Heart and Neck Vessels (Exam 2) Flashcards
What is the pericardium?
sac that surrounds and protects the heart
What is the myocardium?
muscular wall of the heart (does the pumping)
What is the endocardium?
thin layer of tissue that lines the inner surface of the heart chambers and valves
What are the semilunar valves?
separate ventricles and arteries; OPEN DURING PUMPING AKA SYSTOLE
pulmonic valve (right atrium) and aortic valve (left atrium)
What are the atrioventricular valves?
Separate the atria and ventricles; OPEN DURING FILLING PHASE AKA DIASTOLE, ALLOWING VENTRICLES TO FILL
tricuspid valve (right ventricle) and bicuspid (mitral) valve (left ventricle)
The base and apex of the heart are…
upside down! the base is the top and the apex is the bottom
What is the path of blood flow (10 steps!)
- Liver to right atrium via inferior vena cava, superior vena cava drains venous blood from head and upper extremities
- right atrium to right ventricle via tricuspid valve
- right ventricle to pulmonic valve
- pulmonic valve to pulmonary artery
- pulmonary artery to lungs
- lungs to pulmonary veins once blood is oxygenated
- pulmonary veins to left atrium
- left atrium to left ventricle via mitral valve
- left ventricle to aorta via aortic valve
- aorta to rest of body
Subjective Data: S/S
chest pain
dyspnea
orthopnea
cough
fatigue
cyanosis or pallor
edema
nocturia
Subjective Data: Past Cardiac History
hypertension
elevated cholesterol
heart murmur
congenital heart disease
rheumatic fever
heart disease
cardiac procedure/surgery
last ECG/EKG
stress test
Subjective Data: Family Cardiac History
hypertension
high cholesterol
obesity
diabetes
sudden cardiac death
CAD
stroke
Subjective Data: PCC
nutrition
smoking
alcohol
exercise (above 4: risk for CAD)
drugs (medications)
Subjective Data: Infants
mothers health during pregnancy
nursing/feeding
growth
activity/milestones achieved?
Subjective Data: Children
growth
activity
chest pain?
respiratory infections strep??
family history
heart defects
Subjective Data: Pregnancy
BP before and during pregnancy (preeclampsia?)
weight gain
edema
protein in urine
dizziness
Subjective Data: Aging adult
heart/lung disease
treatment
new symptoms
impact on ADLs
cardiac medications
stairs at home?
What order should you conduct your objective data assessment?
- Pulse and BP
- Extremities
- Neck vessels
- Precordium
START PERIPHERAL AND MOVE INWARD TOWARDS THE HEART
What are the steps for objective data for the neck vessels?
- Palpate carotid arteries
- Auscultate carotid arteries
- Inspect jugular venous pulse
Steps for palpating carotid arteries
- Palpate each carotid artery
- Avoid excessive pressure
- PALPATE ONE CAROTID AT A TIME
- Feel contour and amplitude of pulse
- Findings should be the same bilaterally
Steps for auscultation of the carotid arteries
- Auscultate for presence of a bruit
- Keep neck in neutral position
- Use bell of stethoscope
- Avoid compression artery
- Ask patient to take a breath, exhale, and hold it briefly
What is a bruit?
a blowing, swishing sound indicating blood flow turbulence
What are the placements, in order, of where to auscultate carotid arteries?
- Angle of the jaw
- Midcervical area
- Base of neck
What are the steps for inspecting the jugular venous pulse?
- Assess patient supine with HOB elevated 30-45 degrees
- Stand on RIGHT SIDE of patient (veins direct route to the heart)
- Remove pillow to avoid flexing neck
- Turn patients head slightly away from examined side
- Direct strong light onto the neck
- Visualize EJ (external jugular) overlying sternomastoid muscle or IJ (internal jugular) in the sternal notch- MUST BE ABLE TO DISTINGUISH CAROTID AND IJ
What degree angle do EJs flatten and disappear?
45°
IJ PULSE VS carotid pulse
• LOWER MORE LATERAL LOCATION TO MUSCLE vs higher and medial to sternomastoid muscle
• UNDULANT AND DIFFUSE, TWO VISIBLE WAVES PER CYCLE vs brisk and localized, one wave per cycle
• IJ VARIES WITH RESPIRATION vs doesn’t
• IJ NOT PALPABLE vs palpable
• LIGHT PRESSURE AT BASE OF NECK OBLITERATES vs no change
• LEVEL OF PULSE DROPS AS PERSON SITS vs unaffected
What are the correct steps for objective data of the precordium?
- Inspect anterior chest
- Palpate apical pulse
- Palpate precordium
- Percuss precordium
- Auscultate precordium
What is apical impulse?
pulsation of left ventricle against chest wall, seen at 4th or 5th ICS/MCL IF VISIBLE
What is heave or lift?
sustained, forceful thrusting of ventricle during systole; occurs with ventricular hypertrophy as a result of increased workload
right ventricular heave seen at STERNAL BORDER
left ventricular heave seen at APEX
What are the steps to palpate PMI (Point of maximal impulse)?
