3.1 Heart and Lung Assessment Flashcards
Cardiovascular (CV) System includes
Heart
Peripheral vascular
-Arteries, Veins, Capillaries
Hematologic
-Blood – Hemoglobin
Lymphatic
-Lymph, Lymph Nodes, Spleen
The Heart includes
4 Chambers
- Left and Right Atria
- Left and Right Ventricles
4 Valves
- AV- tricuspid and mitral
- Semilunar- pulmonary and aortic
Base at the top
-2nd rib
Apex at the bottom
-5th IC space, midclavicular
Unoxygenated blood flow
Unoxygenated Inferior and Superior Vena Cava → Right Atrium → Tricuspid Valve → Right Ventricle → Pulmonic Valve → Pulmonary Arteries
Oxygenated blood flow
Oxygenated Pulmonary Veins → Left Atrium → Mitral Valve → Left Ventricle → Aortic Valve → Aorta
Cardiac Cycle
Systole (1/3) + Diastole (2/3)
Systole (Pumping)
- Semilunar valves open
- AV valves closed
- Ventricular contraction
Diastole (Filling)
- AV valves open
- Semilunar valves closed
- Ventricular relaxation
Physical Assessment: Cardiac
Inspection -Apical Impulse 4th or 5th IC space, midclavicular -Retraction -Heaves (lifts)
Palpation
- Apical impulse
- Thrills
Percussion
Auscultation
- Heart Tones
- Rate and Rhythm
- Murmurs
- Gallops
Stethoscope
- Bell “light low”
- Diaphragm “high heavy”
Heart Tones S1
- “Lub”
- Systole
- Mitral and tricuspid closure
- Loudest over apex
- Synchronous w/ carotid pulse
- Split S1: right bundle branch block (BBB) or premature ventricular contractions (PVC)
Heart Tones S2
- “Dub”
- Diastole
- Aortic and pulmonic closure
- Loudest over the base
- Split S2: bundle branch block (BBB) or valve disease
Heart Tones: S3
- “Ventricular gallop”
- Early diastolic sound
- Loudest over the apex
- Just after S2 (like Ken-tuc-ky)
- Due to heart failure (3 syllables)
- Low-pitch, heard best with the bell
Heart Tones: S4
- “Atrial gallop”
- Late diastolic sound
- Loudest over the apex
- Just before S1, like Ten-nes-see
- Due to hypertension (4 syllables)
- Low-pitched, heard best with the bell
MURMURS sounds
- Sounds from turbulent blood flow
- Most commonly from valve disease
- Regurgitation- backward flow
- Stenosis- obstructed forward flow
MURMURS described
Described by
- Location- Listening post
- Timing- Systole or Diastole
- Pitch- Low, medium, high
- Quality- Harsh, blowing
- Intensity- I – VI
- Pattern- Crescendo, decrescendo
- Radiation- Axilla, neck
Jugular Vein Distention (JVD)
Assessment of circulatory volume
Normally visible while lying flat
Visible at 45◦ = +JVD
Assess for heart failure
- Mentation (mental activity)
- Urine output
- Skin color and temperature
- Breath sounds
- Edema
- Pulses
Correlates with Central Venous Pressure (CVP)
Oxygen Uptake System
Upper and Lower respiratory
Upper Respiratory
- Nose and Sinuses
- Pharynx
- Larynx
- Trachea
Lower Respiratory
- Lungs
- Pleura
- Bronchi
- Alveoli
- Ribcage and -Intercostal Muscles
Oxygen Uptake System alveoli
- Air reaches the alveoli
- The capillary network exchanges CO2 and O2
Physical Assessment: Thoracic
Inspection
- Trachea
- AP: Transverse ratio
- Rest rate, depth, pattern
- Retractions, bulging
- Expansion
Palpation
- Expansion
- Tactile Fremitus
Percussion
Auscultation
-Breath Sounds
Tactile Fremitus
Tactile Fremitus
- Open palms, ball of hands at upper back
- Have patient say “ninety-nine”
- Move hands down the back and repeat
- Vibrations should be symmetrical
- Strongest at the apices, decrease toward the bases
- Lung consolidations occurs when the air that usually fills the small airways in your lungs is replaced with something else. Depending on the cause, the air may be replaced with: a fluid, such as pus, blood, or water, will increase the intensity
- Air will decrease the intensity
Chest Expansion
Chest expansion
- Thumbs at T9 – T10
- Have patient take a deep breath
- -Hands will amplify the movement
Normal lung sounds
Bronchial
Normal lung sounds
Bronchial: expiratory sounds last longer than inspiratory sounds
-Loud, high-pitched
-Heard over the trachea, upper airways
Normal lung sounds Bronchovesicular
Bronchovesicular: inspiration and expiration sounds are equal
- Medium pitch and intensity
- Heard over the primary bronchi
- -anterior sternal borders, posterior mid-scapulae
Normal lung sounds Vesicular
Vesicular: inspiratory sounds last longer than expiratory sounds
- Soft, low-pitched, breezy
- Heard over alveoli, all fields except major airways
Adventitious and Abnormal Breath sounds Crackles or “Rales”
Crackles or “Rales”
- Short, crackling or bubbling
- smaller airways
- fluid in lungs (alveoli)
- CHF, bronchitis, pneumonia, atelectasis
Adventitious and Abnormal Breath sounds Rhonchi
Rhonchi
- Continuous, snoring
- Large airway congestion
- obstruction or fluid accumulation in larger airways
- COPD, pneumonia
Adventitious and Abnormal Breath sounds Stridor
Stridor
- High-pitched, tight wheezing
- Upper airway obstruction
- over trachea
- foreign airway obstruction
