Heart and Neck Vessels Flashcards
Subjective Data (Heart and Neck Vessels)
- Chest pain
- onset
- frequency
- location
- character/description
- pain brought on by (ex; activity; after eating; sexual intercourse; weather?)
- associated symptoms (sweating, ashen gray or pale skin, heart skips a beat, SOB, nausea or vomiting, racing of heart)
- relieved or made or worse by?
- medications or treatments
2. Dyspnea
- Any shortness of breath
- type of activity and occurrence
- onset
- duration affected by positional changes
- awaken you from sleep at night?
- presence of orthopnea
- affect your ADLs?
- Orthopnea - the need to assume a more upright position to breathe
- how many pillows do they use while sleeping/laying down - Cough
- Duration
- frequency
- type
- is there any mucous (color, odor, blood tinged?)
- associated with activity, change in position, anxiety, talking?
- Does activity make it better or worse?
- Relieved by stress or medication? - Fatigue
- Do you tire easily? Are you able to keep up with family and coworkers?
- onset?
- Sudden or gradual?
- Any recent changes in energy level?
- Timing: related to of day? - Cyanosis or pallor
- ever notice facial skin turning blue or ashen - Edema
- any swelling of feet and legs?
- onset
- timing
- amount
- location
- relief of symptoms (does it go away with rest, elevation, or after sleep
- associated symptoms (SOB) - Nocturia
- awaken at night with urgent urge to urinate?
- how long’s this been occurring?
- recent changes? - Past cardiac history
- History of: HTN, elevated cholesterol or triglycerides, heart murmur, congenital heart disease, rheumatic fever, or joint pains as a child, recurrent tonsillitis, anemia?
- Heart disease
- Any surgeries
- Last ECG, stress test, or EKG, serum cholesterol measurement? or any other heart tests? - Family cardiac history
- Any FH of hypertension, obesity, diabetes, CAD, sudden death at a young age? - Patient-centered care (cardiac risk factors)
- Nutrition - sodium intake, glucose intolerance
Alcohol - related to cardiac disease
Smoking -
- Exercise - do they exercise? what type?–> getting up and moving encouragement
- Drugs - are they taking the vitamins/supplements? Other meds?
Objective Data (Heart and Neck Vessels)
Neck Vessels
1. Inspect and palpate Carotid pulse
- palpate gently and one at a time
- Auscultate
- auscultate for bruit
- use the bell
- Normal strength is 2+
- Have the patient hold there breath so you won’t hear breath sounds
- keep neck neutral and listen over 3 places: (1) angle of the jaw (2) midcervical area (3) base of neck - Inspect jugular veins
- position person supine from 30-45 degree angle
- normally not palpable
Precordium
1. Inspection
- can the apical pulse be seen
- a heave or lift is a sustained forceful thrusting of the ventricle during systole
2. Palpate apical pulse
- Location - should occupy only one interspace (4th or 5th) and be at or medial to the midclavicular line
- Size - normally 1-2 cm
- Amplitude - Normally a short, gentle tap
- Duration - short; normally occupies only first half of systole
3. Palpate across the precordium
- look for any other pulsations
- a thrill is a palpable vibration. it feels like the throat of a purring cat. signifies turbulent blood flow
4. Percuss
5. Auscultate
- move stethoscope in a Z pattern
(1) Aortic valve - 2nd right intercostal space; right sternal border
(2) Pulmonic valve - 2nd left intercostal space; left sternal border
(3) Erb’s point left - 3rd intercostal space; left sternal border
(4) Tricuspid valve - 4th intercostal space; left sternal border
(5) Mitral valve - 5th intercostal space; left midclavicular line
Auscultation
1. Identify anatomic areas where you listen
2. Note rate and rhythm of heartbeat
3. Identify S1 and S2 and note any vibration
4. Listen in systole and diastole for any extra heart sounds
5. Listen in systole and distill for any murmurs
6. Repeat sequence with bell
7. Listen at the apex with person in left lateral position
8. Listen at the base with person in sitting position
Describe the normal sounds of the heart? When do you hear them?
Normal heart sounds are heard as lub-dup
S1
- Caused by the closure of the AV valves (tricuspid and mitral), start of systole
- Louder than S2 at the apex
- coincides with the carotid artery pulse
- lub sound
S2
- associated with the closure of the semilunar valves (aortic and pulmonic valves), beginning of diastole
- Louder than S1 at the base
- dup sound
Systole
the pumping phase; blood is pumped from the ventricles and fills the pulmonary and systemic arteries; the AV valves close to prevent regurgitation of blood back into the atria
Diastole
the filling phase; the ventricles relax and fill with blood; AV valves are open to allow ventricles to fill with blood
What does a heart murmur sound like?
- Blowing, swooshing sound as blood flows across narrowed or abnormal valves that occurs with turbulent blood in the heart or great vessels
When describing a heart murmur what would you document?
- Timing - early, mid, or late diastole
- Loudness - intensity in 6 “grades”
- Pitch - high, medium, or low –> depends on the pressure and rate of blood flow producing the murmur
- Pattern
- Quality - musical, blowing, harsh, or rumbling
- Location - where is it heart best at (note valve area or intercostal space)
- Radiation - is it heard in another place?
- Posture - does the sound change with position change? What positing was the patient in when it was heard?; common in healthy children and adolescents termed innocent or functional
- Change position
How would you grade a heart murmur?
Grade 1 - Barely audible
Grade 2 - Audible but faint
Grade 3 - Moderately loud; easy to hear
Grade 4 - Loud; associated with a thrill palpable on the chest
Grade 5 - Very loud, thrill, heard with the edge of the stethoscope lifted off the chest wall
Grade 6 - Loudest, thrill, hear with stethoscope completely off
