Monday Flashcards
What is the heart?
A hollow muscular organ located in the mediastinum
What is the heart described as?
An inverted cone
What are the three layers of the heart?
Epicardium- outermost layer of the heart
Myocardium- thickest layer of the heart (made up of contractile cardiac muscle cells)
Endocardium-thin layer of endothelial tissue that forms innermost layer of the heart
What are the four chambers of the heart?
Right atrium
Right ventricle
Left atrium
Left ventricle
Anatomy of the heart
Four chambers (see other slide) Superior and inferior vena cava Pulmonary artery Pulmonary vein Aorta Two pumps (see other slide) Four valves(see other slide) Two semilunar valves (see other slide)
What are the two pumps of the heart?
The right side pump- pumps blood to lungs for gas exchange (pulmonary circulation)
The left side pump- pumps blood to the body (systemic circulation)
What are the four valves?
Tricuspid Valve
Mitral Valve
Pulmonary Valve
Aortic Valve
What do the atrioventricular valves do?
Help prevent backflow of blood from the ventricles to the atria. Tricuspid Valve (right atrioventricular valve) Mitral Valve (left atrioventricular valve)
What do the semilunar valves do?
Prevent back-flow of blood from arteries to the ventricles Aortic Valve (left semilunar valve) Pulmonary Valve (right semilunar valve)
Electrical conduction of the heart
Cardiac Cycle Sinoatrial Node A.V. Node A.V Bundle (Bundle of HIS) Perjunkie Fibers
Cardiac cycle
Returns to the filling and emptying of the hearts chambers
Sinoatrial Node
Located on the posterior wall of right atrium, generates impulses at a rate of 60-100 per minute
A.V. Node-
Located in the lower intertersenal septum, delays the S.A. node impulses slightly and then relays the impulse to the A.V. bundle
A.V. Bundle ( Bundle of HIS)
Delays the impulses slightly
Perjunkie Fibers
Then the impulse travels to the right and left bundle branches and the Perjunkie fibers in the myocardium of both ventricles
Cardiac Cycle
Filling and emptying of the heart’s chamber. Two Phases: Diastole and Systole
Diastole
Relaxation of the Ventricles
Systole
Contraction of the Ventricles
Equipment for heart and neck vessels assessment
o Stethoscope with a bell and diaphragm
o Penlight or moveable exam light
o Watch with a second hand
o Alcohol Prep
Neck Vessels Assessment – JVD Inspect 1st Step
INSPECT!!
Stand on right side of client
Suspine position, torso elevated 30-45 degrees
Client turn head slightly to the left
Jugular Venous Distention (JVD) - May shine a light source onto the neck to increase visualization
Pulsations- Inspect suprasternal notch or the area around clavicles for pulsations of the internal jugular vein.
Note: Not going to assess Jugular Venous Pressure – often omitted and replaced by a medical order for pulmonary artery catheter placement
See page 446 Assesment book
Neck Vessels Assessment – JVD Inspect 2nd Step
AUSCULTATE
Carotid Arteries - Use the bell of the stethoscope, ask the client to hold their breath for a moment, detect if there is a possible Bruit (mumur)
Neck Vessels Assessment – JVD Inspect 3rd Step
PALPATE
Carotid Arteries - Pulse (palpate one side at a time)- Vessel elasticity- thrills (Slight palpable vibration associated with cardiac murmur)
Should you auscultate or palpate first?
Auscultate (examine a patient with a stethoscope) before palpating (examine by touching)
What are heart sounds produced by?
Valve Closure (lubdubb- S1&S2)
Lub Sound
S1 - apex diaphragm
Dub Sound
S2 - aortic area
S1=?
BEGINNING of systole (Mitral and Tricuspid valve closure) 1st heart sound
S2=?
Indicates the END of ventricular systole (Aortic and Pulmonic valve closure) 2nd heart sound
S3=?
Congestive heart failure (CHF) is a chronic progressive condition that affects the pumping power of your heart muscles. Commonly called heart failure. Heard LLSB (Tricuspid Area) or apex with bell.
S4=?
Ventricular wall damage- Myocardial Infarction (MI - Heart Attack) Heard LLSB (Tricuspid Area) or apex with bell.
Murmurs
Caused by turbulence secondary to increased blood flow, constricted vessels, dilated vessels or a combination (Causing swooshing or blowing sound)
Heart Sounds Relate to?
Closure of the Valves
Diminished S1
Sound is decreased in obese/barrel chest clients. Can also be decreased with early heart block.
