1. Cardiovascular Assessment
Heart
Lungs
Pulses
Blood Pressure
Central,peripheral cyanosis
Edema

2. הלב

3. THORAX

5. PRECODIUM

8. ANTERIOR VEIW

10. Nursing Principles Identify self Identify patient Wash hands
Bring equipment
Obtain consent
Respect privacy
Explain proceedure

11. Remove clothes to waist
Elevate bed 30 degrees
Patient lying
Good Lighting
STAND ON RIGHT SIDE OF PATIENT
Bend –eyes level to chest wall

12. PHYSICAL ASSESSMENT HEART
INPECTION
PALPATION
PERCUSSION
AUSCULTATION

13. יתכופף -פולסציות -אזורים בולטות הסתכלות
יתכופף -פולסציות -אזורים בולטות הסתכלות

14. מישוש- פעימות

15. PMI- POINT MAXIMUM IMPULSE
LOCATION-5th-6th intercostal space
-7-9 cm mid sternal line
- not beyond mid clavicular line
DIAMETER-5th-6th intercostal space
-2.5cm or 1 interspace
AMPLITUDE- gentle tap-increases with excitment

16. מישוש-רטט

17. מישוש- רטט

18. האזנה-PMI

19. S1 S2 ( DIAPHRAM ) האזנה

20. S S2

21. S3
Rare extra heart sound Occurs after S2 Associated with heart failure KENTUCKY KEN S1 TUC S2 KY S3 Caused by oscultation of blood backand forth between the wall of the ventricle. Indicates increased ventricular filling,mitral and tricuspid regurgitaion

22. S4 Rare extra heart sound Occurs before S1
Caused by atria contracting forcefully in an effort to overcome stiff or hypertrophic ventricles
Caused by turbulent blood flow as atria contract to force blood into ventricles
S4 TEN S1 ES S2 SEE…….TENESSSEE

23. Auscultate-Splitting Breath in, Hold

24. Heart Murmers
Patholgical heart sounds that are produced as a result of turbulent blood flow that is sufficient to produce audible noises heard with a stethoscope
איוושות הינם לא תקינים מזרימת דם מערבולתית היוצרת קול בהאזנה

25. Heart murmers:valvular stenosis
Valve leaflets stiffen,narrowing the valve opening and reducing blood flow through it.

26. Heart murmers: valvular regurgitation
Valve leaflets do not close properly letting blood leak backwards

27. Heart murmers described in terms:
Time-when heard in cycle

28. Shape-cresendo,decrescendo,plateau

29. Location of intensity-where heard best-usually where murmer originates
Radiation-transmission from location
Intensity-1-6
Pitch-high, medium, low
Quality-blowing,harsh

30. Systolic murmers
Audible sound occurs somewhere between S1 or S2 Aortic Stenosis? Pulmonary stenosis? Mitral regurgitation? Tricuspid regurgitation?

31. Systolic heart murmers
Aortic stenosis
Pulmonary stenosis
(Shape- cresendo-decresendo-mid systolic)

32. Systolic heart murmers
Mitral regurgitation
Tricuspid regurgitation
(Shape-Holoststolic-plateau)

33. Best Heard? Aortic Stenosis? Pulmonary Stenosis? Mitral regurgitation?
Tricuspid regurgitation?

34. Diastolic heart Murmers
Starts at or after S2 ends before S1
Divided into 3 catergories
Earlydiastolic
Middiastolic
Latediastolic

35. Aortic regurgitation?
Pulmonary regurgitation?
Mitral stenosis?
Tricuspid stenosis?

36. Best heard Aortic regurgitation? Pulmonary regurgitation?
Mitral stenosis?
Tricuspid stenosis?

37. Aortic regurgitation

38. Other diastolic heart murmers
Pulmonary regurgitation
Mitral stenosis
Tricuspid stenosis

39. כלי דם Carotid Jugular Brachial Radial Femoral Popliteal
Dorsalis pedis
Posterior tibial

40. Carotid artery (Trills Bruit, ).

41. Palpate Right,left Humming vibration-”thrill” Feel with fingers or thumb Never press both carotids at same time

42. Auscultate hold breath Murmurlike sound-”Bruit”-suggests arterial narrowing

43. Internal Jugular vein--Lower third of neck

44. Internal Jugular--Inspection

45. Lower third of neck

46. Jugular Veins Reflect right atrial pressure
Best estimate from internal jugular vein
If cant see internal jugular-external jugular is seen-less reliable

47. JVP (30,)

48. Increase JVP Volume Heart failure
Increase peripheral vascular resistance
Pressures measured as more than
3cm or 4cm above sternal angle-elevated

49. Decreased JVP Decrease in volume-hypovolemic states
Vasodilation-Septic shock

50. גפיים עליונות
Expose Limb Inspect: Size, color, skin ,symetry,swelling Nails Palpate: tempreture

51. Palpate pulses for
Rate Regularity Amplitude: Small weak pulses-heart failure causes decreased stroke volume, hypovolemia. Large bounding pulse-fever, hyperthyroidism,

52. RADIAL PULSE

53. מילוי קפילרי ימין- שמאל

54. Allen Test

55. Brachial

56. גפיים -תחתונות
Expose Limb Inspect: Size, color, skin ,symetry,swelling Nails Palpate: tempreture

57. גפיים -תחתונות

58. Femoral

59. Popliteal

60. Dorsal Pedis

61. Posterior Tibial

62. Medial malleousבצקות-גב הרגל,שוק,אחרי-

63. Phlebitisשריר השוק-

64. Clubbing

65. Central cyanosis

66. Peripheral cyanosis

67. Tiredness ,Lethergy