NSG 121 HEALTH ASSESSMENT EXAM 3 STUDY BLUEPRINT HERZING UNIVERSITY
Unit 8 – Assessment of the Cardiovascular, Peripheral Vascular, & Lymphatic Systems
Topic Location Student Notes
Structure & Function of the CV System NSG a. Aortic: 2nd RIGHT intercostal space. Pulmonic: 2nd LEFT intercostal space, near the left sternal border. Erb’s Point: 3rd LEFT intercostal
121.08.01.01
a. Landmarks space, midway, just left of the sternum. Tricuspid: 4th LEFT intercostal space, near the left sternal border. Mitral: 5th LEFT intercostal
(x2)
space, at midclavicular line. (Mnemonic: Ape to Man: Aortic; Pulmonic; Erb’s Point; Tricuspid; Mitral)
b. Electrical Conduction Path b. (1) Sinoatrial (SA) node {also known as the Pacemaker of the heart (Automaticity; Conduction; Interatrial pathways)}. (2) Atrioventricular (AV) node. (3) Bundle of
His
(4) Purkinje fibers.
Structure & Functions of the PV & Lymphatic Systems NSG a. A pressure gradient created by respiration, skeletal muscle contraction, and intraluminal valves regulates blood flow in the venous
121.08.01.01
a. Venous Blood Flow Regulation system. During inspiration, the diaphragm drops and abdominal pressure increases. During expiration, abdominal pressure decreases,
(x2)
b. Structures of Lymphatic System 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. For example, as a person walks, the contraction of the
calf muscles promotes venous flow.
>The largest vessel of the arterial system is the aorta. The
b. The organs and tissues of the body depend on a healthy and intact peripheral vascular system, which consists of a complex network of
subclavian arteries branch off of the aorta to feed the
arteries, veins, and lymphatic vessels. The arterial system consists of arteries, arterioles, and capillaries that deliver oxygenated
vessels of the upper extremities. The largest arteries of the
blood from the heart to the rest of the body. The venous system consists of veins, venules, and connecting veins called perforators,
upper extremities are the brachial arteries. They bifurcate
which collect unoxygenated blood from the body and return it to the heart. The exchange of nutrients, gases, and metabolites between
into the radial and ulnar arteries, which further divide into
blood vessels and tissues occurs in the capillary beds. Oxygen-rich blood delivers nutrients from the arterioles to the capillaries. Venules
two arterial arches that supply the hands.
then return metabolites from the capillary beds to the venous system.
Lifespan & Cultural Considerations CV, PV, & Lymphatic Systems NSG a. The risk of hypertension and cardiac disease rises dramatically with age. Cardiac reserves decline, and the left ventricular wall becomes
a. Older Adults 121.08.01.0
2 thicker and stiffer in normal aging, even in the absence of increased arterial hypertension or left ventricular afterload.
Subjective Data Collection NSG a. When questioning patients about risk factors, the goal is to identify how likely the patients are to develop or experience consequences
121.08.02.01
a. Risk Factors of cardiovascular diseases. Health care providers can implement necessary interventions to control symptoms, direct education to prevent
(x2)
new problems or complications, and document areas needing ongoing follow-up and emphasis. For example, in the interview, you assess
for smoking, high BP, physical inactivity, and diabetes mellitus—all major contributors to heart disease. After assessment, you identify
focused teaching areas and evaluate the patient’s ongoing progress in controlling modifiable risks.
Common Cardiovascular Symptoms NSG 121. a. Assess quality, duration, and location of pain. Pain that lasts longer than 20 minutes with nausea and diaphoresis is associated with
a. Chest Pain 08.02.02 myocardial infarction. Less than 20 minutes and occurs with activity: benign angina. PE: Anxiety; Diaphoresis. DVT: Warmth of the
b. Frequent Urination (x4) extremity. PAD: Pallor; Poikilothermia
c. Leg Pain Common Cardiovascular Symptoms: Chest pain; Dyspnea, orthopnea, and cough; Diaphoresis; Fatigue; Edema; Nocturia; Palpitations.
d. Leg Edema
Objective Data Collection Neck & Vessel Exam NSG a. Position the patient with the head of the bed at 30–45 degrees to promote visibility of the pulsation. Place a folded pillow under the
a. Assessment Techniques & Positioning 121.08.0 patient’s head to relax the sternocleidomastoid muscle and improve visualization. Keep the patient’s shoulders on the mattress. Move any
>Fluid overload: Jugular vein distension. 3.01
long hair away from the patient to enhance visibility. The right side is easiest to see; it may help the patient to turn the head slightly away
>Dehydration: Flat neck veins. (x3)
from the side being examined and elevate the jaw slightly. Light the area to emphasize the shadows of the pulsations; indirect lighting
>A bruit is audible when the artery is partially obstructed. from a 30-45-degree angle is usually best rather than a bright direct light. The external veins are lateral to the sternomastoid muscles,
No bruit is audible with total occlusion of the carotid
and the pulsations are best observed in the groove near the middle of the clavicle.
artery. Bruits have been associated with an increased risk of
>>Pt. should be asked to hold breath while auscultating the carotid arteries.
stroke.
