Health Assessment (Lecture)

STUDENT ACTIVITY SHEET BS NURSING / FIRST YEAR

Session # 1 4

LESSON TITLE: The Cardiovascular System (Part 3) reduce coronary heart disease.
LEARNING OUTCOMES: Materials:

Upon completion of this lesson, the nursing student can: Book, pen and notebook, index card/class list

1. Obtain an accurate history of the cardiovascular system;

2. Appropriately prepare and position the patient for
References: Bates’ Nursing Guide to Physical
cardiovascular examination;
Examination and History Taking (Second Edition)
3. Inspect, palpate, and auscultate the jugular veins, carotid
by Beth Hogan-Quigley, Mary Louise Palm, and
arteries, and the precordium to evaluate cardiovascular
Lynn Bickley.
status;
4. Discuss risk factors for coronary heart disease;
5. Discuss risk reduction and health promotion strategies to

MAIN LESSON (60 minutes)

The students will study and read Chapter 14 of their book about this lesson:

Auscultatory Sounds

HEART MURMURS

Midsystolic Murmur

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 • A midsystolic murmur begins after S1 and stops before S2. Brief gaps are audible between the murmur and
the heart sounds. Listen carefully for the gap just before S2. It is heard more easily and, if present, usually
confirms the murmur as midsystolic, not pansystolic.

Pansystolic Murmur
• A pansystolic (holosystolic) murmur starts with S1 and stops at S2, without a gap between murmur and heart
sounds.

Late Systolic Murmur

• A late systolic murmur usually starts in mid- or late systole and persists up to S2.

Early Diastolic Murmur

• An early diastolic murmur starts immediately after S2, without a discernible gap, and then usually fades into
silence before the next S1.

Middiastolic Murmur
• A middiastolic murmur starts a short time after S2. It may fade away, as illustrated, or merge into a late
diastolic murmur.

Late diastolic (presystolic) murmur

• A late diastolic (presystolic) murmur starts late in diastole and typically continues up to S1.

Shape
• The shape or configuration of a murmur’s shape is the most difficult for a novice to determine. Concentrate on
learning the other characteristics of murmurs first. As your ears become attuned to listening, shape will
become identifiable.

Location of Maximal Intensity

• Find the location where the murmur is heard in terms of the intercostal space and its relation to the sternum,
the apex, or the midsternal, the midclavicular, or one of the axillary lines.

Intensity
• This is usually graded on a 6-point scale and expressed as a fraction.
• The numerator describes the intensity of the murmur wherever it is loudest; the denominator indicates the
scale you are using. Intensity is influenced by the thickness of the chest wall and the presence of intervening
tissue.

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A client with three or more of these findings may have metabolic syndrome:
● Large waist circumference (abdominal obesity)
Men: waist circumference of 40 inches or more
Women: waist circumference of 35 inches or more
● High blood pressure—130/85 mm Hg or higher
● High fasting blood sugar—fasting glucose of 100 mg/dL or higher
● High triglycerides—150 mg/dL or higher
● Low high-density lipoprotein (HDL; good) cholesterol
Men: 40 mg/dL
Women: 50 mg/dL
• Smoking is also a risk factor for metabolic syndrome.

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to
correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not
allowed. You are given 20 minutes for this activity:

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Multiple Choice

1. This type of murmur starts immediately after S2, without a discernible gap, and then usually fades into silence
before the next S1
a. Midsystolic murmur
b. Early diastolic murmur
c. Late systolic murmur
d. Pansystolic murmur

ANSWER: B
RATIONALE: An early diastolic murmur starts immediately after S2, without a discernible gap, and then
usually fades into silence before the next S1.

2. Which of the following best describes a crescendo-decrescendo murmur?

a. It grows louder
b. It grows softer
c. It first rises in intensity, then falls.
d. It has the same intensity throughout.

ANSWER: C
RATIONALE: The crescendo—decrescendo murmurs (diamond or kite-shaped murmurs), is a progressive
increase in intensity is followed by a progressive decrease in intensity.

3. A nurse has noted that the murmur has a loud with palpable thrill. The nurse should grade this on her chart as
a. Grade 1
b. Grade 2
c. Grade 3
d. Grade 4

ANSWER: D
RATIONALE: The nurse should grade this on her chart as grade 4 as it is loud and with palpable thrill.

4. The shape of a midsystolic murmur is a

a. Crescendo
b. Decrescendo
c. Crescendo-decrescendo
d. Plateau

ANSWER: C
RATIONALE: The mydsystolic murmur of aortic stenosis and innocent flow murmur is a crescendo-
decrescendo that first rises in intensity, then falls.

5. When a patient has a constant blood pressure reading of 150/100, which of the following should be advised to
the patient?
a. No treatment required
b. Lifestyle modifications advised
c. Lifestyle modifications and drug therapy
d. Lifestyle modifications, drug therapy with two-drug combination required

ANSWER: C

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RATIONALE: Constant blood pressure reading of 150/100 is a stage 1 hypertension, so the patient should be
advised for a lifestyle modification and drug therapy.

6. The following are modifiable risk factors for coronary heart disease EXCEPT
a. Diabetes
b. History of cardiovascular disease
c. Obesity
d. Physical inactivity

ANSWER: B
RATIONALE: The history of cardiovascular disease is non modifiable risk factor for coronary disease.

7. Which of the following habits can contribute to the worsening hypertension of the patient?
a. Excessive use of seasonings on food
b. Frequent aerobic exercises
c. Having an average body built
d. Increased intake of potassium-rich foods

ANSWER: A
RATIONALE: The certain lifestyle that can raise the risk of hypertension is excessive use of seasonings or
eating too much sodium (salt).

8. The optimum body mass index that people should maintain is at

a. Below 18.5
b. 18.5 to 24.9
c. 25 to 29.9
d. 30 and above

ANSWER: B
RATIONALE: The optimum body mass index that people should maintain is at 18.5 to 29.9 kg/m 2.

9. Which of the following foods must the nurse recommend to a patient who has hypertension?
a. Carrots
b. Cucumbers
c. Bananas
d. Tomatoes

ANSWER: C
RATIONALE: Bananas are loaded with minerals such as potassium which regulate the sodium-potassium
balance and help in reducing blood pressure.

10. In order to do lifestyle medication on a patient who has a risk for cardiovascular disease the nurse must teach
which of the following?
a. Eating a balanced diet and avoidance of fast food and processed food
b. Having regular aerobic exercises
c. Complete cessation of smoking
d. All of the above

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ANSWER: D
RATIONALE: All of the aforementioned is a lifestyle medication to a patient who has risk for cardiovascular
disease.

LESSON WRAP-UP (10 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help
you track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Strategy: Turn and talk

(Students turn to talk partner/s to – find out, summarize, clarify, share ideas, point of view or opinions)

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