Title: Chapter 10 Assessment of Cardiovascular System
1Chapter 10Assessment of Cardiovascular System
2- Subjective data
- 1. Assessment of chief complaints
- - Chest pain location, quality, duration
associated symptoms. - - Irregular heart beat pound, too fast, jump..
Etc. - 2. Assessment of risk factors
- - Ask about history of hypertension, diabetes,
rheumatic fever? - - Ask about family history of heart attack,
hypertension, stroke, and diabetes?
3- - Describe your nutritional intake have you
ever been told you have high cholesterol,
triglyceride level. - -Do you smoke? How much? And for how long?
- - How do you view yourself? What do you do to
relax? - - How many hours a day do you work? How do you
cope with stress. - - Exercise what do you do for exercise? How
often? - - Pain in calves, feet, buttocks or legs? What
aggravates the pain (walking, sitting long
periods, standing long periods, sleep)? What
relieves the pain elevating legs, rest, lying
down? - - Is there fitting shoes? Does client wear
constricting garments or hosiery?
4- -In what type of chair does client usually sit?
- - Does he/she cross legs frequently?
- - Assessment of the client must be in supine or
sitting positing according to his/her health. - Inspection palpation
- By inspection and palpation you may detect
ventricular hypertrophy (thickening of the
ventricular walls in the heart). - Use source of light to inspect subtle movement
in chest e.g. pulsation, retraction, etc.
5- Apical pulse in left fifth intercostal space, if
deviation in site observed may indicate cardiac
enlargement 6th intercostal space. - Retractions (when some of the tissue is pulled
into the chest on the precordium) may be seen
around site of apical pulse. Marked retraction
may indicate pericardial disease. - Heaves or lifts (precordial movements when right
ventricle work increases). Heaves are best felt
with the heel of the hand at the sternal border).
6 7 8- Palpation (sitting position).
9- Palpation (supine position).
10- Palpate from apex, moving to external border to
base. - Detect abnormalities in site of palpation and
abnormal sounds especially for thrill abnormal
flow of blood - Thrill a fine vibration, felt by an examiner's
hand on a patient's body over the site of an
aneurysm or on the precordium, resulting from
turmoil (disturbance) in the flow of blood and
indicating the presence of an organic murmur of
grade 4 or greater intensity.
11- It is important to describe pulsations in
relation to their timing in the cardiac cycle. - Describe in terms locations of pulsation in
relation to mid-sternal, midclavicular or
axillary lines.
12- Midclavicular and axillary lines
13- Strength of palpation of apical pulse differs
from thin person to obese. - Conditions such as stress, anxiety, anemia,
fever, and hyperthyroidism may increase the
amplitude and duration of apical pulse (you feel
lifting sensation under your fingers). - Palpation of pulse at base of the heart
(putting your hand at second left and right
intercostal spaces at sternal borders). - Percussion is not used in cardiac assessment
14- Auscultation
- -All heart sounds are generally low pitched and
difficult for the human ear to hear. - -You may start auscultation from base to apex or
from apex to the base. - Assess
- Rate and rhythm of the beat.
- Concentrate initially on sound "1", noting its
intensity and variations, possible duplication
and effects of respiration. - Then listen to sound "2" for same
characteristics. - Finally listen for extra sounds and for murmurs.
15- Sound "1" caused by the closing of the tricuspid
and mitral valves. Systole begins with Sound "1"
extends to Sound "2. - Sound "2" results from closing of the aortic
pulmonary valves. - Diastole begins with Sound "2" and extends to
next Sound "1" - Sound "2" louder than Sound "1" at the base of
heart, and is quieter than Sound "1" at the apex.
16- Sound "3" During diastole, rapid distention of
ventricles occurs causes vibrations of
ventricular walls, and this known as sound "3". - Sound "3" best heard at the apex with bell of
stethoscope. -
- Sound "4" occurs after sound "3" (late diastolic
filling), occurs from vibrations of ventricular
wall or vibrations of the valves. - Summation gallop three cardiac sounds heard
S1, S2 and summation of S3 and S4.
17Neck vessels - Jugular veins assessed for
venous pulse waves and pressure. - Assess for
distention, may result from right-sided heart
failure. - The client must be in supine position
or in fowler position "45" degree. - Assess
jugular pulse venous" which is wave of blood
retrograde after ejecting blood into the right
ventricle
18- Assess carotid arteries inspection, then palpate
below and just medial to the angle of the jaw,
then auscultate by the bell of the stethoscope. - Assess carotid arteries for pulsation noting is
it strong or weak, rise or collapse, rapid or
slow, double or single. - Listen for heart murmurs ( abnormal sounds
produced by vibrations within the heart or in the
walls of large vessels during systole or
diastole. - Murmurs occurrence result from valve defects,
changes in the blood vessels or by defects in the
myocardium.
19- Special maneuvers for vascular assessment
- Check for deep phlebitis by quickly squeezing
calf muscles against tibia (normally no pain). - Check Homan's sign by extending leg and
dorsi-flexing foot (normally no pain). - Check for competency of valves (Trendelenburg
test) if client has varicose veins feel dilated
veins with one hand while using the other hand to
compress veins firmly above level of the first
hand, then palpate for impulse of blood flow
which is normally no pulsation palpated.
20- Trendelenburg test (Tourniquet test)
- With the patient in a supine position, the lower
limb is elevated to empty the superficial venous
system. The tourniquet is applied just below
level of sapheno-femoral junction (SFJ). - The patient is then asked to stand. Rapid filling
of the varicosities with the tourniquet still on
suggests incompetent perforators below the level
of the SFJ. If no filling is seen at this point,
the tourniquet is released.
21Arterial and venous insufficiency of lower
extremities
Item Arterial insufficiency Venous insufficiency
Pulses Decreased or absent Present
Color Pale on elevation and cold Pink to cyanotic, brown pigment at ankles
Temperature Cool, cold Warm
Edema Non Present
Skin Shiny skin, thick nails, absent of hair, ulcers on toes, gangrene may develop Ulcers on ankles discolored, scaly
Sensation Leg pain aggravated by standing relieved with rest. Pressure on buttocks or calves or cramps during walking, parasthesia Leg pain aggravated by standing or sitting relieved by elevation of legs, lying down, or walking. Also relieved with use of support hose.
22The end