Heart Sounds & Representations NSG a. S1: The beginning of systole as the mitral and tricuspid valves close.
a. S1: LUB; Louder at apex; Correlates w/ carotid pulse 121.08.0 b. S2: The end of systole and the beginning of diastole as the aortic and pulmonic valves close.
3.02
b. S2: DUB; Louder at base; Aortic and pulmonic valves c. 3rd heart sound (S3) occurs during the early rapid diastolic filling phase immediately after S2. S3 is quiet, low-pitched, and often
(x2)
c. S3: Blood rushes into ventricles abnormally resistant to difficult to hear. Best heard in a quiet room, may be louder in the left lateral position. Usually audible in patients with HF with fluid
filling, distending the ventricular walls causing vibration. overloaded.
d. Murmur: Heart valve fails to close completely, the blood d. Murmurs is a blowing or swooshing sound that occurs due to turbulent blood flow through the heart or great vessels. May result from
leaks back through the valve and causes a whooshing sound intrinsic cardiovascular disease or circulatory disturbances—for example, anemia or pregnancy.
(similar to the Korotkoff sounds). e. The Pericardial friction rub is an important physical sign of acute pericarditis. It may have up to three components during the cardiac
e. Pericardial Friction Rub: Inflamed pericardial heard cycle and is high pitched, scratching, and grating. It can best be heard with the diaphragm of the stethoscope at the left lower sternal
most frequently during expiration and increases when the border. The examiner may need to ask the patient to hold his or her breath briefly to determine whether the rub is pleural or cardiac in
,patient is upright and leaning forward. origin. S4: Occurs in late diastole, usually abnormal.
Peripheral Circulation NSG • Inspect arms and legs to identify symmetry, range of motion, color, hair, nails.
a. Assessment Lower Extremities 121.08. • Palpate arms and legs to identify tenderness, warmth, erythema.
The seven Ps: 03.03 • Palpate peripheral pulses to assess for effectiveness of peripheral circulation.
• Pain (x2) • Auscultate Doppler stethoscope signals: Performed when unable to palpate peripheral pulses.
• Pallor: pale skin color • Assess for edema to evaluate effectiveness of venous return.
• Poikilothermia: inability to regulate core The arms and legs must be accessible for inspection, palpation, and auscultation because side-to-side visualization and palpation for
body temperature comparison is essential.
• Paresthesia’s: numbness, tingling The examination requires the patient to be supine, sitting, and standing. Take safety precautions while helping the patient change
positions. Pay attention to mobility constraints as well as the effects of position changes on respiratory effort as they apply to the patient.
• Pulselessness: lack of pulse via palpation, Cleanse the ultrasonic Doppler stethoscope before and after use to prevent the spread of infection. Use soap and water only because
auscultation alcohol is damaging to the transducer.
• Paralysis: complete loss of muscle Pitting Edema Scale: +1: Slight pitting, 2-mm depression. +2: Increased pitting, 4-mm depression. +3: Deeper pitting, 6-mm
function depression; obvious edema of extremity. +4: Severe pitting, 8-mm depression; extremity appears very edematous.
• Perfusion: capillary refill Patients with PAD (Peripheral Artery Disease) Risk factor: Smoking; high-fat diet; limited activity level; Hypertension; diabetes.
PVD tips: Use mnemonic V.E.I.N.Y. V= voluptuous Daily assessment of the feet-no lotions in between toes. Pain with ambulation, at rest, the pain subsides. NO pain with PVD
pulses, warm legs. E= Edema, (blood pooling). I= Patients with venous disease: >Education: methods of decreasing venous pressure. >Compression stockings. >Patients at risk for or
Irregularly shaped sores. N= NO sharp pain, only DULL with a history of DVT. >Assess pulses – Begin at distal site and work up the extremity assessing next proximal site. 1 st palpate the
pain. NO sharp pain during exercise because the peripherals Dorsalis Pedis, 2nd Popliteal, 3rd Femoral artery. If no pulse is palpated, use doppler.
have oxygen. Y= Yellow and brown ankles.
PAD tips: Low oxygen, low blood flow, cold, and sharp Intermittent CLAUDICATION: Happens with PAD. Claudication causes pain in the CALVES. When claudication is unrelieved at rest, that
pain when walking. in the arteries with PAD. Because indicates a severe case of PAD.
there is low oxygen use mnemonic A.R.T.S. A= Absent ****What makes the pain better with PAD, PVD, and DVT?
pulses, NO hair with shiny, cool legs. R=Round, red, smooth
***With the veins, you elevate the veins. PVD, and DVT you elevate the legs, to get deoxygenated blood to the heart. Remember
sores. T=Toes and feet that are pale from low oxygen. elevating helps to vacuum all that fluid back up to the heart, and relieves the pain from PVD, and PVD.