Split S1
Mitral/Aortic close before tricuspid/pulmonic. Heard in 4th ICS
Accentuated S2
Sound may increase in clients during exercise or with HTN. ( hypertension- High Blood Pressure)
Split S2
During inspiration (inhalation), aortic valve may be heard before pulmonic valve. Heard as “lub”. During expiration (exhalation), valves close as one “Dub”.
What do you do if you detect an irregular rhythm?
Auscultate for a pulse rate deficit - Palpate the radial pulse while you auscultate the apical pulse. Count for a full minute. Radial and apical pulse rates should be identical.
What is a Pulse Deficit
Difference between apical and peripheral/radial pulse.
What can a Pulse Deficit indicate?
May indicate- Atrial Fib, Atrial FLutter, PVC’s (Flutter or Skip a beat heartbeat), and varying degrees of heart block.
What is the precordium?
Anterior chest area (Region in front of the heart)
How many beats do S1 and S2 Count as?
1 Beat- produced by valve closure.
Where do you locate the angle of Louis?
Anterior angle formed by the junction of the manubrium and the body of the sternum. Felt as prominence on the sternum.
“APE To Man” Where is the Aortic Area Located?
Second ICS at the right sternal border- base of the heart
“APE To Man” Where is the Pulmonic Area Located?
Second or third ICS at the left sternal border- the base of the heart
“APE To Man” Where is the Erb Point Located?
Third ICS at the left sternal border
“APE To Man” Where is the Tricuspid Area Located?
Fourth of fifth ICS at the left lower sternal border
“APE To Man” Where is the Mitral (Apical) Located?
Fifth ICS near the left MCL (Mid-Clavicular Line) - Apex of the heart * Located under assessment guide 21-2 pg.438
What are the five areas for listening to the heart?
APE To Man - Aortic - Pulmonary - Erb’s Point- Tricuspid - Mitral
What does it sound like when the Mitral/Tricuspid and Aortic/Pulmonary valves are closing?
“Lub-Dub”
What does the S3 heartbeat sound like?
Ventricular Gallop- KEN-TUC-KEY
What does the S4 heartbeat sound like?
Atrial Gallop- TEN-NES-SEE
What does a Heart Murmur sound like?
Turbulent blood flow with a swooshing or blowing sound when doing auscultation.
What are 4 conditions that contribute to Heart Murmurs?
Increased Blood Velocity
Structural Valve Defects
Valve Malfunction
Abnormal Chamber Openings
What does atherosclerosis (Plaque buildup in the artery wall) cause in older clients?
It could possibly cause obstruction, and compression may easily block circulation.
What is harder to palpate in older clients?
The apical pulse, because of an increased anteroposterior chest diameter.
Overview of coronary heart disease
Accumulation of plaque and lipids-fat around vessels. This can create an inadequate blood supply to heart tissue/muscle and cause an M.I. or Myocardial infarction - heart attack.
Risk factors of coronary heart disease
Family history, increasing age, race, high cholesterol-hyperlipidemia, smoking, hypertension, diabetes, obesity, and physical inactivity.
Risk reduction teaching tips for coronary heart disease
Stop smoking or enroll in a smoking cessation program.
Choose a diet that emphasizes intake of vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, and nuts; and limits intake of sweets, sugar-sweetened beverages, and red meats
Reduce elevated cholesterol (through diet, activity, or per medication if prescribed).
Lower blood pressure (through weight loss and increased activity).
Increase physical activity; participate in at least moderate physical activity daily.
Work to achieve or maintain a healthy weight for height.
Manage diabetes if diagnosed.
Limit alcohol intake to an average of one to two drinks per day for men and one drink per day for women. A drink as one 12 oz. beer, 4 oz. of wine, 1.5 oz. of 80-proof spirits, or 1 oz. of 100-proof spirits.
Practice stress reducing techniques such as exercise, relaxation, meditation, yoga, recreational and diversional activities from everyday work, hobbies, and so forth.
Cultural considerations for coronary heart disease
White middle aged men have the highest incidence of coronary artery disease
- African men have the highest incidence of hypertension
- Women more likely to die after an MI than men
Arteries
Carry oxygenated nutrient-rich blood from the heart to the capillaries
Where are the major arteries of the arm?
Brachial, Radial, Ulnar
Where are the major arteries of the leg? (Peripheral Arteries)
Femoral, Popliteal, Dorsalis Pedis, Posterior Tibial
Veins
Carry deoxygenated, nutrient-depleted, waste-ladden blood from the tissues back to the heart
What are the three types of veins?
