cardiovascular assessment Flashcards
over what areas of the heart do nurses auscultate?
over valves
precordium
area on anterior chest overlying the heart and great vessels
4 chambers of the heart
atria and ventricles
direction of blood flow to the heart
vena cava –> RA –> pulmonic valve –> pulmonary artery –> LA –> bicuspid valve–> LV –> aorta to body
what kind of blood flow do we feel when taking a pulse?
arterial blood flow (arteries are muscular and veins are flat, so we cannot feel venous BF)
diastole
relaxation of the heart
systole
contraction of the heart
what does it mean if there is not a clear S1 and S2 during auscultation?
it means there is a murmur in the heart
swooshing over an artery is a…
bruit
swooshing over the heart is a…
murmur
S1
closure of bicuspid and tricuspid valves (lub)
S2
closure of aortic and pulmonic valves (dub)
abnormal/unexpected heart sounds
ventricular gallop (S3); S4
thrills
palpable vibrations NOT a sound
murmurs
can be diastolic or systolic; systolic occurs after S1, diastolic after S2
swooshing/blowing sounds
systolic murmurs are..
innocent
diastolic murmurs are..
indicators of a heart disease
how to chart murmurs (6 characteristics)
timing, loudness, pitch, location, radiation, posture
what would a provider chart for timing of a murmur?
systolic or diastolic
what would a provider chart for loudness of a murmur?
grade 1-6; barely audible to loudest hear with stethescope off of the chest
what would a provider chart for pitch of a murmur?
high, medium, low
musical, blowing, harsh rumbling
what would a provider chart for location of a murmur?
where is it best heard
what would a provider chart for radiation of a murmur?
does it move and be heard in other locations
what would a provider chart for posture of a murmur?
does it disappear or enhance with posture
what are examples of subjective data collected during assessment? (chest)
chest pain, dyspnea, orthopnea, cough, fatigue, cyanosis or pallor, edema, nocturia, past cardiac history, family cardiac history, patient centered care (risk factors)
equipment
penlight, stethescope
palpation of neck vessels
palpate the carotid artery, only one artery at a time; feel contour and amplitude of pulse, normal strength should be 2+
auscultation of neck vessels
auscultate the carotid, with the BELL of the stethescope; assess for presence of bruit; lightly apply stethescope
what are expected findings when auscultating for a bruit?
NO sound, arteries should be silent
inspection of neck vessels
inspect the jugular venous pulse; use a penlight and patient in semi fowler’s position to observe for distention
JVD
if the jugular vein has a shadow along it, it is a sign of JVD
assessment of precordium
inspect anterior chest; observe for any possible pulsations or thrills
palpate apical impulse
expected v. unexpected findings of precordium
expected: no thrill, no vibration
unexpected: palpable vibrations
procedure of precordium auscultation
aortic valve area– second ICS, RSB
pulmonic valve area – second ICS, LSB
Erbs point – third ICS, LSB
tricuspid valve– fourth ICS, LSB
mitral valve – 5th ICS, MCL
what to look for during precordium auscultation
note rate and rhythm, identify S1 and S2, listen for extra heart sounds, listen for murmurs
abnormal systolic findings
- ejection click
- aortic prosthetic valve sounds
- midsystolic click
abnormal diastolic findings
opening snap, mitral prosthetic valve sound, third or fourth heart sounds, pericardial friction rub
3 step assessment of neck vessels
palpate the carotid artery, auscultate the carotid artery, inspect for JVD
3 step assessment of chest wall
inspect apical impulse, palpate apical pulse, auscultate
abnormal findings for precordium
thrill at the base, lift at the LSB, volume overload at the apex, pressure overload at the apex
abnormal murmur findings
midsystolic ejection murmurs
pansystolic regurgitant murmurs
diastolic rumbles of AV valves
early diastolic numbers
EKG
measures electrical activity of heart, PQRST complex
risk factors for cardiovascular disease
HTN, smoking, serum cholesterol, physical activity, sex and gender differences
modifiable risk factors
smoking and physical activity
red flag findings for cardiovascular assessment
chest pain
unilateral pain, pallor, pulselessness, paresthesia
new onset irregular heart rhythm
tachycardia or bradycardia
waist circumference above 35 for women or 40 in men
summary checklist of neck
carotid pulse - observe and palpate
observe jugular venous pulse
estimate jugular venous pressure
summary checklist of inspection of precordium
describe location of apical pulse, not any heave or thrill
summary checklist of auscultation of precordium
identify anatomic areas noting rate and rhythm, listen in systole and diastole for murmurs, listen at apex and base