(Advanced stages have eschar toes) S= Sharp pain in
****With the arteries, you hang the legs like over the bed, put them down to help arteries put the oxygen away. PAD pain should stop,
calves when stressed, like during exercise or even when and color should return because oxygenated blood is flowing down to extremities. Arteries pump oxygen away, and it's always harder to
legs are elevated.
pump oxygen uphill which is why we hang the leg for pts. suffering leg pain with PAD.
Treatments: What is the main goal? We want to open the blood vessels that flow through the peripherals.
With PVD, want to keep those veins open helping the veins vacuum more blood back to the heart so we can stop the pooling of blood.
With PAD we want to push the oxygen rich blood from the heart down to the toes and extremities.
Peripheral Pulse & Lymph Node NSG Palpate the brachial and radial pulses. Grade the pulses. Use the radial pulse site when assessing the pulse for vital signs. The brachial
a. Assessment 121.08.0 pulses are located at approximately the inner third of the antecubital fossa when the palm is held upward. It is not usually necessary to
3.04
Peripheral Pulses are those pulses that are palpable palpate the ulnar pulse, which is difficult to locate.
(x2)
at the peripheries (hand and legs) –radial, dorsal pedal, >Venous ulcers: Irregular borders; Red pink ulcer base; Pulse normal but can be difficult to find with edema; Pain decreased with
which signal vascular compromise–especially in the legs. elevation; Gangrene not present.
Major peripheral pulses are palpated for symmetry. The >Arterial ulcers: Regular borders; Pale yellow ulcer base; Pulse decreased or absent; Pain decreased with dependency; Gangrene may
elasticity of the arterial wall is also examined. be present.
>Pulse is graded +2/4 on a 4-point scale: 0 Nonpalpable or absent. 1+ Weak and thready. 2+ Normal, expected. 3+ Full, increased.
4+ Bounding.
Unit 9 – Assessment of the Gastrointestinal and Genitourinary Systems
Topic Location Student Notes
Function of Gastrointestinal Organs NSG **The major GI organs found within the abdominal cavity include the stomach, small intestines, and colon. Accessory organs of
Nutrient absorption Almost exclusively in the small 121.09.01 the GI system within the abdomen include the liver, pancreas, and gallbladder.
.01
intestine. Electrolyte and water absorption Occurs in the >These organs are for ingestion, absorption, digestion, and elimination of food, water, and body waste.
large intestine.
Structure and Function of Male Genitalia NSG a. The prostate gland contains muscular and glandular tissue, surrounds the urethra at the bladder neck; its shape resembles that of a
a) Prostate Gland b) Vas Deferens c) Scrotum d) Testicles 121.09.01 large chestnut. Located just below the bladder in front of the rectum. Produces the greatest volume of ejaculatory fluid.
.01
e) Perineum b. The vas deferens (also called the ductus deferens) transports sperm from the epididymis to the ejaculatory duct. The vas deferens,
arteries, veins, and nerves make up the spermatic cord, which ascends through the external inguinal ring and into the inguinal canal.
, Inside the canal, and just before the entrance into the prostate gland, the VD unites with the seminal vesicle to form the ejaculatory
duct.
**The penis contains three distensible structures: two
c. The scrotum is a pouch covered with darkly pigmented, loose, rugous (wrinkled) skin. A septum divides the scrotum into two sacs,
corpora cavernosa, which form the dorsum and sides of the
each of which contains a testis, epididymis, spermatic cord, and muscle layer known as the cremaster muscle. This allows the scrotum to
penis, and a single corpus spongiosum, which forms the
relax or contract. Spermatogenesis requires a temperature of 3.5°F (2°C) lower than core body temperature. When the temperature
bulb.
rises, the scrotal sac relaxes; when temperature decreases, the scrotal sac moves closer to the body.
**The corpus spongiosum surrounds the urethra (the tube
d. The testes (testicles) are smooth and ovoid. The left testicle lies lower than the right. The spermatic cords (composed of the vas
through which urine and sperm pass from the body). It
deferens, arteries, veins, and nerves) suspend the testes in the scrotum. The function of the testicles is to produce spermatozoa (sperm)
contains blood vessels that fill with blood to help make an
and testosterone. e. Located between the anus and bulb of the penis. In males, the perineum lies just below the pelvic floor muscles,
erection and keep the urethra open during the erection.
which support the bladder and bowel. The perineum protects the pelvic floor muscles and the blood vessels that supply the genitals and
Cremaster muscle: Permits contraction and relaxation.
urinary tract. The perineum also protects the nerves used to urinate or have an erection.
Glans penis: lightly pigmented.
Testosterone stimulates pubertal growth of the male
genitalia, prostate, and seminal vesicles.
