Lab 9: Cardiovascular and Peripheral Vascular Assessment

Question 1

What does the cardiovascular (CV) system consist of?

Answer 1

The heart and blood vessels of the body (eg. pulmonary, coronary and neck arteries and vein).

Question 2

What does the peripheral vascular (PV) system consist of?

Answer 2

• Anything not critical to the heart

- Arteries and veins distal to the central vessels, extending all the way to the brain and to the extremities

Question 3

What are the lifespan considerations when assessing the Heart and Central Vessels for Infants?

Answer 3

• physiological splitting of S2
• normally have sinus arrhythmia
• murmurs often heard in newborns
• PMI=4th intercostal space just left of midclavicular line

Question 4

What are the lifespan considerations when assessing the Heart and Central Vessels for children?

Answer 4

• heart sounds loud due to thinner chest wall.
• S3 is present in 1/3 of kids
• PMI higher and more medial 8yo and younger

Question 5

What are the lifespan considerations when assessing the Heart and Central Vessels for older adults?

Answer 5

• cardiac output and strength of contraction decreases
• heart rate takes longer to get to norm
• S4 sometimes heard
• sudden emotional and physical stresses can result in cardiac arrhythmias and heart failure.

Question 6

What are the lifespan considerations when assessing the Heart and Central Vessels for older adults?

Answer 6

• cardiac output and strength of contraction decreases
• heart rate takes longer to get to norm
• S4 sometimes heard
• sudden emotional and physical stresses can result in cardiac arrhythmias and heart failure.

Question 7

Precordium

Answer 7

• area of the chest overlying the heart

- Inspect and palpate for abnormal pulsations or lifts or heaves (rising along the sternal border with each heartbeat)

Question 8

Lift

Answer 8

• abnormal anterior movement of chest due to enlargement of left ventricle

Question 9

Heave

Answer 9

• abnormal lateral movement related to enlargement of left vent.

Question 10

Perfusion

Answer 10

-blood supply to an area or tissue

Question 11

Systole

Answer 11

• ventricular contraction; begins with the first heart sound and ends at the second heart sound; typically shorter than diastole
• Silent

Question 12

Diastole

Answer 12

• ventricular relaxation; starts with the second sound and ends with the first sound of the next cycle
• Heard best at the apical site
• Best heard over the aortic and pulmonic areas associated with the closure of the corresponding valves

Question 13

What is S1 and S2?

Answer 13

S1 “lub” - AV valves closing; Dull, lower pitch, and longer than S2; Best heard over the apex
S2 “dub” - semilunar valves closing; Higher pitch and shorter

Question 14

Bruit

Answer 14

• a blowing or swishing sound
  -Auscultate with diaphragm
  i-Created by turbulence of blood flow created by either narrowed arterial lumen or to a condition (eg. anemia or hyperthyroidism that elevates cardiac output)

Question 15

Thrill

Answer 15

• vibrating sensation, (like cat purr)
• Often accompanies a bruit
• Indicates turbulent blood flow

Question 16

Mrs. Smith is attending your health and wellness clinic and you will be conducting a CV assessment. How will you position Mrs. Smith?

Answer 16

• semi-reclined (Fowler’s position is 45 - 60*)

- start @ 45* then raise after auscultation to about 90*

Question 17

10. Mrs. Smith is attending your health and wellness clinic and you will be conducting a CV assessment. b. What questions might you ask her?

Answer 17

1. family history (heart disease, high cholesterol levels, high bp, stroke, obesity, arterial disease, congenital heart disease, rheumatic fever and hypertension, and age at which event occurred)
2. Client’s past history (rheumatic fever, heart, heart attack, varicosities, murmur, or heart failure)
3. Symptoms of heart disease (fatigue, dyspnea, edema, orthopnea, cough, palpitations,syncope, hypertension, chest pain, wheezing, hemoptysis);
4. Diseases affecting heart (obesity, diabetes, lung disease, endocrine disorders);
5. Lifestyle habits (smoking, alcohol intake, eating and exercise patterns, areas and degree of stress perceived)

Question 18

11. You have finished the CV assessment for Mrs. Smith. It is now time to conduct a PV assessment. What questions might you ask her?

Answer 18

1. Inquire if the client has a past history of
2. Heart disorders, varicosities, arterial disease, and hypertension;
3. Lifestyle habits (exercise patterns, activity patterns and tolerance, smoking, use of alcohol)

Question 19

12. What are the peripheral pulse sites?

Answer 19

Carotid, brachial, radial, femoral, popliteal, dorsalis pedis, and posterior tibial

Question 20

13. All peripheral pulses on both sides of the body are palpated simultaneously, except which one? Why?

Answer 20

• Do not palpate the two carotid pulses simultaneously as that is the only blood source to the brain and it is a sensitive area that requires constant blood flow for its functioning
• We don’t massage carotid to avoid dislodging a potential clot in the area (which could lead to a stroke)

Question 21

15. When inspecting and palpating your client’s peripheral perfusion what are you assessing and what would you include in your assessment?

Answer 21

• Palpation of peripheral pulses, inspection of peripheral veins, and inspection of the skin and tissues to determine perfusion to the extremities
• Veins should be smooth and bounding; no pain or discomfort present (if pain could indicate deep vein thrombosis