Cardio System 1 - Heart & Neck Vessels Flashcards
How do you auscultate the carotid artery?
Keeping neck in neutral position, lightly apply bell of stethoscope at 3 levels (1) angle of jaw, (2) midcervical area, and (3) base of neck; avoid compressing artery as it could create an artificial bruit or compromise circulation;
Ask patient to take a breath, exhale, and hold briefly
Why do you auscultate the carotid artery?
looking for the presence of a bruit (a blowing, swishing, sound indicating blood flow turbulence) - normally none are present
How do you palpate the carotid artery?
Located central to the heart and yields important information about cardiac function; palpate each carotid artery medial to the sternomastoid muscle in the neck; avoid excess pressure as it could stimulate vagal reflex and slow down heart rate; palpate gently and only side at a time; feel the amplitude and contour of pulse; normally contour is smooth with rapid upstroke and slower downstroke; normally strength is 2+; should be equal bilaterally.
Why do you inspect the jugular venous pulse?
It assesses CVP and the heart’s efficiency as a pump; We are observing the pulsations because we cannot see the internal jugular vein directly and it is more reliable because it is attached more directly to the superior vena cava
How do you inspect the jugular venous pulse?
Position patient supine at a 30-40 degree angle (where pulsations are best observed); higher venous pressure, higher the pulsations will be observed; head should be in line with the trunk of the body (avoid flexing, no pillow); turn patient’s head slightly away from examined side and direct a strong light tangentially onto neck to highlight pulsations and shadows; look for pulsations of internal jugular veins in the area of the supra sternal notch or origin of sternomastoid muscle around the clavicle; be able to distinguish between carotid pulsations and jugular venous pulsations
how do you inspect the anterior chest?
looking for the apical impulse - arrange tangential lighting to accentuate any flicker or movement; you may or may not see the apical impulse - the pulsations created as the left ventricle rotates against the chest wall during systole; when it is visible, it appears at the level of the fourth or fifth intercostal space, at or inside the midclavicular line
How do you palpate the apical pulse?
Locate using one finger pad; asking the patient to “exhale and hold it” aids in locating the pulsation; may need to roll the patient midway to the left to find it (note: this displaces the impulse farther to the left); only palpable in about half of adults; not palpable in obese patients or patients with thick chest wall
What should you note when palpating the apical pulse?
Location: should occupy only one intercostal space (4th or 5th); be at or medial to midclavicular line
Size: normally 1x 2 cm
Amplitude: normally a short, gentle tap
Duration: short, normally occupies only first half of systole
How do you palpate across the precordium?
Use palmar aspects of your four fingers, gently palpate over the apex, left sternal border, and the base, searching for any other pulsations; normally none are felt; if any are felt, note the timing; use carotid artery pulsation as a guide, or auscultate as you palpate