Structure and Function of Female Genitalia NSG a. The ovaries are two almond-shaped structures measuring approximately 3 × 2 cm (about 1¼ in. by ¾ in.) in the adult female. The
a) Ovaries 121.09.01 ovaries begin cyclically developing mature ova for ovulation after puberty and shrink (atrophy) and stop developing mature ova for
.01
b) Fallopian Tubes ovulation after menopause.
c) Uterus b. The fallopian tubes transport ova from the ovary to the uterus. They are approximately 12 cm (4¾ in.) long and 1 mm in diameter.
d) Cervix The tubes are composed of four layers of tissues: peritoneal (serous), subserous (adventitial), muscular, and mucous. These layers are
e) Vagina responsible for the blood and nerve supply as well as providing the peristaltic condition necessary to move the ovum toward the uterus.
The fallopian tubes are divided into three parts: isthmus, ampulla, and fimbriae. The fimbriae are closest to the ovaries. Fertilization most
often occurs in the ampullary portion of the fallopian tubes.
The female genitalia can be subdivided into external and
c. The uterus, often referred to as the “womb,” is the organ that holds the endometrial lining and is prepared to accept an implanted
internal parts. External genitalia include the mons pubis,
ovum (Fig. 24.2). It lies between the bladder and rectum and is approximately 7 to 8 cm long (about 2¾ to 3¼ in.) and 4 to 5 cm (1½ to
labia majora, labia minora, prepuce, and clitoris. The internal
2 in.) at its widest part. The uterine walls consist of an outer layer called the parietal peritoneum, a muscular layer called the
genitalia are the vagina, fornix, uterus, cervix, fundus,
myometrium, and an inner layer called the endometrium.
fallopian tubes, ovaries, and supporting tissues.
d. The cervix is the posterior portion of the uterus that protrudes into the vagina. The cervix is smooth, rounded, and has a midline
opening called the os. In a woman who has never given birth (nulliparous), the os resembles a donut with a small hole in the middle. In
> Mons pubis: Subcutaneous fatty tissue covered by pubic hair. a woman who has had one or more pregnancies and vaginal deliveries (parous), the opening generally resembles a horizontal slit.
> Clitoris: Developmentally equivalent to the penis. e. The vagina is a tube of muscular tissue that extends from vaginal introitus to uterus. The three-layer vaginal muscle wall is extremely
> Perineum: Area between the vaginal introitus and rectum. flexible, especially during childbirth. It is lined with a glandular mucous membrane, within which are folds called rugae. These rugae
> Labia minora: Two small folds extending from the clitoral hood become less prominent in advanced years due to decrease in estrogen levels. The vagina is approximately parallel to the lower portion of
to the posterior fourchette or frenulum. the sacrum. This position is the reason the anterior wall of the vagina measures 7 cm (about 2¾ in.), whereas the posterior wall is about
9 cm (about 3½ in.). The vesicovaginal septum separates the anterior wall of the vagina from the urethra and bladder. The rectovaginal
septum separates the posterior wall of the vagina from the rectum.
GI Changes with Aging NSG Cultural Considerations and Disease Prevalence
>In older adults, production of saliva and stomach acid is reduced 121.09.01 >The elderly are less likely to feel pain with abdominal conditions and do not always present with classic symptoms and laboratory
and gastric motility and peristalsis slow. These changes can lead .02 (x3)
findings.
to difficulties with swallowing, absorption, and digestion. >The liver decreases in size and liver function declines, making it harder for older adults to process medications. **Renal function also
>In older men, degeneration of afferent neurons in the rectal wall declines, which decreases the ability to eliminate medications. The older adult also experiences a diminished sensation of thirst, which
can lessen the feeling of rectal distension and interfere with
may result in a lower consumption of liquids, contributing to urinary tract infections (UTIs) and constipation.
relaxation of the rectal sphincter, resulting in retention of stool.
>Among African Americans, chronic liver disease is a leading cause of death. Some cases can be initiated by conditions such as chronic
Incontinence may result.
Alteration in Sexual Function
alcoholism, obesity, and exposure to hepatitis B and C viruses.
> Menopause is defined as 12 consecutive months without > American Indian/Alaska Native adults, Native Hawaiians, Mexican Americans, and Native Americans are all more likely than
menses. As estrogen levels decrease, the uterus becomes smaller, Caucasians to be diagnosed with and die from complications of diabetes.
the ovaries shrink, the normal vaginal rugae flatten, and the > African Americans and Hispanics are almost twice as likely to be diagnosed with diabetes as Caucasians. In addition, they are more
epithelium atrophies. These normal changes may lead to likely to suffer complications from diabetes, such as end-stage renal disease (ESRD) and lower extremity amputations. Native Hawaiians/
difficulties such as vaginal infections, urinary tract infections Pacific Islanders are almost 2.5 times more likely to be diagnosed with diabetes than Caucasians.
(UTIs), dyspareunia, and diminished libido. >When a patient becomes ill, his recognition of and reaction to illness are rooted in cultural beliefs, values, and social and family
>Testosterone levels decline with aging, which may affect both structures.
