Assessment of Cardiovascular System

1
Assessment of Cardiovascular System

• Professor Kneeshaw

2
Objectives

• 1. describe the structure and function of the
  cardiovascular system, including the peripheral
  vascular system
• 2. explain developmental variations a nurse
  considers when assessing the heart neck vessels
  peripheral vascular system
• 3. state the specific areas considered essential
  in gathering subjective data pertaining to the
  cardiovascular system the peripheral vascular
  system
• 4. demonstrate assessment of the heart, neck
  vessels the PV system

3
Anatomy of the Heart

• Four Valves
• Two atrioventricular (AV)
• 1. tricuspid
• 2. mitral
• Two semilunar (SL)
• 1. pulmonic
• 2. aortic

• Four Chambers
• Right atrium
• Left atrium
• Right ventricle
• Left ventricle

4
Blood Flow
Blood Flow
Blood Flow through the Heart
5
Cardiac Cycle

• It has two phases
• (A) Diastole ventricles relax fill with
• blood (This is 2/3 of the
• cardiac
  cycle.)
• (B) Systolic heart contracts pushes
• blood out of the ventricles
  to
• (i) the lungs
• (ii) systemic arteries

6
Pumping
7
Heart Sounds

• S1 when closure of the AV valves
• (tricuspid mitral) ventricles
• contract
• S2 when closure of the semilunar
• valves ( pulmonic aortic)
• the ventricles relax

8
Extra Heart Sounds

• S3 This occurs immediately after S2
• Why? Resistance to filling of ventricles
• Note also called a ventricular gallop
• It is caused by overload.
• use diaphragm (it is a high sound)
• S4 - This occurs at the end of diastole, just
• before the next S1.
• Why? The atrium contract push blood
  into
• a non-compliant ventricles.
• Note also called an atrial gallop
• caused by HTN, CAD, Aortic stenosis,
  cardiomyopathy
• Use bell to listen as it is a low
  sound.

9
Extra Heart Sounds
10
Murmurs

• Caused by turbulence
• Therefore we hear a gentle blowing, swooshing
  sound.
• Why?
• 1. Velocity of blood increases
• (eg. exercise, thyrotoxicosis)
• 2. Velocity of blood decreases (eg. anemia)
• 3. Structural defect in the valves or an unusual
• opening occurs in the chambers

11
Grading of Murmurs

• Use VI point grading scale record as a
  fraction
• (ie. I/VI or II/VI)
• Grades
• Grade I barely audible, heard only in a quiet
  room then with
• difficulty
• Grade II clearly audible, but faint
• Grade III moderately loud, easy to hear
• Grade IV loud, associated with a thrill
  palpable on the chest wall
• Grade V very loud, heard with one corner of the
  stethoscope lifted
• off the chest wall
• Grade VI loudest, still heard with the entire
  stethoscope lifted off
• the chest

12
The Neck Vessels

• The Carotid Artery
• The Jugular Venous Pulse Pressures
• 2 components (a) internal jugular
• (b) external
  jugular

13
Subjective Data

• 1. chest pain
• 2. dyspnea ( DOE, PND)
• 3. Orthopnea
• 4. Cough
• 5. Fatique
• 6. cyanosis or pallor
• 7. edema
• 8. nocturia
• 9. past cardiac history
• 10. family cardiac history
• 11. personal habits
• 12. environment

14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
(No Transcript)
22
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
Preparation for Assessment

• Room that is warm quiet
• Examining table positioned so you can stand on
  the patients right side
• Patient Gown
• A watch with a second hand
• Stethoscope with diaphragm bell
• Tape measure

26
Recommended Sequencefor assessing cardiovascular
system

• 1. Pulses BP
• 2. Extremities
• 3. Neck Vessels
• 4. Precordium

27
The Neck Vessels

• Carotid Arteries
• Palpate low in neck to avoid the sinus
• Be gentle
• Palpate only one side at a time to avoid
  compromising blood flow to the head
• Auscultate using the bell
• Listen in 3 places angle of jaw
• midcervical
  area
• base of neck
  

28
Assessment of the Jugular Vein

• Purpose To measure the
• central venous pressure
• Method Position patient _at_ 45 degree
• angle at the hip
• Turn head slightly away
• Use a strong light tangentially
• Observe the external jugular
  over the
• sternomastoid muscle

29
Specific Process for CVP Measurement

• Locate the internal jugular pulsation
• Mark the highest point of pulsation
• Locate the angle of Louis
• Make a T square with 2 index cards
• Read the level of intersection
• Note The normal jugular venous pressure is
• 2 cm or less above the sternal angle.

