Cardiovascular System: Anatomy and Assessment

• The study notes cover cardiovascular, respiratory, peripheral vascular, lymphatic, and integumentary systems, including assessment techniques, normal and abnormal findings, and developmental considerations

Blood Flow Through The Heart

• Blood flows in a specific route, entering the right atrium, then flowing to the right ventricle, pulmonary artery, lungs, pulmonary vein, left atrium, left ventricle, and finally the aorta

Chambers of The Heart

• The heart consists of four chambers: the right atrium, right ventricle, left atrium, and left ventricle

Heart Sounds

• S1 represents the closure of the atrioventricular (AV) valves (mitral and tricuspid) and signals the beginning of systole
• S2 signifies the closure of the semilunar (SL) valves (aortic and pulmonic) and marks the end of systole and beginning of diastole

Abnormal Heart Sounds

• S3 is a diastolic sound that occurs after S2, often indicating increased fluid volume or heart failure
• S4 is another diastolic sound that occurs before S1, often indicating a stiff or noncompliant ventricle

Systole and Diastole

• Systole is the phase of ventricular contraction, while diastole is the phase of ventricular relaxation and filling

Heart Valves: Atrioventricular (AV) Valves

• The AV valves, mitral and tricuspid, are located between the atria and ventricles
• They open during diastole to allow ventricular filling and close during systole to prevent backflow into the atria

Heart Valves: Semilunar (SL) Valves

• The SL valves, aortic and pulmonic, are located between the ventricles and the great arteries
• They open during systole to allow blood ejection into the aorta and pulmonary artery and close during diastole to prevent backflow into the ventricles

Heart Murmurs

• Heart murmurs are abnormal heart sounds caused by turbulent blood flow
• They are described by their location, timing (systolic or diastolic), and characteristics which include: pitch, quality, and intensity
• They can be caused by valve stenosis (narrowing) or regurgitation (leaking)

Preload and Afterload

• Preload is the volume of blood in the ventricles at the end of diastole (end diastolic pressure)
• Afterload is the resistance against which the heart must pump to eject blood

Cardiovascular Assessment: Inspection

• Includes general appearance, skin color, and presence of edema or distended neck veins

Cardiovascular Assessment: Palpation

• Involves assessing pulses (rate, rhythm, amplitude), capillary refill, and presence of thrills or heaves

Cardiovascular Assessment: Percussion

• Can help determine the size and borders of the heart

Cardiovascular Assessment: Auscultation

• Identifies normal heart sounds (S1 and S2) and any abnormal sounds (murmurs, S3, S4)

Arteries of The Arms and Legs: Pulse Descriptions

• Pulses are graded on a scale, typically from 0 (absent) to 3+ or 4+ (bounding), to indicate their amplitude or strength

Cardiovascular Assessment: Developmental Considerations

• Considers age-related changes in heart function in infants, children, and older adults

Respiratory Assessment: Developmental Considerations

• Considers age-related changes in respiratory function in infants, children, and older adults

Function of The Respiratory System

• The primary function is gas exchange, taking in oxygen and eliminating carbon dioxide

Breath Sounds: Normal

• Vesicular sounds are soft, breezy sounds heard over most of the lung fields
• Bronchovesicular sounds are moderate sounds heard over the main bronchi
• Bronchial sounds are louder, harsher sounds heard over the trachea

Breath Sounds: Adventitious

• Crackles (rales) are discontinuous, popping sounds heard during inspiration, often indicating fluid in the lungs
• Wheezes are continuous, musical sounds heard during expiration, often indicating airway obstruction
• Rhonchi are coarse, rattling sounds heard during inspiration or expiration, often indicating secretions in the large airways
• Stridor is a high-pitched, crowing sound heard during inspiration, indicating upper airway obstruction
• Pleural friction rub is a grating sound heard during inspiration and expiration, indicating inflammation of the pleural surfaces

Respiratory Assessment: Inspection

• Includes assessment of respiratory rate, rhythm, depth, and effort, as well as chest shape and symmetry

Respiratory Assessment: Palpation

• Involves assessing chest expansion, tactile fremitus (vibration felt on the chest wall), and any tenderness or masses

Respiratory Assessment: Percussion

• Helps determine lung density and identify areas of consolidation or effusion

Respiratory Assessment: Auscultation

• Involves listening to breath sounds to identify normal and abnormal sounds

Rate and Rhythm of Breathing

• Assessed for abnormalities such as tachypnea (rapid breathing), bradypnea (slow breathing), and apnea (cessation of breathing)

Respiratory: Abnormal Assessment Findings

• Include dyspnea (shortness of breath), cyanosis (bluish discoloration), and use of accessory muscles

Thoracic Landmarks

• Used to locate anatomical structures during assessment, including ribs, intercostal spaces, and lung lobes

Peripheral Vascular Assessment: Pulses and Arteries

• Includes assessment of pulses in the extremities (e.g., dorsalis pedis, posterior tibial) and palpation of arteries

Peripheral Vascular Disease (PVD): Abnormal Findings

• Include diminished or absent pulses, skin changes (e.g., pallor, cyanosis, ulcers), and edema

Peripheral Arterial Disease (PAD): Clinical Manifestations

• Include intermittent claudication (leg pain with exercise), rest pain, and non-healing ulcers

Edema: Stages

• Graded on a scale from 1+ to 4+ based on the depth of pitting and how long it takes to resolve

Pressure Ulcers: Stages

• Pressure ulcers are staged from I to IV based on the depth of tissue damage
  • Stage I: Non-blanchable redness
  • Stage II: Partial-thickness skin loss
  • Stage III: Full-thickness skin loss with damage to subcutaneous tissue
  • Stage IV: Full-thickness skin loss with damage to muscle, bone, or supporting structures
• Unstageable: Full-thickness skin loss, base of ulcer is covered by slough and/or eschar so depth cannot be determined

Pressure Ulcers: Risk Factors

• Immobility, incontinence, malnutrition, and impaired sensation

Ankle-Brachial Index (ABI)

• Calculated by dividing the ankle systolic blood pressure by the brachial systolic blood pressure
• Used to assess the presence and severity of peripheral arterial disease

Lymphatic System: Function

• The lymphatic system plays a role in fluid balance, immune function, and absorption of fats

Lymphatic System: Node Location

• Lymph nodes are located throughout the body, including the upper and lower extremities, groin, and axillae

Lymphatic System: Abnormal Findings

• Include enlarged, tender, or fixed lymph nodes

Integumentary System: Developmental Stages

• Considers age-related changes in skin, hair, and nails

Integumentary System: Inspection

• Involves assessing skin color, temperature, moisture, and lesions

Integumentary System: Palpation

• Involves assessing skin texture, turgor, and presence of edema or masses

Wounds: Classification

• Can be classified as acute or chronic, and by their cause (e.g., surgical, traumatic, pressure)

Wounds: Complications

• Include infection, dehiscence (wound opening), and evisceration (protrusion of organs)

Wounds: Signs of Infections

• Include redness, warmth, swelling, pain, and purulent drainage

Skin, Hair and Nail Assessment, Function and Structure

• Assessment includes inspection and palpation of the skin, hair, and nails to identify abnormalities

Primary and Secondary Skin Lesions

• Primary lesions are the initial lesions that appear on the skin
• Secondary lesions result from changes or trauma to primary lesions

Skin Assessment: ABCDE-EFG

• ABCDE: Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolving
• EFG: Elevated, Firm, Growing
• Used to assess moles for signs of melanoma
• Shapes and configurations of skin lesions are also noted during assessment