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NUR 634 exam 2/38 Complete Questions with Answers
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NUR 634 exam 2/38 Complete Questions with Answers
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NUR 634 exam 2/38 CompleteQuestions with Answers
innocent murmur - -left 2-4 ICS between left sternal border and apex,
minimal radiation, grade 1 or 2 possibly 3, soft to med pitch, variable quality,
usually decreases or disappears when sitting, normal splitting, no ejection
sounds, no diastolic murmurs, no palpable evidence of ventricular
enlargement, mechanism- turbulent blood flow prob generated by ejection of
blood into aorta from left and occasionally right ventricle, common in
children and young adults, no underlying CVD, midsystolic
-physiologic murmur - -left 2-4 ICS between left sternal border and apex,
minimal radiation, grade 1 or 2 possibly 3, soft to med pitch, variable quality,
usually decreases or disappears when sitting, signs of physiologic causes,
mechanism- turbulence r/t increase in blood flow in predisposing conditions
such as anemia, pregnancy, fever, hyperthyroidism, midsystolic
-aortic stenosis murmur - -2nd and 3rd right ICS, radiation often to
carotids/down left sternal border/even to apex, if severe may radiate to left
2nd 3rd ICS, sometimes soft but often loud with thrill, grade 4/6 and above,
medium pitch, harsh, more musical at apex, known maneuver to best hear,
midsystolic
-sitting and leaning forward - -position to best hear aortic stenosis murmur
-aortic stenosis associated findings - -as this murmur worsens it peaks later
in systole, A2 decreases in intensity, A2 may be delayed and merge with P2,
single S2 on expiration or paradoxical split, carotid upstroke may be delayed
with slow rise/small amplitude/decreased volume, hypertrophied LV may
produce sustained apical impulse and S4 r/t decreased compliance, after 40
yo may be dilated aorta and murmur or aortic regurgitation, subendocardial
ischemia d/t poor coronary perfusion distal to valve causes angina and
syncope
-Mechanism of aortic stenosis - -significant stenosis causes turbulent flow
across valve increasing left ventricular afterload, most common cause is
valve calcification in older adults, can progress from non-obstructing
sclerosis to stenosis, second most common cause is congenital bicuspid
valve not recognized until adulthood
-hypertrophic cardiomyopathy murmur - -location 3rd 4th ICS, radiation
down left sternal border to apex, poss at base but not to neck, variable
intensity, medium pitch, harsh quality, know maneuvers, carotid upstroke
rises quickly, apical impulse sustained, S2 may be single, S4 usually present
, at apex, usually benign but progresses in 25% to
syncope/ischemia/afib/dilated cardiomyopathy/ht failure/stroke/increased
risk sudden death, midsystolic
-maneuver to detect hypertrophic cardiomyopathy - -intensity decreases
with squatting and valsalva release phase (increases venous return),
increases with standing and valsalva strain (decreases LV volume)
-mechanism of hypertrophic cardiomyopathy - -unexplained diffuse or focal
ventricular hypertrophy with myocyte disarray and fibrosis associated with
unusually rapid ejection of blood from left ventricle during systole, outflow
tract obstruction of flow may coexist, associated distortion of mitral valve
may cause mitral regurgitation
-pulmonic stenosis murmur - -located 2nd 3rd ICS, radiation if loud toward
left neck and shoulder, soft to loud intensity, if loud associated with thrill,
medium pitch, crescendo-decrescendo, often harsh quality, midsystolic
-pulmonic stenosis associated findings - -JVP usually normal but may have
prominent a wave, right ventricle impulse often sustained, early pulmonic
ejection sound present in mild to mod, if severe S2 widely split and P2
softens, may hear right sided S4 over left sternal border
-mechanisms of pulmonic stenosis - -primarily congenital disorder with
valvular, supravalvular, or subvalvular stenosis, stenosis impairs flow across
valve, increasing right ventricular afterload, in ASD increased flow across
pulmonic valve may mimic this murmur
-mitral regurgitation murmur - -pansystolic murmur, located at the apex
with radiation to left axilla, less often left sternal border, soft to loud
intensity, if loud associated with apical thrill, pitch medium to high, harsh,
holosystolic quality, intensity doesn't change with inspiration
-associated findings or mitral regurgitation murmur - -S1 normal (75%),
loud (12%), soft (12%), apical S3 reflects volume overload of left ventricle,
apical impulse may be diffuse and laterally displaced, may be sustained
lower left parasternal impulse from dilated left atrium
-mechanism of mitral regurgitation murmur - -valve fails to close fully
during systole, blood regurgitates from left ventricle to left atrium causing
murmur and increasing left ventricle preload leading to
left ventricular dilation, causes are structural from prolapse, infectious
endocarditis, rheumatic heart disease, functional from ventricular dilation
and dilation of valve annulus from leaflet, papillary muscle or chordae
tendinae dysfunction
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