30
Hepatojugular Reflux

• This is measured if the CVP is elevated or CHF is
  suspected.
• Patient is supine
• Instruct patient to breathe quietly with mouth
  open
• With rt. hand on the patients RUQ of abdomen,
  just below the rib cage, exert firm consistent
  pressure for 30 seconds
• Watch the level of the jugular pressure
• Note Normally the jugular rises but recedes
  back.
• Abnormally, the pressure elevates stays.

31
The Heart ( Precordium)

• Inspection Check pulsations, heaves, lifts
• (You may see the apical
  pulse.)
• Note The apical is located in the 4th or 5th
• ICS _at_ the left MCL .
• Palpate Feel the apical impulse (also
• called the PMI). Use 1 finger
• pad.
• Use palmar side of 4 fingers to
  feel for
• other pulsations on the chest.
  
• (eg. thrills

32
Heart Assessment (continued)

• Percussion To check for heart
• enlargement
• (Noteoften done by chest
  Xray)
• Auscultation Start at the base of the heart.
• APE to Man
• Aortic - 2nd Rt. ICS
• Pulmonic 2nd left ICS
• Erbs Point
• Tricuspid left sternal
  border
• Mitral 5th ICS _at_ left MCL

33
Sequence for Auscultating

• A. Begin with the diaphragm.
• Note at each area
• 1. rate rhythm
• 2. identify S1 and S2
• 3. assess S1 and S2 separately
• 4. listen for extra heart sounds (ie.
  S3,S4)
• 5. listen for murmurs
• B. Repeat above using the bell.

34
What do you hear?

• S1 and S2 sound like lub-dup
• S1 is louder than S2 at the apex
• S2 is louder than S1 at the base
• S1 coincides with the carotid pulsation

35
Assessment of the Peripheral Vascular System

• Arteries assessed in cephalocaudal direction
• Head temporal
• carotid
• Arms brachial
• ulnar
• radial
• Legs femoral
• poplitial
• Feet - dorsalis pedis
• posterior tibialis

36
Assessment of Veins

• Neck Jugular veins
• Arms Superficial
• Deep
• Legs - Deep veins femoral, popliteal
• Superficial veins-
• great saphenous (inside
  of leg)
• small saphenous
  (outside of leg)
• Perforators join the above 2
  sets
• Note The veins have valves that keep blood
  moving toward
• the heart. However, you need
  exercise too.

37
Lymph Nodes

• Superficial nodes available for palpation
• 1. Cervical nodes
• 2. Axillary nodes
• 3. Epitrochlear Nodes
• 4. Inguinal nodes
• Also organs
• Spleen - assessed in abdomenal exam
• Tonsils assessed with head neck
• Thymus (behind sternum)

38
Subjective Data for Peripheral Vascular System

• Leg pain
• Skin changes
• Swelling in arms legs
• Lymph node enlargement
• Medications
• Smoking

39
Techniques used to assess the Peripheral
Vascular System

• Arms Inspection
• Palpation radial, ulnar,
  brachial,
• epitrochlear lymph
  nodes
• perform the Allen Test
• Legs Inspection
• If calf pain, check the Honans sign
• Palpation femoral, poplitial,
  dorsalis
• pedis, posterior
  tibialis
• If pretibial edema, press over tibia
  or
• medial malleolas for 5 seconds
• Use rating scale

40
An Additional Test

• If there is a color change in the lower
  extremities
• Elevate the legs 30 cms (12 inches)
• Have patient wag feet to drain blood
• Sit patient up with legs over side of table
• Note the time it takes for color to return.
• Normally, the color returns in 10 seconds.

41
The end