Description This program provides information on cardiac, vascular, and lymphatic anatomy, and includes graphic depictions of system functions including cardiac conduction and the three roles of the lymphatics. The subjective assessment portion includes discussion on the importance of obtaining patient and family cardiac and lymphatic history. The objective assessment portion examines palpation of superficial nodes; the ABCs and signs related to normal and abnormal circulation; palpation of the point of maximum impulse and the peripheral pulses; and grading of edema if present. There is detailed information provided on the technique of cardiac auscultation and proper use of a stethoscope. Examples of cardiac sounds are provided as well as discussion of normal sounds, murmurs, and extra sounds. Learning Objectives After viewing the program, the learner will be able to do the following: 1. Describe the structures and function of the lymph and cardiac systems. 2. Trace the flow of blood through the heart and pulmonary system. 3. Outline the cardiac conduction system. 4. Discuss the function of the lymph nodes. 5. Demonstrate an effective subjective assessment of the cardiac and lymph systems. 6. Assess for the presence of a deep vein thrombosis. 7. Demonstrate palpation of lymph nodes. 8. Demonstrate an assessment of the peripheral pulses. 9. Explain the grading systems for both edema and palpable pulses. 10. Demonstrate auscultation of the heart. 11. Describe the different heart sounds and their causes. Page 2 Educational Media Distributors 2013

3 Pre-Viewing Questions True or False 1. The cardiovascular system is responsible for delivering oxygen and nutrients to the cells and removing wastes from the cells. 2. Over an average lifetime, the heart could fill one supertanker with blood. 3. The heart is composed of two types of cells. 4. The AV node is the primary pacemaker. 5. A primary role of the lymph system is prevention of tissue edema. 6. Lymph consists of interstitial fluid, fat, and lymphocytes. 7. Cardiac history should always include family history of cardiac problems. 8. Leg pain may be indicative of circulatory disorders. 9. Nursing evaluation of lymph nodes is done primarily in the cervical, axillary, and inguinal regions. 10. Enlarged nodes always indicate significant disease processes. 11. Every patient contact begins with observation of the ABCs. 12. Capillary refill is a primary indicator for adults, less so for children. 13. The apical impulse should be palpable at both the 4 th and 5 th interspace over the heart. 14. There are four peripheral pulses that are normally palpated. 15. The force of the pulse is graded using numbers. 16. Edema is graded a numerical scale. 17. A heart rate below 60 is always reason for concern. 18. Auscultation of the heart is best done in an X pattern. 19. A bruit indicates total blockage of a vessel. 20. A midsystolic click is indicative of mitral valve prolapse. Page 3 Educational Media Distributors 2013

4 Pre-Viewing Questions Answer Sheet 1. T F 2. T F 3. T F 4. T F 5. T F 6. T F 7. T F 8. T F 9. T F 10. T F 11. T F 12. T F 13. T F 14. T F 15. T F 16. T F 17. T F 18. T F 19. T F 20. T F Page 4 Educational Media Distributors 2013

5 Pre-Viewing Questions Answer Key 1. F F 2. T F 3. F F 4. T F 5. F F 6. F F 7. F F 8. F F 9. T F 10. T F 11. F F 12. T F 13. T F 14. T F 15. F F 16. F F 17. T F 18. T F 19. T F 20. F F Page 5 Educational Media Distributors 2013

6 Discussion Questions 1. What are the commonalities between the cardiovascular and lymph systems? 2. Why is it true that any patient contact must begin with observing for the ABCs? 3. What is the association between the pulses and the heart sounds? Page 6 Educational Media Distributors 2013

7 Post-Viewing Questions 1. The adult heart pumps blood at approximately liters per minute. a. three b. four c. five d. six e. seven For questions 2-6, choose the appropriate match from the column on the right. 2. Right atrium a. sends oxygenated blood to body cells 3. Right ventricle b. pumping action of heart 4. Left atrium c. sends blood to lungs 5. Left ventricle d. receives deoxygenated blood 6. Myocardium e. receives oxygenated blood For questions 7-11, choose the appropriate match from the column on the right. 7. Sinoatrial node a. directs impulse to right and left 8. Atrioventricular node b. directs impulse to bundle branches 9. Bundle of His c. delays conduction impulses 10. Bundle branches d. causes contraction of ventricles 11. Purkinje fibers e. pacemaker 12. Which of the following is not true regarding the lymph system? a. conserves leaked plasma fluids and proteins b. a major part of the immune system c. contains the majority of monocytes. d. absorbs lipids from intestinal tract e. removes cellular debris and microorganisms 13. Subjective data collection for the cardiac and lymph systems routinely includes all of the following except: a. chest pain b. edema c. enlarged nodes d. blurry vision e. history of cancer Page 7 Educational Media Distributors 2013

