CH17 Cardiovascular Assessment _ Nk07

8/11/2019 CH17 Cardiovascular Assessment _ Nk07

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Cardiovascular System

Chapter 17


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Figure 17.3 Structural components of the heart.


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Heart Heartpump composed of synchronized structures

Cardiac Vessels

Coronary Arteriesextensive network of arteries supplying the heart

Coronary Veinsnetwork for venous blood drainage

Conduction systemheart has it own conduction system whichcan initiate and transmit an electrical impulse via cardiac muscle

fibers This electrical charge stimulates muscular contraction of the heart

SA node, AV node, Bundle of His, Right and Left Bundle Branch Block,and Purkinje fibers

Nerves

Sympatheticstimulate the heart, increases heart rate, force ofcontraction, and dilation of coronary arteries.

Parasympatheticopposite effect

CNSinfluences the activation and interaction of nerves throughinformation supplies by the cardiac plexus.


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Cardiac Musculature

Heart Muscle

Base

Apexpoint of maximum impulse so heart beat is more

easily palpated over the apex5thintercostal space

Three Layers:

Epicardiumouter layer

Myocardiumthick muscular layer

Endocardium - smooth inner lining of chambers


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Valves

Valves - Permit the Flow of Blood Between

Chambers and into Blood Vessels

Atrioventricular (AV)

Tricuspid Mitral

Semilunar

Pulmonary

Aortic


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Heart Sounds

Heart SoundsClosure of valves which are associatedwith the contraction and relaxation phases of the heart.

Systolerefers to ventricular contraction and begins with

closure of the AV valves (S1) and ends with the closure of

the aortic and pulmonic valve (S2)

Diastolerefers to ventricular relaxation and begins with

closure of the aortic and pulmonic valve (S2) and ends with

closure of AV valves (S1).

S1 (lub) S2 (dub)


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Figure 17.5 Heart sounds in systole and diastole.


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Table 17.3 Distinguishing Heart Murmurs


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Table 17.3 (continued) Distinguishing Heart Murmurs


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Table 17.4 (continued) Classifications of Heart Murmurs


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Electrocardiogram

Electrocardiogram (EKG) - Paper Recording ofDeflections That Represent the Cardiac Cycle

Signifies electrical conduction

Electrical deflections P wave

PR interval

QRS interval

T wave


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Figure 17.11 Electrocardiogram wave.


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Cardiac Function

Stroke volume - Amount of blood that is ejected witheach heartbeat

Cardiac output - Amount of blood ejected from the leftventricle over one minute

Cardiac index - Measurement accounting for anindividuals weight when evaluating the pumpingaction of the heart


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Landmarks for Cardiac Assessment

Landmarks for Cardiac Assessment Sternum

Clavicles

Ribs

Second through fifth intercostal spaces

Correlating assessment findings over body landmarks

provides vital information related to underlying

pathologic mechanisms.


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Figure 17.18 Landmarks in precordial assessments.


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Inteview

General Questions Specific Questions Illness

SymptomsBehaviors

Infants and children

Pregnant female

Older adultEnvironment


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Equipment

Examination gown

Examination drape

Stethoscope

Metric rulers Doppler


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Techniques

Physical Assessment of the Cardiovascular System Techniques

Inspection

Palpation

Percussion Auscultation


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Specific Areas

Specific Areas of the Cardiovascular Assessment Inspection of the face, lips, ears, and scalp

Skin color

Movement

Earlobe creases

Inspection of the jugular veins Pulsations

Distention

Inspection of the carotid arteries

Pulse characteristics Inspection of the hands and fingers

Color

Shape of fingers


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Figure 17.17 Splinter hemorrhage.


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Specific Areas

Inspection of the chest, abdomen, legs, andskeletal structure

Landmarks Right sternal border, 2ndintercostal space

Left sternal border, 2ndintercostal space Left sternal border, 3rd5thintercostal space

Heaves and lifts


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Palpation

Palpation of the chest, including the following Precordium at the right and left second intercostal

spaces

Left third intercostal space

Left fourth intercostal space

Left fifth intercostal space at the midclavicular line

Position patient at a 30 degree angle or less

No thrills, heaves or lifts should be palpated inany of the five locations


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Figure 17.19 Landmarks for palpation of the chest.


