Circulation + Perfusion chp 38 Physical Assessment Flashcards
Circulation
flow of blood throughout the heart and blood vessels
Perfusion
describes blood flow to a capillary bed to provide nutrients and oxygen to tissues and organs
Cardiac Cycle
simultaneous contraction of the two atria, followed by a fraction of a second later the simultaneous contraction of the ventricles
Electrical Conduction
electrical activity that initiates contraction of the myocardium
Sinoatrial (SA) Node
pacemaker of the heart
Atrioventricular (AV) Node
electrical activity passes through the AV node into the left and right bundles of HIS and into Purkinje Fibers to the ventricles
Arteries
oxygenated blood to tissues
Veins + Venules
deoxygenated blood back to heart/ lungs
Hemoglobin
carries oxygen
4 Chambers of the Heart
Two Atria: act as reservoir, receives blood returning via veins from body + lungs
Two Ventricles: larger, thicker
-pumps blood to lungs + body
4 Valves of the Heart
Two Atrioventricular Valves:
1. Tricuspid
2. Mitral
Two Semilunar Valves:
1. Pulmonic (separates right ventricle from pulmonary artery)
2. Aortic (separates left ventricle from aortic artery)
Apical Pulse
PMI
- apex of the heart
- at the bottom of heart
- where left ventricle almost touches chest
- left ventricle contracts and forms apical pulse
- PMI (point of maximal impulse)
- PMI located at 5th ICS left midclavicular line
Characteristics of Normal Heart Sounds
>Lub -first heart sound -S1 -Mitral + Tricuspid Valves >Dub -2nd heart sound -S2 -Aortic + Pulmonic Valves
Correct Order of Auscultation
All Physicians Take Money
A= Aortic Valve
P= Pulmonic Valve
(S2 DUB)
T= Tricuspid Valve
M= Mitral Valve
(S1 LUB)
Coronary Arteries
- heart has its own blood supply to the heart
- fill during diastole
- from the coronary sinus, blood flows into the two main coronary arteries, which branch into several sections to supply the heart muscle with blood
- the coronary arteries are the only arteries in the body that fill during diastole
Autonomic Nervous System
- sympathetic fibers
- parasympathetic fibers
> heart: regulate heart rate + contractility
Vascular system: maintain vascular tone
Factors that Influence Cardiac function
- developmental stage
- environment
- stress
- allergic reactions + air quality
- heat + cold
- medications
- lifestyle
- nutrition
- exercise
- obesity
- heredity
- tobacco use
- substance abuse
- pregnancy
- pathophysiological conditions
Factors that Influence Cardiac Function in Older Adults
- thicker, more rigid valves
- decreased myocardial strength
- lower exercise tolerance
- health problems
Heart Failure
Pathophysiological condition
- occurs when the heart becomes an inefficient pump and is unable to meet the body’s demands
- blood is oxygenated when it passes through the lungs, but is not well circulated to the organs + tissues
Cardiomyopathy
Pathophysiological condition
-heart muscle disorder that results in heart enlargement and impaired cardiac contractility
Cardiac Ischemia
Pathophysiological Condition
-occurs when oxygen requirements of the heart are unmet
-prolonged ischemia leads to myocardial infarction (MI) as parts of the heart necroses (die) from inadequate oxygen
-angina pectoris is transient pain in chest due to MI
(tissue becomes injured but does not necrose)
Coronary Artery Disease
leading cause of cardiac ischemia
-condition in which plague builds up inside the coronary arteries
-plague narrows the arteries reducing blood flow to the heart muscle
(more likely clots will form and block the arteries)
Dysrhythmias
alterations in heart rhythm
-can lower cardiac output and decrease tissue oxygenation
Heart Valve Abnormalities
create turbulent flow, leading to a decrease in cardiac output and compromised tissue oxygenation
- often audible murmur
- mitral + aortic valves mostly affected
Non-modifiable Risk Factors of Heart Disease
- family history
- gender
- race, ethnicity
- age
Modifiable Risk Factors of Heart Disease
- hyperlipidemia (high concentration of fats or lipids)
- smoking
- drug or alcohol use
- diabetes
- obesity
- sedentary lifestyle
- stress
- high fat diet
- left ventricular hypertrophy
- use of oral contraceptives
Health History Questions Used
- chief complaint?
- history of chest pain, pressure, heaviness?
- leg pain, swelling in ankles, feet or hands?
- cyanosis or pallor in extremities?
- fatigue, shortness of breath?
- precipitating or alleviating factors?
- palpitations, dizziness?
- family history of hypertension, heart failure, MI?
Effective Cardiac Pump Looks Like?
- systolic and diastolic BP in expected range
- activity is tolerated
- peripheral pulses are palpable
- skin color is normal for individual
- urinary output is in the expected range
- cognitive status WNL
Effective Cardiac Pump NOT Look Like?