8 Post-Viewing Questions continued 14. The routine objective assessment of the lymph system does not include palpation of nodes in the region. a. epitrochlear b. mediastinal c. axillary d. cervical e. All of these are routinely assessed 15. Normal capillary refill is less than second(s). a. one b. two c. three d. four e. five 16. All of the following are true regarding the apical impulse except: a. it is palpable at the 4 th or 5 th interspace b. it was once called the point of maximal pressure c. it may be difficult or impossible to feel in patients who are overweight d. it requires significant pressure to feel it e. it is palpable in approximately 50% of adults 17. The peripheral pulses that are routinely assessed are the: a. brachial, radial, popliteal, dorsalis pedis, posterior tibial b. carotid, brachial, radial, popliteal, dorsalis pedis, posterior tibial c. carotid, brachial, radial, dorsalis pedis, posterior tibial d. carotid, radial, brachial, popliteal, posterior tibial e. carotid, brachial, radial, popliteal, dorsalis pedis 18. When grading edema and pulses: a. edema is graded numerically while the pulses are graded descriptively b. edema is graded descriptively while the pulses are graded numerically c. both are graded numerically d. both are graded descriptively e. None of the above Page 8 Educational Media Distributors 2013

9 Post-Viewing Questions continued 19. All of the following are true about S 1 except: a. it corresponds to the closure of the mitral valve b. it corresponds to the closure of the aortic valve c. it corresponds to the closure of the tricuspid valve d. it occurs as blood enters the ventricles e. it marks the beginning of systole 20. All of the following are true about S 2 except: a. it corresponds to the closure of the mitral valve b. it corresponds to the closure of the aortic valve c. it corresponds to the closure of the pulmonic valve d. it occurs as blood exits the ventricles e. it marks the end of systole For questions 21-25, choose the appropriate match from the column on the right. 21. S 1 a. left lower sternal border 22. S 2 b. right second intercostal space 23. Aortic valve c. corresponds to R on EKG 24. Pulmonic valve d. corresponds to end of T wave 25. Tricuspid valve e. left second intercostal space For questions 26-30, choose the appropriate match from the column on the right. 26. Bruits a. louder at apex 27. Pulse deficit b. partial blockage 28. S 1 c. more apical than radial beats 29. S 2 d. louder at base 30. Mitral valve prolapse e. midsystolic click 31. Which of the following statements is not true? a. A murmur is caused by turbulent blood flow b. A functional murmur is related to non-cardiac, resolvable causes c. Innocent is another name for functional d. All murmurs should be treated as significant until proven otherwise e. There are eight criteria that are addressed when assessing a murmur Page 9 Educational Media Distributors 2013

10 Post-Viewing Questions Answer Sheet 1. a b c d e 2. a b c d e 3. a b c d e 4. a b c d e 5. a b c d e 6. a b c d e 7. a b c d e 8. a b c d e 9. a b c d e 10. a b c d e 11. a b c d e 12. a b c d e 13. a b c d e 14. a b c d e 15. a b c d e 16. a b c d e 17. a b c d e 18. a b c d e 19. a b c d e Page 10 Educational Media Distributors 2013

11 Post-Viewing Questions Answer Sheet continued 20. a b c d e 21. a b c d e 22. a b c d e 23. a b c d e 24. a b c d e 25. a b c d e 26. a b c d e 27. a b c d e 28. a b c d e 29. a b c d e 30. a b c d e 31. a b c d e Page 11 Educational Media Distributors 2013

12 Post-Viewing Questions Answer Key 1. a b c d e 2. a b c c e 3. a b c d e 4. a b c d c 5. c b c d e 6. a c c d e 7. a b c d c 8. a b c d e 9. a c c d e 10. c b c d e 11. a b c c e 12. a b c d e 13. a b c c e 14. a c c d e 15. a b c d e 16. a b c c e 17. a c c d e 18. a b c d e 19. a c c d e Page 12 Educational Media Distributors 2013

13 Post-Viewing Questions Answer Key continued 20. c b c d e 21. a b c d e 22. a b c c e 23. a c c d e 24. a b c d c 25. c b c d e 26. a c c d e 27. a b c d e 28. c b c d e 29. a b c c e 30. a b c d c 31. a b c d e Page 13 Educational Media Distributors 2013

