Chapter 10 Assessment of Cardiovascular System - PowerPoint PPT Presentation

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Chapter 10 Assessment of Cardiovascular System

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Chapter 10 Assessment of Cardiovascular System * * Subjective data: 1. Assessment of chief complaints: - Chest pain: location, quality, duration & associated symptoms. – PowerPoint PPT presentation

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Title: Chapter 10 Assessment of Cardiovascular System


1
Chapter 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
  • Apical pulse

7
  • Apical pulse

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.

17
Neck 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.

21
Arterial 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.
22
The end
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