Deep veins, Superficial Veins, and Perforator Veins
Other Veins
Femoral, Popliteal, Saphenous Veins
What is the Primary Function of the Lymphatic System?
To drain excess fluid and plasma proteins from bodily tissues and return them to the venous system.
What is the Secondary Function of the Lymphatic System?
To function as a major part of the Immune System and defend the body against microorganisms.
What is the Third Function of the Lymphatic System?
To absorb fats (lipids) from the small intestine into the blood stream.
What does the Lymphatic System consist of?
Lymphatic Capillaries, Lymphatic Vessels, and Lymph Nodes.
Capillaries and Fluid Exchange.
Small Blood Vessels.
It also forms the connection between the arterioles and venules.
What does the Lymphatic System do in addition to the three functions?
Form the connection between the arterioles and venules.
Allow the circulatory system to maintain equilibrium.
Arterial Insufficiency Pain
Intermittent claudication to sharp, unrelenting, constant
Arterial Insufficiency Pain
Intermittent claudication to sharp, unrelenting, constant
Arterial Insufficiency Skin
Dependent rubor (flush or blushing)
Arterial Insufficiency Skin
Dependent rubor (rusty, ruddy, or brownish pigmentation) ; elevation pallor or foot; dry, shiny skin; cool to cold temperature (clammy)
Arterial Insufficiency Other Effects on the Body
Loss of hair, especially over legs - Nails thickened and rigid.
Venous Insufficiency Pain
Aching Cramping
Venous Insufficiency Pulses
Present, but can be difficult to palpate through edema
Venous Insufficiency Skin
Brown discoloration along ankles and extending up the calf
Skin thickened and rough; may be reddish-blue in color
Frequently associated with dermatitis
Edema
Warm Skin
Venous Insufficiency - What to avoid
Prolonged sitting, standing, restrictive clothing, leg crossing
What Can Venous Insufficiency Lead To?
Venous Ulceration
What is Peripheral Artery Disease?
Disorder of the arteries and veins that causes narrowed arteries to reduce blood flow to the limbs. (Chronic condition that deprives lower extremities of oxygen and nutrients)
What is Peripheral Artery Disease also known as?
Peripheral Vascular Disease (if occurs in veins and arteries alike)
What can Peripheral Artery Disease describe?
Arterial or Venous diseases
What is the most common cause of Peripheral Artery Disease?
Atherosclerosis is the most common cause of altered blood flow-blockage
Peripheral Artery Disease Symptoms
Painful cramping in hip, thigh or calf muscles after certain activities such as walking or climbing stairs (claudication)
Leg numbness or weakness
Coldness in lower leg or foot, especially when compared with the other side
Sores on toes, feet or legs that won’t heal
A change in the color of legs
Hair loss or slower hair growth on feet and legs
Slower growth of toenails
Shiny skin on legs
No pulse or a weak pulse in legs or feet
Erectile dysfunction in men
Peripheral Artery Disease Risk Factors
Smoking Diabetes Obesity (BMI over 30) High Blood Pressure High Cholesterol Increasing age ( After 50) Family history of Peripheral Artery Disease High levels of homocysteine (commonly found in meat) African Americans - Twice as likely
Peripheral Venous Disease Symptoms
Heaviness of legs
Aching sensation aggravated by sitting or standing for a long period of time
Leg edema
Varicosities
Risk Factors for Venous Stasis
Long periods of standing still, sitting down, or lying down
Lack of muscular activity that causes blood to pool in legs which increases pressure in the veins
Varicose (tortuous and dilated) Veins which increase venous pressure. Damage to the vein wall can also contribute to venous stasis.
Deep Vein Thrombosis (DVT) Risk Factors
Reduced Mobility Dehydration Increased viscosity of the blood Venous stasis Leg edema, pain, warm skin, erythema Calf tenderness on palpation USE HOMANS SIGN TO HELP CHECK
Pitting Edema
1+ Sight Pitting
2+ Deeper than 1+
3+ Noticeably deep pit; extremity looks larger
4+ Very deep pit; gross edema in extremity
Phlebitis and Thrombophlebitis Signs and Symptoms
Palpable, firm subcutaneous, cord-like vein, tender, red and warm, may have edema
Most common cause of Phlebitis and Thrombophlebitis is?
IV Therapy
Phlebitis and Thrombophlebitis Treatment
Immediately remove IV catheter; elevation of extremity to promote venous return, and warm, moist heat to relieve pain and treat inflammation
Inspection for the Peripheral Vascular System Arms
Size, presence of edema, venous return
