WEEK 8- HEART AND VESSELS Flashcards
heart and blood vessels
where do u auscultate the carotid artery
Location
Angle of jaw, midcervical, base of neck
what do u wish to not hear when auscultating
BRUIT
what is the positioning for the carotid artery
sitting upright
what is the positioning for the precordium
supine with head and chest slightly elevated
what is the angle your head should be elevated for the jugular venous pulsations
30-45 degrees
whats the acronym for auscultating the carotid arteries
AASURR
what does AASURR stand for
A- ask patient to tilt head slightly to one side
A- ask patient to hold breath
S- start at the angle of the jaw, mid neck, and at the base of the neck
U- use the bell of the stethoscope
R- remind the client to breathe
R- repeat on the other side
how to inspect external jugular venous pulsations
External jugular veins
Location: Over sternomastoid muscle
Present or full
how to inspect internal jugular venous pulsations
Internal jugular pulsation
Location: Suprasternal notch or origin of sternomastoid muscle
Diffuse with two visible waves
internal jugular characteristics
lower, undulant diffuse with 2 visible waves.
disappears as person sits up
carotid pulse
higher, medial to sternomastoid muscle,
-brisk, localized with one wave
-does not vary with R
-unaffected by position
cardiovascular system is made up of 2 things
heart and blood vessels
the two types of blood vessels
pulmonary and systematic circulation
the heart landmarks
- precordium
- mediastinum
layers of the heart
pericardium-outer layer
epicardium
myocardium- muscular layer of the heart
endocardium- innermost layer of the heart
what are the 4 valves
atrioventricular
- tricuspid
- mitral/bicuspid
semilunar
- pulmonic
- aorta
the 2 types of circulation
systematic and pulmonary
what are the 2 phases of the cardiac cycle
systole and diastole
diastole
- pressure is greater in atria than ventricles
- av valves open
- ventricles fills
atrial kick
- 25% of stroke volume
systole
- ventricular pressure greater than atrial
- AV valves close (sound of S1 “lub”
- all 4 valves closed
- pressure builds in ventricles
- SL valves open and ventricles contract
- ventricular pressure falls below aortic
(SL valves comes sound of S2 “dup”)
what is split t-dup
its because the aortic valve closers earlier than pulmonic
- more to the right heart
- less to the left
electrical conduction system is made up of
- the cardiac cycle
- abilities of cardiac muscle cells
- the pathway of the electrical conduction system of the heart
what is CO
cardiac output is the amount of blood pumped by ventricles during 1 min.
whats the measurement for CO
stroke volume x HR= CO
developmental considerations - infant and children
- foramen ovale
- ductus arteriosus
- position of heart in chest apex higher
developmental considerations- pregnant women
- increase in blood volume
- increase in stroke volume and cardiac output
developmental considerations- older adult
- influence in lifestyle
- increase in systolic blood pressure
- decreased tolerance
socioeconomic factors
- high blood pressure
- smoking
- serum cholesterol
- obesity
- diabetes
subjective data
- chest pain
- dyspnea
- orthopnea
- cough
- fatigue
- cyanosis
- edema
- nocturia
- cardiac hx
- family cardiac hx
- personal habits (cardiac risk factors)
landmarking the body (the 3 lines)
- midsternal
- midclavicular
- anterior axillary line
precordium (objective exam) inspect
Inspect the anterior chest- can use tangential light
precordium (objective exam) palpation
Palpate the apical impulse and pulsations
heaves or lifts due to enlarged ventricle d/t overload
precordium (objective exam) 3 sites of palpation
Palpate across the precordium 3 locations
At 5th ICS at midclavicular line
Left Sternal Border
Base of Heart
Assessing for Thrills
precordium- supine, what are you feeling for?
apex, left sternal border, base
- normally no pulsations/thrills felt
the apical pulse is only palpable in what % of the population
50%
where to auscultate the apical pulse
Landmark
5th ICS at left MCL (same location as the mitral valve)
Note rate & rhythm
auscultatory location for the tricuspid valve
4TH ICS at L sternal border
auscultatory location for mitral valve
5TH ICS at left MCL
auscultatory location for aortic valve
2ND ICS at R sternal border
auscultatory location for pulmonic valve
2ND ICS at L sternal border
DEVELOPMENTAL CONSIDERATIONS
Infants
Difference in apical, radial pulses
HR 100-180 bpm
May be in higher range with crying or other activity
Murmurs more common in first days
Children
Position of apical impulse
Venous hum
Innocent heart murmurs
DEVELOPMENTAL CONSIDERATIONS 2
Pregnant women
Changes in BP (varies with position)
Heart sound changes from increased blood volume and workload
Older adult
Orthostatic hypotension
Abnormal findings
Abnormal pulsations on the precordium
Thrill murmur
Aortic stenosis
Lift (heave) at the sternal border
RV hypertrophy
Congenital heart defects
Patent ductus arteriosus (PDA)
Atrial septal defect (ASD)
Ventricular septal defect (VSD)
Coarctation of the aorta