- neck veins are distended
- dysrhythmia is present
- peripheral edema is present
- profuse diaphoresis
- c/o nausea fatigue and pain
- difficulty breathing
- weight gain
Peripheral Arterial Disease
- found in legs + feet
- occurs when tissues do not receive enough blood flow to keep up with the demand for oxygen
- caused by build up of fatty deposits and plague within the arteries (atherosclerosis)
Intermittent Claudication
when arteries that supply blood to the legs are narrowed
-leg pain occurs especially with walking
What Happens When Blood Flow Becomes More Restricted In Legs?
as blood flow becomes more restricted, pain occurs at rest, as well as numbness or a cold feeling to the leg or foot, especially on one side
- weak pulse
- change in color
- hair loss or shiny skin on leg
- sores that wont heal
Why is Peripheral Vascular Assessment Important?
reveal arterial and venous disorders
- history
- inspection
- palpation
Peripheral Vascular History
does the patient have:
- intermittent claudication? (pain on walking that disappears at rest)
- leg cramps
- varicose veins
- leg ulcers
- edema of feet or legs
- blood clots
- pallor of fingertips
Peripheral Vascular Inspection
compare side to side
- size
- symmetry
- skin/color
- nail beds/ capillary refill
- venous pattern
- hair growth
Peripheral Vascular Palpation
- temperature
- capillary refill
- edema (pitting or non-pitting)
- pulses
Capillary refill:
- performed on fingers + toes
- squeeze patients finger or toes nails
- may use tips of fingers or toes
- normal capillary refill immediate or < 3 seconds
Assessment of Pulse
- Rate: 60 to 100 beats/ min
- Rhythm: regular or irregular
- Strength: amplitude and quality i.e. weak + thready or strong + binding
- Equality: equal on both sides of the body
Pulse Amplitude Descriptions and Numbers
0= absent 1+= diminished, weak 2+= normal 3+= bounding (may indicate hypertension or too much circulating blood volume)
Indicators of Normal Peripheral Tissue Perfusion
- BP WNL
- peripheral pulses 2+ and equal
- sensation normal
- skin color + temperature normal
- no edema, variscosities, lesions noted
- equal hair growth
What do Arterial Changes look like?
- Color= pale, brownish discoloration, bluish red color if insufficiency is severe
- Temperature= cool
- Pulse= decreased or absent
- Skin Changes= thin, shiny, decreased hair growth, thickened nails
- Edema= absent or mild
- Sensory loss
Venous Insufficiency Look Like?
-Color= normal, reddened or cyanotic or brown pigment
-Temperature= normal or warm
-Pulse= normal
-Edema= present or marked
may also indicate an obstruction of the lymphatic system
-pain more severe standing, relieved with elevation
2 Most Common Venous Problems
- varicose veins
- thrombophlebitis
Varicose Veins
occur when the heart valves are incompetent
Erythema
reddened area
Pitting Edema
4+ Edema
usually associated with fluid retention and heart failure
Thrombophlebitis
- a difference in the size of the leg may indicate a blood clot
- symmetry is an observation we expect to find; if there is asymmetry anywhere it usually indicates a problem and should be noted
Arterial Insufficiency
narrowing of the arteries
-commonly pelvis + legs
Arterial Insufficiency Clinical Symptoms
PAD–> Peripheral arterial disease
- cramping
- pain
- tired legs or hip muscles that worsens during walking/ activity and subsides with rest
Venous Insufficiency
inadequate return of venous blood from legs to heart
Clinical Symptoms of Venous Insufficiency
PVD–> peripheral venous disease
- tired/heavy, achy cramping in legs
- pain worsens when standing and improves with leg elevation and activity
Arterial Ulcers
- intermittent claudication pain
- no edema
- no pulse or weak pulse
- no drainage
- round smooth sores
- black eschar
- location of sores: toes + feet
Venous Ulcers
- dull, achy pain
- lower leg edema
- pulse present
- drainage
- sores with irregular borders
- yellow slough or ruddy skin
- location of sores: ankles
Basic Assessment: Cardiovascular
-heart + blood vessles
Heart: muscle that pumps blood throughout the body
-size of a clenched fist
Blood Vessels: make up the vascular system
-2 Main networks:
>pulmonary circulation
>systemic circulation
Basic Assessment: Heart
-Heart Sounds Location: >aortic, pulmonic, tricuspid, mitral -S1, S2, S3, S4 murmurs -Inspection >PMI >Heaves/ Lifts -Palpation >thrill
Basic Assessment: Vessels
Central Vessels (provide circulation to brain) >carotid arteries -palpate pulsations -auscultate for bruit >jugular veins Peripheral Vessels (supply blood to all body cells) -BP -peripheral pulses -signs of inadequate oxygenation -variscosities
