UPDATED Family Nurse Practitioner 100% VERIFIED SOLUTIONS 2023//2024

MR. ASS - ANSWER MR: mitral regurgitation AS: aortic stenosis S: Systolic (S1) Murmur pneumonic for timing MS. ARD - ANSWER MS: mitral stenosis AR: aortic regurgitation D: Diastolic (S2) Murmur pneumonic for timing Murmur Location: Mitral - ANSWER - Apex or apical area - Fifth ICS, left midclavicular line - PMI or apical pulse Murmur Location: Aortic - ANSWER - Second ICS to the right of the upper sternal border Murmur Location: Erb's Point - ANSWER - Third to fourth ICS on the left sternal border - Aortic Regurgitation Systolic Murmurs - ANSWER - occur during S1 - loud and radiate: to the neck in aortic stenosis or to the axilla mitral regurgitation - all benign murmurs are systolic and do not have a thrill Diastolic Murmur - ANSWER - occur during S2 - always indicative of heart disease or abnormality Grading Murmurs - ANSWER I: soft II: mild to moderate III: loud, easily heard IV: loud, easily heard, thrill or palpable murmur present V: Very loud, obvious thrill VI: Loudest, heard when stethoscope is off chest, easily palpated thrill Heart Sounds: S1 - ANSWER - systole - "lub" - closure of MV and TV -- Atrioventricular Valves Heart Sounds: S2 - ANSWER - diastole - "dub" - closure of Aortic and PV -- semilunar valves - physiological split: heard at pulmonic area (upper left sternum, 2nd ICS) ... normal if occurs with inspiration and disappears with expiration Heart Sounds: S3 - ANSWER - indicates heart failure of congestive heart failure (CHF) - early diastole - "Ken-Tuck-Y" or ventricular gallop - normal if 40+ yoa, child, pregnant, or athletes 35+ yoa Heart Sounds: S4 - ANSWER - indicates left ventricular heart failure (LVH) - stiff left ventricle - late diastole - "Ten-ness-ee" or atrial gallop/kick - heard at apex - can be normal in elderly if no s/sx of heart or valvular disease MoTiVAted ApPleS - ANSWER "motivated apples": pneumonic for which valves and types of valves produce what heart sound MoTiVAted: mitral valves & tricuspid valves = atrioventricular valves ApPleS: aortic valves & pulmonic valves = semilunar valves Abdominal Aortic Aneurysm (AAA): Defintion - ANSWER A rapidly fatal condition in which the walls of the aorta in the abdomen weaken and blood leaks into the layers of the vessel, causing it to bulge. Abdominal Aortic Aneurysm (AAA): Signs and symptoms - ANSWER S/Sx: asymptomatic; may have severe, sharp, excruciating abdominal pain in the abdomen, flank, and/or back with a pulsatile abdominal mass (50% of pts, 3cm) if rupture has occurred Abdominal Aortic Aneurysm (AAA): Risk Factors - ANSWER - 70+ yoa - white - current or former smoker - HTN Abdominal Aortic Aneurysm (AAA): Imaging - ANSWER - ultrasound & CT first, then xray - widened mediastinum - tracheal deviation - obliteration of aortic knob Infective Endocarditis (IE): Definition - ANSWER also known as bacterial endocarditis; inflammation of endothelium that lines heart and cardiac valves. most commonly damages mitral valve, then aortic and tricuspid valves. commonly caused by bacteria that are normally present in the body (MSSA and MRSA). can also occur after an invasive medical or dental procedure. Infective Endocarditis (IE): Signs and Symptoms - ANSWER - fever/chills - new onset murmur - anorexia/weight loss valvular dysfunction - Finger/Toe abnormalities: clubbing, subungal hemorrhages (splinter hemorrhages), violet colored nodes (Osler nodes), and nontender red spots on palms (Janeway lesions) - petechiae on palate - Roth spots (retinal hemorrhages) with funduscopic exam Infective Endocarditis (IE): Imaging & treatment - ANSWER Imaging: transthoracic echocardiogram Tx: IV antibiotics; Amoxicillin Prophylaxis: prior to invasive procedure (dental work, respiratory tract incision or biopsy) if hx of disease, prosthetic heart valves, hx of cyanotic congenital heart disease, cardiac transplant Deep Vein Thrombosis (DVT): Definition - ANSWER formation of a clot in a deep vein of the body, occurring most often in the femoral and iliac veins Deep Vein Thrombosis (DVT): Risk Factors - ANSWER - DVT secondary to: stasis, trauma, inflammation, or increased coagulation (inherited or external) Examples: birth control, inactivity/traveling, surgery/hospitalization, malignancy, fractures, Factor C deficiency, CHF