Unit 8 – Assessment of the Cardiovascular, Peripheral Vascular, & Lymphatic Systems
Topic Location Student Notes
Structure & Function of the CV System NSG a. Aortic: 2nd RIGHT intercostal space. Pulmonic: 2nd LEFT intercostal space, near the left sternal border. Erb’s Point: 3rd LEFT intercostal
121.08.01.01
a. Landmarks space, midway, just left of the sternum. Tricuspid: 4th LEFT intercostal space, near the left sternal border. Mitral: 5th LEFT intercostal
(x2)
space, at midclavicular line. (Mnemonic: Ape to Man: Aortic; Pulmonic; Erb’s Point; Tricuspid; Mitral)
b. Electrical Conduction Path b. (1) Sinoatrial (SA) node {also known as the Pacemaker of the heart (Automaticity; Conduction; Interatrial pathways)}. (2) Atrioventricular (AV) node. (3) Bundle of
His
(4) Purkinje fibers.
Structure & Functions of the PV & Lymphatic Systems NSG a. A pressure gradient created by respiration, skeletal muscle contraction, and intraluminal valves regulates blood flow in the venous
121.08.01.01
a. Venous Blood Flow Regulation system. During inspiration, the diaphragm drops and abdominal pressure increases. During expiration, abdominal pressure decreases,
(x2)
b. Structures of Lymphatic System 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. For example, as a person walks, the contraction of the
calf muscles promotes venous flow.
>The largest vessel of the arterial system is the aorta. The
b. The organs and tissues of the body depend on a healthy and intact peripheral vascular system, which consists of a complex network of
subclavian arteries branch off of the aorta to feed the
arteries, veins, and lymphatic vessels. The arterial system consists of arteries, arterioles, and capillaries that deliver oxygenated
vessels of the upper extremities. The largest arteries of the
blood from the heart to the rest of the body. The venous system consists of veins, venules, and connecting veins called perforators,
upper extremities are the brachial arteries. They bifurcate
which collect unoxygenated blood from the body and return it to the heart. The exchange of nutrients, gases, and metabolites between
into the radial and ulnar arteries, which further divide into
blood vessels and tissues occurs in the capillary beds. Oxygen-rich blood delivers nutrients from the arterioles to the capillaries. Venules
two arterial arches that supply the hands.
then return metabolites from the capillary beds to the venous system.
Lifespan & Cultural Considerations CV, PV, & Lymphatic Systems NSG a. The risk of hypertension and cardiac disease rises dramatically with age. Cardiac reserves decline, and the left ventricular wall becomes
a. Older Adults 121.08.01.0
2 thicker and stiffer in normal aging, even in the absence of increased arterial hypertension or left ventricular afterload.
Subjective Data Collection NSG a. When questioning patients about risk factors, the goal is to identify how likely the patients are to develop or experience consequences
121.08.02.01
a. Risk Factors of cardiovascular diseases. Health care providers can implement necessary interventions to control symptoms, direct education to prevent
(x2)
new problems or complications, and document areas needing ongoing follow-up and emphasis. For example, in the interview, you assess
for smoking, high BP, physical inactivity, and diabetes mellitus—all major contributors to heart disease. After assessment, you identify
focused teaching areas and evaluate the patient’s ongoing progress in controlling modifiable risks.
Common Cardiovascular Symptoms NSG 121. a. Assess quality, duration, and location of pain. Pain that lasts longer than 20 minutes with nausea and diaphoresis is associated with
a. Chest Pain 08.02.02 myocardial infarction. Less than 20 minutes and occurs with activity: benign angina. PE: Anxiety; Diaphoresis. DVT: Warmth of the
b. Frequent Urination (x4) extremity. PAD: Pallor; Poikilothermia
c. Leg Pain Common Cardiovascular Symptoms: Chest pain; Dyspnea, orthopnea, and cough; Diaphoresis; Fatigue; Edema; Nocturia; Palpitations.
d. Leg Edema
Objective Data Collection Neck & Vessel Exam NSG a. Position the patient with the head of the bed at 30–45 degrees to promote visibility of the pulsation. Place a folded pillow under the
a. Assessment Techniques & Positioning 121.08.0 patient’s head to relax the sternocleidomastoid muscle and improve visualization. Keep the patient’s shoulders on the mattress. Move any
>Fluid overload: Jugular vein distension. 3.01
long hair away from the patient to enhance visibility. The right side is easiest to see; it may help the patient to turn the head slightly away
>Dehydration: Flat neck veins. (x3)
from the side being examined and elevate the jaw slightly. Light the area to emphasize the shadows of the pulsations; indirect lighting
>A bruit is audible when the artery is partially obstructed. from a 30-45-degree angle is usually best rather than a bright direct light. The external veins are lateral to the sternomastoid muscles,
No bruit is audible with total occlusion of the carotid
and the pulsations are best observed in the groove near the middle of the clavicle.
artery. Bruits have been associated with an increased risk of
>>Pt. should be asked to hold breath while auscultating the carotid arteries.
stroke.
