Week 2: Cardio and Peripheral Assessment Flashcards
where does the heart extend from
Second to fifth intercostal spaces (rib spaces)
Goes from the sternum to the left midclavicular line
Blood Flows from…
from the body (deoxygenated) through the vena cava to the RA through T-valve to RV through P-valve to pulmonary artery to lungs (to get oxygenated) to the pulmonary vein to the LA through the M-valve to the LV through the AV to the aorta and to the body again
Heart Apex
At the bottom, 5th intercostal space, left midclavicular line (MCL)
Heart Base
Top, 2nd intercostal space, right sternal border (SB) to LMCL
how does the heart supply itself
through the cardiac arteries/veins
pediatric hearts
Blood flows differently; bypasses the lungs during gestation, mother oxygenates it
- Foramen Ovale (oval hole) between RA and LA; 2/3rds of blood flows through -> aorta
Closes within 1 hour of birth
- Ductus Arteriosus: 1/3 of blood goes from RA to pulmonary artery through DA to aorta
Children’s apexes are at the 4th intercostal space, LMCL
Dyspnea
(shortness of breath)
Orthopnea/PND
(difficulty breathing lying down, ex., how many pillows do you use)
Paroxysmal Nocturnal Dyspnea
Cyanosis/Pallor
(extremities/lips turning blue, or paleness)
Edema
(swelling)
Nocturia
(waking up at night to pee)
cardio subjective assessment
Chest pain/Angina
Dyspnea (shortness of breath)
Orthopnea/PND (difficulty breathing lying down, ex., how many pillows do you use)
Paroxysmal Nocturnal Dyspnea
Cough
Fatigue (more tired than usual, tire more quickly)
Cyanosis/Pallor (extremities/lips turning blue, or paleness)
Medications (any medications specific for heart)
Edema (swelling)
Nocturia (waking up at night to pee)
Past cardiac history (have they had heart attack, surgery, CV surgery)
Family cardiac history (anybody in the family having those things)
Cardiac risk factors (lifestyle, genetics, exercise habits)
peripheral vascular subjective assessment
Leg pain/cramps
History of vascular problems
Diabetes
Pregnancy
Smoking
Trauma
Skin changes on arms/legs
Edema
Lymph node enlargement
Medications
Occupation (on their feet a lot)
Recent travel (edema, DVT risk)
Recent surgery (blood clots)
cardiac risk factors
Conditions (Non-modifiable risk factors)
Gender (men, usually), Age (men in 40s, women after menopause), family history
Modifiable risk factors:
Smoking (offer if they want to quit; ask/advise/assess/assist/arrange), physical inactivity/diet/stress, hypertension (140/90+, 130 for diabetics)
heart sounds - s1 and s2 + split-s2
Heart sounds are really the sounds of valves closing
S1 is the sound of the Tricuspid/Mitral valves; systole beginning (LUB-dub)
S2 is the sound of the Aortic/Pulmonic valves; end of systole (lub-DUB)
Split-S2: Normal, aortic valve closes before pulmonic valve, Lub-T-DUB
heart sounds - s3 and s4
When listening in Left-Lateral Position for abnormal sounds:
S3: Soft, dull, low-pitched sound after S2 – Al-Ber(ta)
Normal in children, young adults: pathological in older adults
S4: Very soft, low-pitched sound before S1 — (New)Bruns-Wick
hearing all heart sounds - s4,s1,s2,s3…
Could be a pericardial friction rub
murmurs
Murmurs: Blowing sounds from turbulent blood flow
Innocent (healthy, normal), Functional (from increased blood flow), Pathological (from valve defect; stenosis, regurgitation), often felt/found with a thrill
If you find a murmur, repeat the auscultation in Left-Lateral position, auscultate with bell
Listen for: timing (first or second), loudness (i-vi), pitch, pattern (louder/softer), quality (harsh/blowing), location (which valve), radiation (does it spread anywhere), posture (supine/left-lateral)
bruit
Bruit: An abnormal swishing sound due to turbulent blood flow
Palpate then auscultate the carotid artery
cardio assessment starting patient in supine: objective
Patient is supine
First, inspect for skin colour/condition (lumps, bumps, bruises)
Also inspect for pulsations (if you’re able to see the apical impulse)
Palpate for the apical impulse (5ICS LMCL), any thrills (rumbling)
Auscultate the apical impulse; take the heart rate from there (30 normal/60 abnormal)
Use diaphragm to auscultate 4 valve areas for S1/S2 sounds: APe To Man
Aortic (2ICS,RSB) Pulmonic (2ICS,LSB) Tricuspid (5ICS,LSB), Mitral (5ICS,LMCL)
Use the bell to auscultate the 4 valve areas for S3/S4 sounds and murmurs
Assist them into the left-lateral position, auscultate apex (mitral) w/ bell for S3,S4,murmurs
With them seated & leaning forward, use the bell at the base, left/right side for murmurs
peripheral assessment: subjective
Patient is seated upright
Inspection arms for lumps/bumps/bruises/scars/tattoos/freckles/hair distribution/lesions/symmetry, assess nailbed angle, capillary refill, temperature
Palpate for any edema, texture
Palpate brachial and radial pulses on both arms, grade (0-3)
Legs
Inspection of legs for lumps/bumps/bruises/scars/tattoos/hair distribution, symmetry
Palpate shins for edema (grade based on time to disappear)
Is it dependent, pitting, bi/unilateral?
Palpate for texture, temperature
Palpate femoral pulse (leg crease), popliteal (knee crease), posterior tibialis (behind medial ankle), dorsalis pedis (middle of foot, between first two toes)
DVT
DVT = Deep vein thrombosis = Blood clot
Risk factors are bedrest/immobility/surgery, smoking, birth control pills
Signs/symptoms are redness/swollen/painful calf, Homan’s sign (not specific enough)
Prevented by encouraging mobility, compression stockings, SQ heparin (blood thinner)
