Summary
Summary NSG 121 EXAM 3 Study Guide
- Course
- NSG 121
- Institution
- Herzing University
This is a comprehensive and detailed study guide on Exam 3 for NSG
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NSG 121 HEALTH ASSESSMENT EXAM 3 STUDY BLUEPRINTUnit 8 – Assessment of the Cardiovascular, Peripheral Vascular, & Lymphatic Systems
Structure & Function of the CV System
1. Landmarks
a. The locations for auscultating heart sounds are identified by landmarks on the anterior thoracic wall. The
intercostal spaces (ICSs), sternal lines, and midclavicular line (MCL) are used to describe the location of
heart sounds and impulses.
b. The base of the heart is found at the 2nd ICS, spanning from the left sternal border to right sternal border.
c. The apex is located in the 5th ICS midclavicular line. The heart is rotated so the right side of the heart is
more anterior and the left side is positioned mostly posterior.
d. The point of maximal impulse (PMI) is a term used to describe the area where the apical pulsation can be
seen or palpated.
e. The inferior border of the heart lies at the junction between the xiphoid process and the sternum to the left
5th ICS in the MCL laterally.
f. The precordial area on the anterior chest overlies the heart and great vessels, between the 2nd and 5th ICS at
the right sternal border to approximately the 2nd and 5th ICS at the left MCL.
g. The carotid arteries transport blood from the heart to the head. They are located in the depression between
the trachea and sternomastoid muscle in the anterior neck and run parallel to the trachea from clavicle to jaw
bilaterally. Palpation of the carotid arteries normally reveals a strong pulsation.
h. The internal and external jugular veins are named for their position in the neck. The internal jugular vein is
deeper and nearer the carotid artery.
i. Internal jugular vein: not visible (not palpable because it’s a vein)
j. External jugular vein is visible (not palpable because it’s a vein)
k. The tricuspid valve separates the right atrium and right ventricle, and the mitral (bicuspid) valve separates
the left atrium and left ventricle. The AV valves are open during the ventricular filling period—or diastole.
The AV valves close during ventricular contraction—or systole—to prevent regurgitation or backflow of
blood.
l. The two semilunar valves separate the ventricles from the great vessels. The pulmonic valve lies between
the right ventricle and pulmonary artery. The aortic valve lies between the left ventricle and aorta. The valves
are named after the vessel that they fill. The semilunar valves open during ventricular contraction or systole
to allow blood to flow from the ventricles to the great vessels.
,2. Electrical Conduction Path
a. A small electrical impulse that fires in the sinoatrial (SA) node in the
right atrium generates the normal heartbeat. The SA node functions as the
“pacemaker” of the heart.
b. Signal moves through an electrical “wiring” pathway through the left and
right atria (via intraatrial pathways). The electrical impulse causes the
atrial muscle cells to contract.
c. The impulse pauses briefly at the AV junction to allow the atria to
contract, travels through the electrical pathways in the bundle of His and
bundle branches in the left and right ventricles, and finally moves to the
Purkinje fibers of the ventricles. The impulse causes the ventricular
muscle cells to contract.
Structure & Functions of the PV & Lymphatic Systems
1. Venous Blood Flow Regulation
a. A pressure gradient created by respiration, skeletal muscle contraction, and intraluminal valves regulates
blood flow in the venous system.
b. During inspiration, the diaphragm drops and abdominal pressure increases.
c. During expiration, abdominal pressure decreases, creating a suction effect that promotes venous return.
Because veins do not have the same muscular walls that arteries do, they also rely on the calf muscle pump to
combat the pull of gravity and promote venous return.
d. i.e. as a person walks, the contraction of the calf muscles promotes venous flow. Veins contain bicuspid
valves that prevent the retrograde flow or reflux of venous blood, thus maintaining unidirectional flow
2. Structures of Lymphatic System
a. The lymphatic system consists of the lymph nodes and lymphatic vessels as well as the spleen, tonsils, and
thymus. It maintains fluid and protein balance and functions with the immune system to fight infection. The
lymphatic vessels carry lymph in the tissues back to the bloodstream.
b. The pathways of lymphatic vessels often run parallel to the arteries and veins. The thoracic ducts at the
junctions of the subclavian and internal jugular veins return the lymph fluid to the circulation. The lymphatic
vessels contain valves to maintain unidirectional flow.
c. Skeletal muscle contraction, passive movement, and increases in heart rate all support lymph flow.
, Lifespan & Cultural Considerations CV, PV, & Lymphatic Systems
1. Older Adults
a. The risk of hypertension and cardiac disease rises dramatically with age
b. Cardiac reserves decline, and the left ventricular wall becomes thicker and stiffer in normal aging, even in the
absence of increased arterial hypertension or left ventricular afterload
c. The left atrial size increases and the mitral valve closes more slowly. The heart fills more slowly in early
diastole but compensates by filling more quickly in late diastole during atrial contraction.
d. Blood flow is approximately equal during early and late diastole, unlike in younger hearts
e. During stress or exercise, the ability of the aging heart to respond with increased heart rate or cardiac output
is diminished
f. Because of fibrotic changes and fat deposits on the SA node, older adults have less heart rate variability than
younger adults. Additionally, their hearts respond less to the sympathetic nervous system, so older adults have
reduced maximum heart rates (80-year-old person has a maximum heart rate of 140 to 150 beats/min)
g. Receptors for stress hormones also may become less sensitive in older adults
h. Calcification of the arteries, or arteriosclerosis, causes them to become more rigid in older adults. Less
arterial compliance results in increased systolic BP.
i. incidence of peripheral arterial disease (PAD) increases significantly as people age
j. Primary varicose veins are seen more often in people older than 50 years of age and in those with obesity.
Varicose veins and lymphedema may be familial
Subjective Data Collection
1. Risk Factors
a. Biographical:
i. Advanced age, hypertension, male gender, particular ethnic heritages,
ii. Risk doubles with elevated cholesterol and c-reactive protein
iii. BNP is sensitive and specific to heart failure
iv. Hyperthyroidism is linked to atrial fibrillation
b. Past medical history:
i. High BP
ii. High cholesterol
iii. History of diabetes
c. Lifestyle/personal habits
i. Smoke cigarettes or use tobacco
1. Smokers are two to four times more likely to develop CHD and are twice as likely to have
sudden cardiac arrest
ii. Height and weight
1. overweight or obese is associated with an increased risk for cardiovascular disease as well as
an increased risk for the development of cardiovascular risk factors, including hypertension,
hyperlipidemia, and diabetes mellitus
iii. Usual level of activity
1. low level of activity is associated with an increased risk for cardiovascular disease. Physical
activity can help control blood cholesterol, diabetes, and obesity as well as help lower BP.
iv. Diet / alcohol / drugs
1. diet low in fruits and vegetables and high in fat and cholesterol is associated with an
increased risk
2. more than two drinks of alcohol per day for men or one drink of alcohol per day for women
can raise BP and contribute to heart failure
3. Cocaine and other amphetamines increase the risk of MI and coronary vasospasm
v. Medications
1. Taking any meds for cardiac conditions? Review compliance for safety
2. Taking any OTCs? note any potential drug interactions
vi. Family history of cardiovascular conditions
1. Premature coronary artery disease in a first- or second-degree relative increases the patient’s
risk for the same condition – highest risk between siblings
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