Heart Sounds & Representations NSG a. S1: The beginning of systole as the mitral and tricuspid valves close.
a. S1: LUB; Louder at apex; Correlates w/ carotid pulse 121.08.0 b. S2: The end of systole and the beginning of diastole as the aortic and pulmonic valves close.
3.02
b. S2: DUB; Louder at base; Aortic and pulmonic valves c. 3rd heart sound (S3) occurs during the early rapid diastolic filling phase immediately after S2. S3 is quiet, low-pitched, and often
(x2)
c. S3: Blood rushes into ventricles abnormally resistant to difficult to hear. Best heard in a quiet room, may be louder in the left lateral position. Usually audible in patients with HF with fluid
filling, distending the ventricular walls causing vibration. overloaded.
d. Murmur: Heart valve fails to close completely, the blood d. Murmurs is a blowing or swooshing sound that occurs due to turbulent blood flow through the heart or great vessels. May result from
leaks back through the valve and causes a whooshing sound intrinsic cardiovascular disease or circulatory disturbances—for example, anemia or pregnancy.
(similar to the Korotkoff sounds). e. The Pericardial friction rub is an important physical sign of acute pericarditis. It may have up to three components during the cardiac
e. Pericardial Friction Rub: Inflamed pericardial heard cycle and is high pitched, scratching, and grating. It can best be heard with the diaphragm of the stethoscope at the left lower sternal
most frequently during expiration and increases when the border. The examiner may need to ask the patient to hold his or her breath briefly to determine whether the rub is pleural or cardiac in
,patient is upright and leaning forward. origin. S4: Occurs in late diastole, usually abnormal.
Peripheral Circulation NSG • Inspect arms and legs to identify symmetry, range of motion, color, hair, nails.
a. Assessment Lower Extremities 121.08. • Palpate arms and legs to identify tenderness, warmth, erythema.
The seven Ps: 03.03 • Palpate peripheral pulses to assess for effectiveness of peripheral circulation.
• Pain (x2) • Auscultate Doppler stethoscope signals: Performed when unable to palpate peripheral pulses.
• Pallor: pale skin color • Assess for edema to evaluate effectiveness of venous return.
• Poikilothermia: inability to regulate core The arms and legs must be accessible for inspection, palpation, and auscultation because side-to-side visualization and palpation for
body temperature comparison is essential.
• Paresthesia’s: numbness, tingling The examination requires the patient to be supine, sitting, and standing. Take safety precautions while helping the patient change
positions. Pay attention to mobility constraints as well as the effects of position changes on respiratory effort as they apply to the patient.
• Pulselessness: lack of pulse via palpation, Cleanse the ultrasonic Doppler stethoscope before and after use to prevent the spread of infection. Use soap and water only because
auscultation alcohol is damaging to the transducer.
• Paralysis: complete loss of muscle Pitting Edema Scale: +1: Slight pitting, 2-mm depression. +2: Increased pitting, 4-mm depression. +3: Deeper pitting, 6-mm
function depression; obvious edema of extremity. +4: Severe pitting, 8-mm depression; extremity appears very edematous.
• Perfusion: capillary refill Patients with PAD (Peripheral Artery Disease) Risk factor: Smoking; high-fat diet; limited activity level; Hypertension; diabetes.
PVD tips: Use mnemonic V.E.I.N.Y. V= voluptuous Daily assessment of the feet-no lotions in between toes. Pain with ambulation, at rest, the pain subsides. NO pain with PVD
pulses, warm legs. E= Edema, (blood pooling). I= Patients with venous disease: >Education: methods of decreasing venous pressure. >Compression stockings. >Patients at risk for or
Irregularly shaped sores. N= NO sharp pain, only DULL with a history of DVT. >Assess pulses – Begin at distal site and work up the extremity assessing next proximal site. 1 st palpate the
pain. NO sharp pain during exercise because the peripherals Dorsalis Pedis, 2nd Popliteal, 3rd Femoral artery. If no pulse is palpated, use doppler.
have oxygen. Y= Yellow and brown ankles.
PAD tips: Low oxygen, low blood flow, cold, and sharp Intermittent CLAUDICATION: Happens with PAD. Claudication causes pain in the CALVES. When claudication is unrelieved at rest, that
pain when walking. in the arteries with PAD. Because indicates a severe case of PAD.
there is low oxygen use mnemonic A.R.T.S. A= Absent ****What makes the pain better with PAD, PVD, and DVT?
pulses, NO hair with shiny, cool legs. R=Round, red, smooth
***With the veins, you elevate the veins. PVD, and DVT you elevate the legs, to get deoxygenated blood to the heart. Remember
sores. T=Toes and feet that are pale from low oxygen. elevating helps to vacuum all that fluid back up to the heart, and relieves the pain from PVD, and PVD.
