ch17 cardiovascular assessment _ nk07
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Cardiovascular System
Chapter 17
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Figure 17.3 Structural components of the heart.
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Heart Heartpump composed of synchronized structures
Cardiac Vessels
Coronary Arteriesextensive network of arteries supplying the heart
Coronary Veinsnetwork for venous blood drainage
Conduction systemheart has it own conduction system whichcan initiate and transmit an electrical impulse via cardiac muscle
fibers This electrical charge stimulates muscular contraction of the heart
SA node, AV node, Bundle of His, Right and Left Bundle Branch Block,and Purkinje fibers
Nerves
Sympatheticstimulate the heart, increases heart rate, force ofcontraction, and dilation of coronary arteries.
Parasympatheticopposite effect
CNSinfluences the activation and interaction of nerves throughinformation supplies by the cardiac plexus.
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Cardiac Musculature
Heart Muscle
Base
Apexpoint of maximum impulse so heart beat is more
easily palpated over the apex5thintercostal space
Three Layers:
Epicardiumouter layer
Myocardiumthick muscular layer
Endocardium - smooth inner lining of chambers
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Valves
Valves - Permit the Flow of Blood Between
Chambers and into Blood Vessels
Atrioventricular (AV)
Tricuspid Mitral
Semilunar
Pulmonary
Aortic
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Heart Sounds
Heart SoundsClosure of valves which are associatedwith the contraction and relaxation phases of the heart.
Systolerefers to ventricular contraction and begins with
closure of the AV valves (S1) and ends with the closure of
the aortic and pulmonic valve (S2)
Diastolerefers to ventricular relaxation and begins with
closure of the aortic and pulmonic valve (S2) and ends with
closure of AV valves (S1).
S1 (lub) S2 (dub)
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Figure 17.5 Heart sounds in systole and diastole.
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Table 17.3 Distinguishing Heart Murmurs
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Table 17.3 (continued) Distinguishing Heart Murmurs
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Table 17.4 (continued) Classifications of Heart Murmurs
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Electrocardiogram
Electrocardiogram (EKG) - Paper Recording ofDeflections That Represent the Cardiac Cycle
Signifies electrical conduction
Electrical deflections P wave
PR interval
QRS interval
T wave
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Figure 17.11 Electrocardiogram wave.
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Cardiac Function
Stroke volume - Amount of blood that is ejected witheach heartbeat
Cardiac output - Amount of blood ejected from the leftventricle over one minute
Cardiac index - Measurement accounting for anindividuals weight when evaluating the pumpingaction of the heart
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Landmarks for Cardiac Assessment
Landmarks for Cardiac Assessment Sternum
Clavicles
Ribs
Second through fifth intercostal spaces
Correlating assessment findings over body landmarks
provides vital information related to underlying
pathologic mechanisms.
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Figure 17.18 Landmarks in precordial assessments.
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Inteview
General Questions Specific Questions Illness
SymptomsBehaviors
Infants and children
Pregnant female
Older adultEnvironment
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Equipment
Examination gown
Examination drape
Stethoscope
Metric rulers Doppler
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Techniques
Physical Assessment of the Cardiovascular System Techniques
Inspection
Palpation
Percussion Auscultation
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Specific Areas
Specific Areas of the Cardiovascular Assessment Inspection of the face, lips, ears, and scalp
Skin color
Movement
Earlobe creases
Inspection of the jugular veins Pulsations
Distention
Inspection of the carotid arteries
Pulse characteristics Inspection of the hands and fingers
Color
Shape of fingers
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Figure 17.17 Splinter hemorrhage.
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Specific Areas
Inspection of the chest, abdomen, legs, andskeletal structure
Landmarks Right sternal border, 2ndintercostal space
Left sternal border, 2ndintercostal space Left sternal border, 3rd5thintercostal space
Heaves and lifts
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Palpation
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
Position patient at a 30 degree angle or less
No thrills, heaves or lifts should be palpated inany of the five locations
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Figure 17.19 Landmarks for palpation of the chest.