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Palpation

Carotid pulses (sequentially) Client may be supine or sitting upright

Asses: Presencediminished or absent may indicate carotid disease

or dissecting aortic aneurysm Strengthshould be strong but not bounding

Rhythmregular pattern

Equalityconsistent bilaterally

Palpate each artery separatelymay obstruct

blood flow to the brain, resulting in severebradycardia or asystole


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Figure 17.20 Palpating the carotid artery.


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Percussion

Percussion of the chest for cardiac border 5thintercostal space at the left anterior axillary line

Normal findings would be resonance because you will beover lung tissue

Next, percuss the mid clavicular line and the leftsternal border

Should change to dull as you percuss over the heart

Advance to the 3rdand 2ndintercostal space on the left

side. Should change from resonnance to dullness as youpercuss over the heart


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Figure 17.21 Percussing the chest.


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Figure 17.22 Auscultating the chest over five key landmarks.


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Figure 17.24A Positions for auscultation of the heart. A. Supine.


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Figure 17.24B Positions for auscultation of the heart. B. Lateral


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Figure 17.24C Positions for auscultation of the heart. C. Sitting.


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Auscultation of Apical Pulse

Specific Areas of the CardiovascularAssessmentAuscultation of the carotid arteries using the

diaphragm and bell

Comparison of the apical pulse to a carotid pulse


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Abnormal Findings

Abnormal Findings in the Cardiovascular System Myocardial and pump disorders

Valvular disease

Septal defects

Congenital heart disease

Electrical rhythm disturbances


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Muscular and Pump Disorders

Myocardial and Pump Disorders Myocardial ischemia

Myocardial infarction

Congestive heart disease

Ventricular hypertrophy


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Valvular Disorders

Valvular Diseases Mitral, aortic, tricuspid, and pulmonic stenosis

Mitral and aortic regurgitation

Mitral valve prolapse


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Figure 17.25 Mitral stenosis.


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Figure 17.26 Aortic stenosis.


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Figure 17.27 Mitral regurgitation.


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Figure 17.28 Pulmonic stenosis.


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Figure 17.29 Tricuspid stenosis.


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Figure 17.30 Mitral valve prolapse.


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Figure 17.31 Aortic regurgitation.


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Setal Defects

Septal Defects Openings between the right and left atria or right and left

ventricles


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Figure 17.32 Ventricular septal defect.


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Figure 17.33 Atrial septal defect.


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Congenital Heart Diseases

Congenital Heart Diseases Coarctation of the aorta

Patent ductus arteriosus

Tetralogy of Fallot


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Figure 17.34 Coarctation of the aorta.


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Figure 17.35 Patent ductus arteriosus.


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Figure 17.36 Tetralogy of Fallot.


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Figure 17.36 (continued) Tetralogy of Fallot.


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Rhythm Disturbances

Electrical Rhythm Disturbances Ventricular tachycardia

Ventricular fibrillation


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Fi 17 38 V t i l fib ill ti


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Figure 17.38 Ventricular fibrillation.

Fi 17 39 H t bl k


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Figure 17.39 Heart block.

Figure 17 40 Atrial flutter


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Figure 17.40 Atrial flutter.


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Developmental Considerations

Pediatric Fetus receives oxygen and nutrients from the mother

Changes occur in the newborns cardiovascular system

Infants heart rate


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Pregnant Female Heart is displaced to the left and upward

Blood volume increases 30 to 50 percent

Cardiac output and stroke volume increase

Resting pulse may increase Murmurs may be auscultated


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Geriatric Loss of ventricular compliance and vascular rigidity

Conduction system loses automaticity

Psychosocial Considerations


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Psychosocial Considerations

Stress and workload of the heart

Considerations


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Co s de a o s

Race Ethnicity

Diet

Substance abuse


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Healthy People 2010

Focus Areas Outlined in the Healthy People 2010 Coronary heart disease

High blood cholesterol


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Healthy People 2010

Key Objectives for High Blood Cholesterol Reduce the number of adults with elevated cholesterol

levels

Increase the number of adults who have cholesterol

levels measured

Documents

CH17 Cardiovascular Assessment _ Nk07