(Advanced stages have eschar toes) S= Sharp pain in
****With the arteries, you hang the legs like over the bed, put them down to help arteries put the oxygen away. PAD pain should stop,
calves when stressed, like during exercise or even when and color should return because oxygenated blood is flowing down to extremities. Arteries pump oxygen away, and it's always harder to
legs are elevated.
pump oxygen uphill which is why we hang the leg for pts. suffering leg pain with PAD.
Treatments: What is the main goal? We want to open the blood vessels that flow through the peripherals.
With PVD, want to keep those veins open helping the veins vacuum more blood back to the heart so we can stop the pooling of blood.
With PAD we want to push the oxygen rich blood from the heart down to the toes and extremities.
Peripheral Pulse & Lymph Node NSG Palpate the brachial and radial pulses. Grade the pulses. Use the radial pulse site when assessing the pulse for vital signs. The brachial
a. Assessment 121.08.0 pulses are located at approximately the inner third of the antecubital fossa when the palm is held upward. It is not usually necessary to
3.04
Peripheral Pulses are those pulses that are palpable palpate the ulnar pulse, which is difficult to locate.
(x2)
at the peripheries (hand and legs) –radial, dorsal pedal, >Venous ulcers: Irregular borders; Red pink ulcer base; Pulse normal but can be difficult to find with edema; Pain decreased with
which signal vascular compromise–especially in the legs. elevation; Gangrene not present.
Major peripheral pulses are palpated for symmetry. The >Arterial ulcers: Regular borders; Pale yellow ulcer base; Pulse decreased or absent; Pain decreased with dependency; Gangrene may
elasticity of the arterial wall is also examined. be present.
>Pulse is graded +2/4 on a 4-point scale: 0 Nonpalpable or absent. 1+ Weak and thready. 2+ Normal, expected. 3+ Full, increased.
4+ Bounding.
Unit 9 – Assessment of the Gastrointestinal and Genitourinary Systems
Topic Location Student Notes
Function of Gastrointestinal Organs NSG **The major GI organs found within the abdominal cavity include the stomach, small intestines, and colon. Accessory organs of
Nutrient absorption Almost exclusively in the small 121.09.01 the GI system within the abdomen include the liver, pancreas, and gallbladder.
.01
intestine. Electrolyte and water absorption Occurs in the >These organs are for ingestion, absorption, digestion, and elimination of food, water, and body waste.
large intestine.
Structure and Function of Male Genitalia NSG a. The prostate gland contains muscular and glandular tissue, surrounds the urethra at the bladder neck; its shape resembles that of a
a) Prostate Gland b) Vas Deferens c) Scrotum d) Testicles 121.09.01 large chestnut. Located just below the bladder in front of the rectum. Produces the greatest volume of ejaculatory fluid.
.01
e) Perineum b. The vas deferens (also called the ductus deferens) transports sperm from the epididymis to the ejaculatory duct. The vas deferens,
arteries, veins, and nerves make up the spermatic cord, which ascends through the external inguinal ring and into the inguinal canal.
, Inside the canal, and just before the entrance into the prostate gland, the VD unites with the seminal vesicle to form the ejaculatory
duct.
**The penis contains three distensible structures: two
c. The scrotum is a pouch covered with darkly pigmented, loose, rugous (wrinkled) skin. A septum divides the scrotum into two sacs,
corpora cavernosa, which form the dorsum and sides of the
each of which contains a testis, epididymis, spermatic cord, and muscle layer known as the cremaster muscle. This allows the scrotum to
penis, and a single corpus spongiosum, which forms the
relax or contract. Spermatogenesis requires a temperature of 3.5°F (2°C) lower than core body temperature. When the temperature
bulb.
rises, the scrotal sac relaxes; when temperature decreases, the scrotal sac moves closer to the body.
**The corpus spongiosum surrounds the urethra (the tube
d. The testes (testicles) are smooth and ovoid. The left testicle lies lower than the right. The spermatic cords (composed of the vas
through which urine and sperm pass from the body). It
deferens, arteries, veins, and nerves) suspend the testes in the scrotum. The function of the testicles is to produce spermatozoa (sperm)
contains blood vessels that fill with blood to help make an
and testosterone. e. Located between the anus and bulb of the penis. In males, the perineum lies just below the pelvic floor muscles,
erection and keep the urethra open during the erection.
which support the bladder and bowel. The perineum protects the pelvic floor muscles and the blood vessels that supply the genitals and
Cremaster muscle: Permits contraction and relaxation.
urinary tract. The perineum also protects the nerves used to urinate or have an erection.
Glans penis: lightly pigmented.
Testosterone stimulates pubertal growth of the male
genitalia, prostate, and seminal vesicles.
