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
Adventitious and Abnormal Breath sounds Pleural Friction Rub
Pleural Friction Rub
- Harsh, grating
- Pleural inflammation
Adventitious and Abnormal Breath sounds Decreased or absent
Decreased or absent
-Pneumothorax, pleural effusion
Errors to avoid when listening to lungs and heart
Errors to avoid
Listening over clothing
Allowing tubing to rub against rail or clothing
Mistaking chest hair sound for an adventitious sound
Auscultating the convenient places only
Pressing too hard on the bell
60 Second Assessment
General survey to develop situational awareness
Observe for “60 seconds”
- ABCs
- Tubes and lines
- Respiratory equipment
- Safety survey
- Environmental survey
- Sensory
- Additional assessment – other questions?
- Who will you see first? Why?
