Module 5 Heart & Peripheral Vascular System Flashcards
Heart assessment
Neck vessels
Inspect precordium
Auscultate precordium (area of chest wall over the heart)
Diaphragm
Bell
PVS assessment
Inspect & palpate arms
Inspect & palpate legs
Neck vessels:
Cardiovascular assessment includes
survey of vascular structures in neck
• Carotid artery
• Jugular veins
• These vessels reflect efficiency of cardiac
function
Neck vessels:
Palpate carotid arteries
• Palpate each carotid artery
medial to sternomastoid
muscle in lower half of
neck; palpate gently
• Palpate only one carotid
artery at a time
• Assess amplitude of pulse
• Findings should be same
bilaterally
Neck vessels
Auscultate carotid arteries
• For persons middle-aged or older, or who
show symptoms or signs of cardiovascular
disease, auscultate each carotid artery for
presence of a bruit
A bruit is a blowing, swishing sound indicating
blood flow turbulence; normally none is
present
Neck vessels
Jugular Venous Pressure
Indication of heart’s efficiency as a pump and
intravascular volume status, or Central
Venous Pressure (CVP)
Heart Inspection
Precordium
During contraction, apex beats against chest
wall, producing an apical impulse
• May be visible in 4th or 5th ICS @ or medial to
L) MCL
• Abnormal pulsations, such as a heave or lift
may be visible
Heart - Auscultation
Auscultate with the diaphragm of the
stethoscope to assess heart rate,
rhythm & sounds
Pneumonic for heart auscultation
All People Enjoy Time Magazine
- All- Aortic Area (2nd intercostal space)
- Ppl- Pulmonic area (2nd intercostal space)
- Enjoy- Erbs Point (3rd intercostal space)
- Time- tricuspid area (4th or 5th intercostal space)
- Magazine- mitral area/ apex (5th intercostal space)
Heart Sounds: S1
S1- Closure of mitral & tricuspid valves
Louder at apex
Onset of systole
Synchronous with carotid pulse
High pitched
“Lubb”
Heart Sounds: S2
• S2- Closure of aortic & pulmonic valves
Louder at base
Onset of diastole
High pitched
“Dubb”
Heart sounds: S3
S3- Ventricular filling in early diastole
Heard at apex or L) lower sternal
border
Lower pitched
Rhythm of sound resembles
rhythm of Ken-TUCK-y
Signifies decreased ventricular
compliance; early sign of heart
failure
Heart sounds: S4
S4- Ventricular filling in late diastole
due to atrial contraction
Heard at apex
Lower pitched
Rhythm of sound resembles
rhythm of TEN-nes-see
Signifies increased resistance to
filling due to loss of ventricular
wall compliance
When do you use the bell for auscultating?
Use the bell to listen to the 5 precordial
areas, in reverse order, for lower
pitched sounds, such as S3, S4 and
murmurs
• Murmurs are prolonged extra sounds
during systole or diastole, due to
turbulent blood flow in the heart or great
vessels
• Helpful to also auscultate with client in
L) lateral position & sitting up & leaning
forward
PVS: upper extremities
- Inspect, then turn person’s hands over,
noting color of skin and nailbeds;
temperature, and the presence of any
edema or clubbing
• Assess peripheral perfusion and
cardiac output by checking capillary
refill