Structure and Function of Female Genitalia NSG a. The ovaries are two almond-shaped structures measuring approximately 3 × 2 cm (about 1¼ in. by ¾ in.) in the adult female. The
a) Ovaries 121.09.01 ovaries begin cyclically developing mature ova for ovulation after puberty and shrink (atrophy) and stop developing mature ova for
.01
b) Fallopian Tubes ovulation after menopause.
c) Uterus b. The fallopian tubes transport ova from the ovary to the uterus. They are approximately 12 cm (4¾ in.) long and 1 mm in diameter.
d) Cervix The tubes are composed of four layers of tissues: peritoneal (serous), subserous (adventitial), muscular, and mucous. These layers are
e) Vagina responsible for the blood and nerve supply as well as providing the peristaltic condition necessary to move the ovum toward the uterus.
The fallopian tubes are divided into three parts: isthmus, ampulla, and fimbriae. The fimbriae are closest to the ovaries. Fertilization most
often occurs in the ampullary portion of the fallopian tubes.
The female genitalia can be subdivided into external and
c. The uterus, often referred to as the “womb,” is the organ that holds the endometrial lining and is prepared to accept an implanted
internal parts. External genitalia include the mons pubis,
ovum (Fig. 24.2). It lies between the bladder and rectum and is approximately 7 to 8 cm long (about 2¾ to 3¼ in.) and 4 to 5 cm (1½ to
labia majora, labia minora, prepuce, and clitoris. The internal
2 in.) at its widest part. The uterine walls consist of an outer layer called the parietal peritoneum, a muscular layer called the
genitalia are the vagina, fornix, uterus, cervix, fundus,
myometrium, and an inner layer called the endometrium.
fallopian tubes, ovaries, and supporting tissues.
d. The cervix is the posterior portion of the uterus that protrudes into the vagina. The cervix is smooth, rounded, and has a midline
opening called the os. In a woman who has never given birth (nulliparous), the os resembles a donut with a small hole in the middle. In
> Mons pubis: Subcutaneous fatty tissue covered by pubic hair. a woman who has had one or more pregnancies and vaginal deliveries (parous), the opening generally resembles a horizontal slit.
> Clitoris: Developmentally equivalent to the penis. e. The vagina is a tube of muscular tissue that extends from vaginal introitus to uterus. The three-layer vaginal muscle wall is extremely
> Perineum: Area between the vaginal introitus and rectum. flexible, especially during childbirth. It is lined with a glandular mucous membrane, within which are folds called rugae. These rugae
> Labia minora: Two small folds extending from the clitoral hood become less prominent in advanced years due to decrease in estrogen levels. The vagina is approximately parallel to the lower portion of
to the posterior fourchette or frenulum. the sacrum. This position is the reason the anterior wall of the vagina measures 7 cm (about 2¾ in.), whereas the posterior wall is about
9 cm (about 3½ in.). The vesicovaginal septum separates the anterior wall of the vagina from the urethra and bladder. The rectovaginal
septum separates the posterior wall of the vagina from the rectum.
GI Changes with Aging NSG Cultural Considerations and Disease Prevalence
>In older adults, production of saliva and stomach acid is reduced 121.09.01 >The elderly are less likely to feel pain with abdominal conditions and do not always present with classic symptoms and laboratory
and gastric motility and peristalsis slow. These changes can lead .02 (x3)
findings.
to difficulties with swallowing, absorption, and digestion. >The liver decreases in size and liver function declines, making it harder for older adults to process medications. **Renal function also
>In older men, degeneration of afferent neurons in the rectal wall declines, which decreases the ability to eliminate medications. The older adult also experiences a diminished sensation of thirst, which
can lessen the feeling of rectal distension and interfere with
may result in a lower consumption of liquids, contributing to urinary tract infections (UTIs) and constipation.
relaxation of the rectal sphincter, resulting in retention of stool.
>Among African Americans, chronic liver disease is a leading cause of death. Some cases can be initiated by conditions such as chronic
Incontinence may result.
Alteration in Sexual Function
alcoholism, obesity, and exposure to hepatitis B and C viruses.
> Menopause is defined as 12 consecutive months without > American Indian/Alaska Native adults, Native Hawaiians, Mexican Americans, and Native Americans are all more likely than
menses. As estrogen levels decrease, the uterus becomes smaller, Caucasians to be diagnosed with and die from complications of diabetes.
the ovaries shrink, the normal vaginal rugae flatten, and the > African Americans and Hispanics are almost twice as likely to be diagnosed with diabetes as Caucasians. In addition, they are more
epithelium atrophies. These normal changes may lead to likely to suffer complications from diabetes, such as end-stage renal disease (ESRD) and lower extremity amputations. Native Hawaiians/
difficulties such as vaginal infections, urinary tract infections Pacific Islanders are almost 2.5 times more likely to be diagnosed with diabetes than Caucasians.
(UTIs), dyspareunia, and diminished libido. >When a patient becomes ill, his recognition of and reaction to illness are rooted in cultural beliefs, values, and social and family
>Testosterone levels decline with aging, which may affect both structures.