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Palpation
Carotid pulses (sequentially) Client may be supine or sitting upright
Asses: Presencediminished or absent may indicate carotid disease
or dissecting aortic aneurysm Strengthshould be strong but not bounding
Rhythmregular pattern
Equalityconsistent bilaterally
Palpate each artery separatelymay obstruct
blood flow to the brain, resulting in severebradycardia or asystole
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Figure 17.20 Palpating the carotid artery.
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Percussion
Percussion of the chest for cardiac border 5thintercostal space at the left anterior axillary line
Normal findings would be resonance because you will beover lung tissue
Next, percuss the mid clavicular line and the leftsternal border
Should change to dull as you percuss over the heart
Advance to the 3rdand 2ndintercostal space on the left
side. Should change from resonnance to dullness as youpercuss over the heart
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Figure 17.21 Percussing the chest.
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Figure 17.22 Auscultating the chest over five key landmarks.
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Figure 17.24A Positions for auscultation of the heart. A. Supine.
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Figure 17.24B Positions for auscultation of the heart. B. Lateral
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Figure 17.24C Positions for auscultation of the heart. C. Sitting.
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Auscultation of Apical Pulse
Specific Areas of the CardiovascularAssessmentAuscultation of the carotid arteries using the
diaphragm and bell
Comparison of the apical pulse to a carotid pulse
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Abnormal Findings
Abnormal Findings in the Cardiovascular System Myocardial and pump disorders
Valvular disease
Septal defects
Congenital heart disease
Electrical rhythm disturbances
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Muscular and Pump Disorders
Myocardial and Pump Disorders Myocardial ischemia
Myocardial infarction
Congestive heart disease
Ventricular hypertrophy
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Valvular Disorders
Valvular Diseases Mitral, aortic, tricuspid, and pulmonic stenosis
Mitral and aortic regurgitation
Mitral valve prolapse
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Figure 17.25 Mitral stenosis.
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Figure 17.26 Aortic stenosis.
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Figure 17.27 Mitral regurgitation.
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Figure 17.28 Pulmonic stenosis.
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Figure 17.29 Tricuspid stenosis.
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Figure 17.30 Mitral valve prolapse.
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Figure 17.31 Aortic regurgitation.
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Setal Defects
Septal Defects Openings between the right and left atria or right and left
ventricles
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Figure 17.32 Ventricular septal defect.
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Figure 17.33 Atrial septal defect.
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Congenital Heart Diseases
Congenital Heart Diseases Coarctation of the aorta
Patent ductus arteriosus
Tetralogy of Fallot
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Figure 17.34 Coarctation of the aorta.
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Figure 17.35 Patent ductus arteriosus.
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Figure 17.36 Tetralogy of Fallot.
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Figure 17.36 (continued) Tetralogy of Fallot.
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Rhythm Disturbances
Electrical Rhythm Disturbances Ventricular tachycardia
Ventricular fibrillation
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Fi 17 38 V t i l fib ill ti
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Figure 17.38 Ventricular fibrillation.
Fi 17 39 H t bl k
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Figure 17.39 Heart block.
Figure 17 40 Atrial flutter
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Figure 17.40 Atrial flutter.
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Developmental Considerations
Pediatric Fetus receives oxygen and nutrients from the mother
Changes occur in the newborns cardiovascular system
Infants heart rate
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Developmental Considerations
Pregnant Female Heart is displaced to the left and upward
Blood volume increases 30 to 50 percent
Cardiac output and stroke volume increase
Resting pulse may increase Murmurs may be auscultated
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Developmental Considerations
Geriatric Loss of ventricular compliance and vascular rigidity
Conduction system loses automaticity
Psychosocial Considerations
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Psychosocial Considerations
Stress and workload of the heart
Considerations
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Co s de a o s
Race Ethnicity
Diet
Substance abuse
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Healthy People 2010
Focus Areas Outlined in the Healthy People 2010 Coronary heart disease
High blood cholesterol
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Healthy People 2010
Key Objectives for High Blood Cholesterol Reduce the number of adults with elevated cholesterol
levels
Increase the number of adults who have cholesterol
levels measured