Assessment of Cardiovascular System

 Copyright 2002 by Delmar, a division of Thomson Learning 7-2 The Heart Extends from the 2ed to the 5th intercostal space Between the R boarder of the sternum to the L midclavicular Beats against chest wall to produce apical impulse Palpate 5th intercostal space 7-9cm form the mid sternal line

 Copyright 2002 by Delmar, a division of Thomson Learning 7-3 Anatomy and Physiology of the Heart Four Chambers: Right atriumRight atrium Left atriumLeft atrium Right ventricleRight ventricle Left ventricleLeft ventricle

 Copyright 2002 by Delmar, a division of Thomson Learning 7-4 Cycle of Cardiac Events It has two phases: DiastoleDiastole ventricles relax & fill with blood (This is 2/3 of the cardiac cycle.)ventricles relax & fill with blood (This is 2/3 of the cardiac cycle.) SystolicSystolic heart contracts & pushes blood out of the ventricles to: the lungsthe lungs Systemic arteriesSystemic arteries

 Copyright 2002 by Delmar, a division of Thomson Learning 7-5 Heart Sounds S1 – when closure of the AV valves (tricuspid & mitral) & ventricles contractS1 – when closure of the AV valves (tricuspid & mitral) & ventricles contract S2 – when closure of the semilunarS2 – when closure of the semilunar valves ( pulmonic & aortic) & the ventricles relax

 Copyright 2002 by Delmar, a division of Thomson Learning 7-6 Assessment of Cardiovascular System

 Copyright 2002 by Delmar, a division of Thomson Learning 7-7 Preparation for Assessment Room that is warm & “quiet”Room that is warm & “quiet” Examining table positioned so you can stand on the patient’s right sideExamining table positioned so you can stand on the patient’s right side Patient GownPatient Gown A watch with a second handA watch with a second hand Stethoscope with diaphragm & bellStethoscope with diaphragm & bell Tape measureTape measure

 Copyright 2002 by Delmar, a division of Thomson Learning 7-8 Subjective Data 1. chest pain location, quality, duration & associated symptoms. - Irregular heart beat: pound too fast, jump….. Etc. 2. dyspnea 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

 Copyright 2002 by Delmar, a division of Thomson Learning 7-9 Risk Factors History of hypertension, diabetes, rheumatic fever.History of hypertension, diabetes, rheumatic fever. Family history of heart attack, hypertension, stroke, and diabetesFamily history of heart attack, hypertension, stroke, and diabetes Nutritional intakeNutritional intake Smoke habits How much? for how long?Smoke habits How much? for how long? Working hours, coping with stressWorking hours, coping with stress Exercise, How often.Exercise, How often. Exercise? How often Exercise? How often

 Copyright 2002 by Delmar, a division of Thomson Learning 7-10 During assessment the client must be in supine or sitting positing according to his health.

 Copyright 2002 by Delmar, a division of Thomson Learning 7-11 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

 Copyright 2002 by Delmar, a division of Thomson Learning 7-12 Murmurs Vibrations within the hearts chambers or major arteries from the back and forth blood flow; swishing sound

 Copyright 2002 by Delmar, a division of Thomson Learning 7-13 Assessment of the Jugular Vein Purpose: To measure the CVP “central venous pressure” Method: Position patient at 45 degreePosition patient at 45 degree angle at the hipangle at the hip Turn head slightly awayTurn head slightly away Use a strong light tangentiallyUse a strong light tangentially Observe the external jugular over the sternomastoid muscleObserve the external jugular over the sternomastoid muscle

 Copyright 2002 by Delmar, a division of Thomson Learning 7-14 Arterial and Venous Insufficiency of lower Extremities Item Arterial insufficiency Venousinsufficiency Pulses Decreased or absent Present Color Pale on elevation and cold Pink to cyanotic, brown pigment at ankles Temperature Cool, cold Warm EdemaNonPresent 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.

 Copyright 2002 by Delmar, a division of Thomson Learning 7-15 Characteristics and Problems associated with Cardiac dysrhythmias Heart failure.Heart failure. Ischemic heart diseaseIschemic heart disease Myocardial infarctionMyocardial infarction HypertensionHypertension Cor pulmonaleCor pulmonale Infection and inflammation.Infection and inflammation.

 Copyright 2002 by Delmar, a division of Thomson Learning 7-16

 Copyright 2002 by Delmar, a division of Thomson Learning 7-17 Thank You