Assessment of Cardiovascular and Peripheral Vascular System Flashcards by christine tin

Complete examination of the cardiovascular system consists of _____________________________________________ to evaluate functioning of the heart and vessels.

history taking, inspection, palpation, percussion, and auscultation

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is defined as the succession of coordinated events taking place in the heart during each beat

Cardiac Cycle

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Each heart beat consists of two parts:

SYSTOLE and DIASTOLE

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Ventricular contraction

SYSTOLE

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Ventricular relaxation

DIASTOLE

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is the volume of blood pumped out of the heart during each Systolic Cardiac contraction

Stroke Volume

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is the speed of heartbeat measured by the number of contractions (beats) of heart per minute (bpm)

Heart Rate

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is the amount of blood the heart pumps (SV) through the circulatory system in a minute (HR)

Cardiac Output

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Cardiac Output formula

Stroke Volume x Heart Rate = Cardiac Output

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Borders of the Heart

Upper Border
Right Border
Lower Border
Left Border

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is formed by the 2 atria

Upper Border

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it is conceled by ascending aorta and pulmonary trunk

Upper Border

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is formed by right atrium

Right Border

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is formed mainly by right ventricle + apical part of left ventricle

Lower Border

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is formed mainly by left ventricle + left auricle

Left Border

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Four (4) Heart Sounds

S1. S2, S3, S4

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Marks the beginning of systole (end of diastole)

First heart sound: S1

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It resembles to spoken word “Lub”

First heart sound: S1

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Loudest at the apex and lower left sternal border

First heart sound: S1

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S1 is loudest at?

at the apex and lower left sternal border

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Marks the end of systole (beginning of diastole)

Second heart sound: S2

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It resembles to spoken word “Dub”

Second heart sound: S2

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Loudest at the base

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S2 is loudest at?

at the base

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Heard in early diastole

Third heart sound: S3

This may be a normal sound in some people but in people with heart conditions may indicate heart failure.

Third heart sound: S3

S3 may be a normal sound in some people but in people with heart conditions may indicate

heart failure

Low-intensity sound heard just before S1 in the cardiac cycle

Fourth heart sound: S4

The sudden slowing of blood flow by the ventricle as the atrium contracts causes this sound.

Fourth heart sound: S4

S4 is caused by

sudden slowing of blood flow by the ventricle as the atrium contracts

May be a sign of heart disease.

Fourth heart sound: S4

S4 heart sound may be a

sign of heart disease

Calculating pack-years of smoking

number of cigarettes smoked per day x number of years smoking / 20

Equipment

▪ Watch with second hand ▪ Centimeter ruler (two) ▪ Stethoscope ▪ Penlight

Assessment techniques

▪ Inspection ▪ Palpation ▪ Auscultation

Physical examination

▪ General survey ▪ General appearance ▪ Vital signs ▪ Height and weight

place patient supine in bed and gradually raise the head of the bed 30, 45, 60, 90 degrees. using tangential lighting , note the highest level of venous pulsation. measure the vertical distance between this point and the sternal angle. record this distance in centimeters and the angle of the head of the bed

assessment of jugular venous pressure

how to tell JVP from carotid pulse

Palpation Occlusion Location Inspiration Contour Erection/Position

is created by turbulence of blood flow due either to a narrowed arterial lumen

bruit

is a vibrating sensation like the purring of a cat orwater running through a hose.

thrill

▪ Auscultating the precordium ▪ Location

✓ Apex ✓ Mitral ✓ Tricuspid ✓ Erb’s point ✓ Base ✓ Murmurs

is a whooshing, humming or rasping sound between the heartbeat sounds.

heart murmur

This is caused by noisy blood flow within the heart. Blood can flow abnormally through the heart for many reasons, including defective valves, congenital heart disorders and anemia

heart murmur

upper extremity pulses

✓ Brachial pulse ✓ Radial pulse ✓ Ulnar pulse

Lower extremity pulses

✓ Femoral pulse ✓ Popliteal pulse ✓ Dorsalis pedis ✓ Posterior tibialis

Lightly place your fingers just lateral to the trachea and below the jaw angle. Never palpate both carotid arteries at the same time.

Carotid pulse

Position your fingers medial to the biceps tendon

Brachial pulse

Apply gentle pressure to the medial and ventral side of the wrist, just below the base of the thumb.

Radial pulse

Press relatively hard at a point inferior to the inguinal ligament. For an obese patient, palpate in the crease of the groin, halfway between the pubic bone and the hip bone.

Femoral pulse

Press firmly in the popliteal fossa at the back of the knee.

Popliteal pulse

Apply pressure behind and slightly below the malleolus of the ankle.

Posterior tibial pulse

Place your fingers on the medial dorsum of the foot while the patient points his toes down. The pulse is difficult to palpate here and may seem to be absent in healthy patients

Dorsalis pedis pulse

Palpating calf circumference

Homans’ testAdditional test to assess peripheralvascular flow:

Additional test to assess peripheralvascular flow:

❑ Allen test ❑ Ankle-brachial index ❑ Manual compression test ❑ Trendelenburg test

is a first-line standard test used to assess the arterial blood supply of the hand.

Allen test

This test is performed whenever intravascular access to the radial artery is planned or for selecting patients for radial artery harvesting, such as for coronary artery bypass grafting or for forearm flap elevation.

Allen test

is a simple test that compares the blood pressure in the upper and lower limbs

ankle brachial index, or ABI

is performing manual compression to assess competence of venous valves in clients with varicose veins

Manual compression test

Health care providers calculate ABI by

dividing the blood pressure in an artery of the ankle by the blood pressure in an artery of the arm. The result is the ABI.

is a useful procedure for detecting hip-joint dysfunction.

unilateral leg stand or Trendelenburg test

is identified when the patient is unable to maintain the pelvis horizontal to the floor while standing first on one foot and then on the other foot.

positive Trendelenburg sign

A positive Trendelenburg sign usually indicates weakness in the hip abductor muscles:

gluteus medius and gluteus minimus

Very faint, may only be heard by an expert, not heard in all positions, no thrill

Grade I

Soft, heard in all positions, no thrill

Grade Il

Moderately loud, no thrill

Grade Ill

Loud and associated with a palpable thrill Very loud, with thrill, heard with the stethoscope partly off the ches

Grade IV

Loudest, with thrill, heard with the stethoscope entirely off the chest (just above the precordium, not touching the skin)

Grade V

Normal lower extremity blood flow

>0.90 (with a range of 0.90 to 1.30)

Mid PAD

<0.89 to >0.60

Moderate PAD

<0.59 to >0.40

Severe PAD

<0.39

Performing cardiovascular assessment

▪ Inspecting the carotid artery and jugular vein ▪ Measuring jugular venous pressure ▪ Inspecting the precordium ▪ Palpating the neck ▪ Palpating the carotid (assessing rate, rhythm, amplitude, contour, symmetry, elasticity) ▪ Palpating the jugulars ▪ Auscultating the vascular structures of the neck ▪ Auscultating the precordium

2nd ICS

Aortic Pulmonic

3rd ICS

Erb's Point

4th or 5th ICS

Tricuspid

5th ICS

Mitral/Apex

ABI

BP in an artery of ankle/BP in an artery of arm

Manual compression test is performing manual compression to assess competence of venous valves in clients with

varicose veins

The unilateral leg stand or Trendelenburg test is a useful procedure for detecting

hip-joint dysfunction

Bilateral measurements above ________________ (1.2 to 1.6 in.) are considered elevated (may indicate ________________________)

3 to 4 cm; right-sided heart failure

may be caused by local obstruction

Unilateral distention