- Use 1 finger pad
- Ask patient to exhale and then hold it
- Best measured in left lateral position
- Best felt at end of expiration
What are some characteristics of the PMI (apical impulse)?
Location: 4th or 5th ICS, MCL
Size: 1-2cm occupying one ICS
Amplitude: short gentle tap
Duration: short, only first half of systole
What are the steps to palpating the precordium?
- Use palmar aspects of four fingers (search for pulsations and vibrations)
- Gently palpate apex, left sternal border, and base
- Normally none occur but if present, note the timing
What is a thrill?
palpable vibration, signifies turbulent blood flow and directs you to locate the origin of loud murmurs. ABSENCE OF THRILL DOESNT RULE OUT PRESENCE OF A MIRMUR
Percussion was replaced by ____ according to EBP
chest x-ray and echocardiogram
What are the steps for auscultating the precordium?
- Start with diaphragm
- Note rate and rhythm
- Assess S1 and S2
- Listen for extra sounds (S3 and S4)
- Listen for murmurs
- Switch to bell, listen again
What are five traditional valve areas?
Aortic: 2nd ICS, RSB
Pulmonic: 2nd ICS, LSB
Erbs Point: 3rd ICS, LSB
Tricuspid: 4th ICS, LSB
Mitral: 5th ICS, MCL
REVIEW PICTURES
What are the characteristics of the sounds of systole?
period between S1 and S2 (when ventricles contract)
What are the characteristics of the sound of diastole?
period between S2 and beginning of next heartbeat (S1) (ventricles relaxing)
Describe the S1 heart sound
normal; closure of AV valves
beginning of systole
LUB SOUND, LOUDER AT APEX
coincides with carotid
Describe the S2 heart sound
normal; closure of SL valves
end of systole
DUB SOUND, LOUDER AT BASE
Describe the S3 heart sound (ventricular gallop)
ABNORMAL in adults, NORMAL in children
indicated decreased compliance of ventricles (heart failure)
heard at apex or lower LSB
LUB DUB TA “kentucky”
follows IMMEDIATELY AFTER S2
Describe the S4 heart sound (atrial gallop)
ventricular filling sound, occurs when atria contracts late in diastole
HEARD IMMEDIATELY BEFORE S1
heard best at apex with patient in left lateral position
indicates decreased compliance of ventricle (CAD, cardiomyopathy)
TA LUB DUB “a stiff wall”
What are heart murmurs?
a blowing, swooshing sound that occurs with turbulent blood flow in the heart or great vessels
ABNORMAL EXCEPT FOR INNOCENT MURMURS
What are the 6 grades of heart murmurs?
Grade 1: Barely audible
Grade 2: Clearly audible but faint
Grade 3: Moderately loud, easy to hear
Grade 4: Loud, palpable thrill on chest wall
Grade 5: Very loud, heard with one corner of stethoscope and there’s thrill
Grade 6: Loudest, can be heard with entire stethoscope lifted just off chest wall
Developmental Competence: Infants
- HR after birth: 100-180, stabilizes to 120-140
- sinus arrhythmia
- difficult to count radial pulses-auscultate HR for accuracy
Developmental Competence: Children
- Average HR slows with age
- Look for indications of heart disease
- apical impulse can be visible
- venous hum can be normal
- innocent heart murmur common
Developmental Competence: Pregnancy
- Increased resting HR 10-20 BPM
- BP decreases 2nd trimester and slowly increases during 3rd
- BP varies with position, lowest in left lateral and highest in sitting
- Apical impulse palpated higher and lateral
Developmental Competence: Aging Adult
- gradual rise in BP common
- orthostatic hypotension
- Chest can increase in AP diameter
- systolic murmurs common
ABCS for health promotion
A: Aspirin Therapy
B: BP Control
C: Cholesterol Control
S: Smoking cessation
Small changes in lifestyle
Why is there low cardiac output during heart failure?
heart fails as a pump and circulation is backed up, kidney compensatory mechanism of retaining water and sodium causes further congestion
Acute Onset Heart Failure
as following a myocardial infarction when the hearts contracting ability has been directly damaged
Chronic Onset Heart Failure
as with hypertension, when the ventricles must pump against chronically increased pressure
3 STEPS FOR NECK ASSESSMENT CHECKLIST
- OBSERVE AND PALPATE CAROTID
- OBSERVE JUGULAR VENOUS PULSE
- ESTIMATE JUGULAR VENOUS PRESSURE
10 STEPS FOR PRECORDIUM ASSESSMENT CHECKLIST
- Describe location of apical impulse
- Note any heave or thrill
- Identify anatomic areas where you listen
- Note rate and rhythm of heartbeat
- Identify S1 and S2 and note any variation
- Listen in systole and diastole for extra heart sounds
- Listen in systole and diastole for murmurs
- Repeat sequence with bell
- Listen at apex with person in left lateral
- Listen at base with person sitting