14 Glossary of Terms Adenoids: Two masses of lymphoid tissue located at the back of the pharynx. When enlarged they can obstruct nasal and ear passages, interfering with hearing and causing mouth breathing. Apical impulse: Formerly called PMI or the point of maximal impulse, it is a point located at either the 4 th or the 5 th interspace where the pulse can be palpated in about 50% of adults. Atria: The two upper chambers of the heart. They receive blood from the major veins and pump it into the two lower chambers of the heart, the ventricles. Atrial fibrillation: Rapid contractions of the atria which do not coordinate with the pulse. Agitation of blood in the atria in this manner can lead to the formation of clots leading to heart attack and stroke. Atrioventricular (AV) node: Small mass of tissue in the right atrium which passes impulses from the sinoatrial node to the ventricles via the Bundle of His. It can act as a pacemaker should the sinoatrial node fail. Bruits: An abnormal sound arising from an artery when a partial blockage is present. Bundle branch: The right or left branch of the Bundle of His. Bundle of His: Conductive tissue originating at the AV node and branching to the cardiac ventricles. It serves to conduct the wave of excitation from the right atrium to the ventricles to maintain the cardiac rhythm. Capillary refill time: The time necessary for the capillary beds to refill following compression. It is normally less than 3 seconds. Cardiac conduction system: The system responsible for initiating and transmitting electrical impulses that cause cardiac contraction. It consists of the sinoatrial node, also known as the pacemaker, the atrioventricular node, the Bundle of His and the Purkinje fibers. Cardiac cycle: The rhythmic movement of blood through the heart. It has two components. Systole, which occurs as the heart contracts, and diastole, the resting phase between contractions. Cardiac murmur: An atypical extra cardiac sound which may or may not be clinically significant. Murmurs have a variety of causes. Cardiac valves: Structures between the heart chambers that open and close with the cardiac cycle and allow movement of blood in only one direction. Page 14 Educational Media Distributors 2013

15 Glossary of Terms continued Deep vein thrombosis (DVT): Presence of a clot in a deep vein of the leg or pelvis. It obstructs normal flow, leading to significant edema of the affected leg, pain at the site of the thrombus, and has the potential for becoming a pulmonary embolism if it breaks free. Heart sounds: Normal heart sounds include S 1 caused by closure of the AV valves and signals the beginning of systole; and S 2 which occurs with the closure of the semilunar valves at the end of systole. S 3 is heard in some patients during diastole due to vibration occurring because there is some resistance to ventricular filling. S 4 occurs at the end of diastole when the ventricle is resistant to filling. Lymph fluid: The fluid within the lymph vessels. It is coagulable, usually clear, and contains lymphocytes, occasionally red blood cells, but no platelets. Lymph node: Rounded masses of lymphoid tissue occurring at intervals throughout the body along the lymphatic system which serve to filter the lymph fluid. Lymphatic system: An adjunct to the circulatory system that recovers fluids lost into the tissues from the vascular system. It is also an integral part of the immune system and is composed of the thymus, spleen, tonsils, lymph, lymph nodes, lymphatic vessels, lymphocytes, and bone marrow. Lymphocyte: White blood cell that arises from lymphatic tissue. It comprises approximately 20 percent of the white blood cells. Lymphoma: A tumor of lymphoid tissue that is usually malignant. Peripheral pulses: Pulses palpable in the neck and limbs. They include the carotid, brachial, radial, popliteal, dorsalis pedis, and posterior tibial pulse. Pitting edema: Tissue swelling from fluid that forms indentations when subjected to pressure and that resolve slowly when the pressure ceases. Sinoatrial (SA) Node: Small mass of tissue imbedded in the right atrium composed of Purkinje fibers, ganglion cells, and nerve fibers. It originates the impulses stimulating the heartbeat. Spleen: A vascular, ductless abdominal organ involved in filtration, final destruction of non-viable red cells, and blood storage. Thymus gland: A glandular structure located in the upper mid chest and consisting mostly of lymphoid tissue where T cells are formed. It tends to become rudimentary or to be absorbed as children mature. Page 15 Educational Media Distributors 2013

16 Glossary of Terms continued Tonsils: Two rounded lymphatic tissue masses located on either side of the throat that serve as filters. Ventricles: The two lower chambers of the heart. They receive blood from the corresponding atrium that is then pumped into the corresponding arteries. Page 16 Educational Media Distributors 2013