Cardiac Assesment Flashcards
Blood flow in the heart
Atrium to ventricle, valves are open, blood keep filling and filling, until the heart beats, right atrium pushes blood into left ventricle, then the valve opens
Heart Valves
Atrioventricular-between atria and ventricles
Tricuspid=opens from right atrium to right ventricle
Mitral opens from left atrium to left ventricle
Semilunar=pulmonic and aortic valve
Neck Vessels
Carotid artery and jugular artery
Subjective data for cardiovascular assessment
Chest pain
Dyspnea
Orthopnea
Cough
Fatigue
Cyanosis or pallor
Edema
Nocturia
Past cardiac history
Family cardiac history
Personal habits
Socioeconomicfactors
high blood pressure
smoking
serum cholesterol
obeisity
diabetes
Non-modifiable vs modifiable risk factors
Non-modifiable-age, gender, genetic factors, race and ethnicity
Modifiable-high BP, smoking, diabetes mellitus, physical inactivity, obesity, high blood cholesterol
Additional health questions
Infants-maternal health, feeding without tiring, growth, milestones
Children-growth, activity, headaches and nosebleeds, respiratory disease
Adult-hyper or hypotension
Older adults-disease, medications, environment
Women and heart attacks
often ignored
women minimize symptoms
ovaries decrease estrogen production=increased LDLs, blood pressure and body fat, sugar metabolism affected
Objective Assessment
Inspection
Palpation
Percussion
Auscultation
Physical Exam
Carottd artery while client is sitting-palpate and auscultate
Assist client to sitting position-inspect anterior chest(deformities, pulsations, skin) then palpate apical impulse, palpate for thrills, repeats laterally because the heart moves spots and blood flow shifts
Landmarking the chest
intercostal spaces
Midclavicular line
Sternal border
axillary lines
Physical Exam continued
Precordium
Inspect anterior chest, palpate apical impulse, palpate across precordium, percuss outline of cardiac borders
Identify auscultatory areas
S1 is louder than S2 at apex
S1 coincides with carotid artery pulse
2ndLCS, RSB (aortic)
2nd LCS, LSB (pulmonic)
5th ICS, LSB (tricuspid)
5th ICS, LMCL (mitral)
Auscultory Pneumonic
APe To Man
What is split S2
Normal occurrence at the end of inspiration
Inspiration -aortic closes before pulmonary
Dup becomes T-Dup
Expiration-aortic and pulmonic valves close together
Usually heard in pulmonic valve area
Murmurs
Blowing/swooshing from turbulent blood flow
Frequently found with a thrill
Physical exam of murmurs
timing
loudness
pitch
pattern
quality
location
radiation
posture
Extra heart sounds
filling sounds at LLSB in lateral position
S3 and S4
summation gallop S4,S1,S2, S3 together
pericardial friction rub
Developmental considerations
Infants-difference in. apical pulse, normal heart rates, murmurs are common
Children-venous hum, innocent heart murmurs
Pregnant women-mammary souffle, changes in BP
Older adults-orthostatic hypotension, avoid pressure on carotid artery, premature ectopic beats
Cardiovascular assessment sequence
Palpate and auscultate
Supine position to inspect, palpate and auscultate
Lateral position to auscultate
DOs!
Take time
quiet room
warm room
solid visual
Consider what is happening when you listen to the heart
Don’ts!
don’t rush
don’t push too hard
don’t forget to turn your stethescope
Don’t tell the patient about their broken heart
Veins in peripheral system
Veins run parralel to arteries but there are more veins than arteries in the body, and they lie closwer to the skin so they are easier to palpate
Jugular, arm and leg veins
Peripheral developmental considerations
Infants and children-transient acrocyanosis and skin mottling
Pregnant women-diffuse bilateral pitting edema and varicose veins
Older adults-arteriosclerosis, atherosclerosis, DVT, dorsalis pedis
Health history subjective data
leg pain or cramps
skin changes on arm or legs
Swelling in arms or legs
Medications
Occupation
Recent travel
Recent surgery
Arms-objective data
inspect and palpate skin, profile sign, capillary refill, symmetry, radial pulses, ulnar pulses and brachial pulse
Legs- Objective data
inspect and palpate- skin and hair, symmetry, temperature, calf muscle, femoral pulse, popiteal pulse, posterior tibial pulse, dorsalis pedis pulse, pretibial edema, and colour
edema
depress skin over bone and release
1+ is mild
2+ is moderate
3+ is swollen and pitting
4+ is very deep
Peripheral vascular disease in legs
Chronic arterial insufficiency
Chronic venous insufficiency
Arterial ulcer
Venous ulcer
Diabetic changes
Chronic venous disease
Superficial varicose veins
Deep venous thrombophlebitis
Foot care
foot problems are the firs sign of arthritis/diabetes/ nerve or circulatory disorders
check feet daily, dry feet carefully, trim toenails straight across
keep blood flow to feet
Abnormal findings
Pain profiles of PAD
Arterial disease
Venous disease
Deep Vein Thrombosis
Risk factors-bedrest immobility, surgery
Signs and symptoms-redness, swelling, pain,
Prevention-ealy mobilization, compression stockings
