Health & Physical Assessment in Nursing

1. Health & Physical Assessment in Nursing Cardiovascular System

2. Cardiovascular System • Heart • Vasculature

3. Heart • Pericardium • Cardiac muscle • Chambers • Valves • Cardiac vessels • Conduction system • Nerves

4. Figure 17.1 Layers of the heart.

5. Structural components of the heart.

6. Valves of the heart.

7. Pericardium • Thin Sac Composed of Fibroserous Material That Surrounds the Heart • Outer layer • Inner layer • Fluid between the layers

8. Heart Muscle • Base • Apex • Epicardium • Myocardium • Endocardium

9. Chambers in the Heart • Left and right atria • Left and right ventricles

10. Valves • Permit the Flow of Blood Between Chambers and Into Blood Vessels • Atrioventricular (AV) • Tricuspid • Mitral • Semilunar • Pulmonary • Aortic

11. Heart Sounds • S1 • S2

12. Heart sounds in systole and diastole.

13. Table 17.1 Characteristics of Heart Sounds

14. Table 17.3 Distinguishing Heart Murmurs

15. Contraction and Relaxation Phases of the Heart • Systole • Diastole

16. Pulmonary and systemic circulation. The left side of the heart pumps oxygenated blood (indicated in red) into the arteries of the systemic circulation, which provides oxygen and nutrients to the cells. Deoxygenated blood (indicated in blue) returns via the venous system into the right side of the heart, where it is transported to the pulmonary arterial system to be reoxygenated.

17. Circulation of the Heart • Coronary arteries • Left main • Right coronary • Left anterior descending • Circumflex

18. Vessels of the heart. A. Anterior. A

19. (continued) Vessels of the heart. B. Posterior. B

20. Conduction System of the Heart • Sinoatrial (SA) node • Intra-atrial pathways • AV node • Bundle of His • Right and left bundle branches • Purkinje fibers

21. Conduction system of the heart.

22. Cardiac Cycle • Contraction and Relaxation of the Chambers

23. The cardiac cycle.

24. Cardiac Cycle • Ventricular filling • Ventricular systole • Isovolumetric relaxation

25. Electrocardiogram (ECG) • Paper Recording of Deflections That Represent the Cardiac Cycle • Electrical deflections • P wave • PR interval • QRS interval • T wave

26. Electrocardiogram wave.

27. Cardiac Function • Stroke volume • Amount of blood that is ejected with each heartbeat • Cardiac output • Amount of blood ejected from the left ventricle over 1 minute • Cardiac index • Measurement accounting for an individual’s weight when evaluating the pumping action of the heart

28. Pumping Action of the Heart • Preload volume overload • Afterload pressure overload • Cardiac output: stroke volume x heart rate • Blood pressure: cardiac output x systemic vascular resistance

29. A. Preload is related to the amount of blood and stretching of the ventricular myocardial fibers. A

30. (continued) B. Afterload is the pressure that the ventricles must overcome in order to open the aortic and pulmonic valvular cusps. B

31. Landmarks for Cardiac Assessment • Sternum • Clavicles • Ribs • Second through fifth intercostal spaces

32. Landmarks for cardiovascular assessment.

33. Focused Interview • General questions

34. Focused Interview • Specific questions • Illness • Symptoms • Behaviors • Infants and children • Pregnant female • Older adult • Environment

35. Equipment • Examination gown • Stethoscope • Metric rulers • Doppler

36. Other Considerations • Age • Gender • Language • Culture

37. Physical Assessment of the Cardiovascular System • Techniques • Inspection • Palpation • Percussion • Auscultation

38. Specific Areas of the Cardiovascular Assessment • Inspection of the face, lips, ears, and scalp • Inspection of the jugular veins • Inspection of the carotid arteries • Inspection of the hands and fingers • Inspection of the chest, abdomen, legs, and skeletal structure

39. Jugular Venous Pressure (JVP)and Pulsations • Recall that jugular veins reflect right atrial pressure • Steps for examination • Raise the head of the bed or examining table to 30° • Turn the patient’s head gently to the left • Identify the topmost point of the flickering venous pulsations • Place a centimeter ruler upright on the sternal angle • Place a card or tongue blade horizontally from the top of the JVP to the ruler, making a right angle • Measure the distance above the sternal angle in centimeters: a 3- to 4-centimeter elevation is normal

40. Assessment of central venous pressure.

41. Top line – level of the higest visible point of distention • Bottom line – level of the sternal angle • Measure: the vertical distance between the sternal angle and the highest level of jugular distention

42. Splinter hemorrhage.

43. Landmarks in precordial assessments.

44. Specific Areas of the Cardiovascular Assessment • Palpation of the chest, including the following • Precordium at the right and left second intercostal spaces • Left third intercostal space • Left fourth intercostal space • Left fifth intercostal space at the midclavicular line

45. Landmarks for palpation of the chest.

46. Specific Areas of the Cardiovascular Assessment • Palpation of the carotid pulses (sequentially) • Percussion of the chest for cardiac border

47. Palpating the carotid artery.

48. Assessing the Carotid Pulse • Keep the patient’s head elevated to 30° • Place your index and middle fingers on the right then the left carotid arteries, and palpate the carotid upstroke • Never palpate right and left carotid arteries simultaneously • The upstroke may be: • Brisk – normal • Delayed – suggests aortic stenosis • Bounding – suggests aortic insufficiency • Listen with the stethoscope for any bruits

49. Percussing the chest.

50. Specific Areas of the Cardiovascular Assessment • Auscultation of the chest using the diaphragm and bell in various positions to include the following locations • Aortic area at the right second intercostal space–S2 is louder than S1 • Pulmonic area at the left second intercostal space–S2 is louder than S1 • Erb’s point at the left third intercostal space–S1 and S2 are heard equally