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Questions and Answers
What is the primary purpose of face assessment in physical examination?
What is the primary purpose of face assessment in physical examination?
What is the normal position of the trachea during breathing?
What is the normal position of the trachea during breathing?
What is the significance of tracheal deviation?
What is the significance of tracheal deviation?
What is the normal appearance of the internal jugular vein in the supine position?
What is the normal appearance of the internal jugular vein in the supine position?
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What is Kussmaul's Sign?
What is Kussmaul's Sign?
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What happens to the column of blood in the internal jugular vein when the bed is elevated to >45°?
What happens to the column of blood in the internal jugular vein when the bed is elevated to >45°?
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When should the assessment of JVD be made?
When should the assessment of JVD be made?
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What is the normal classification of JVD in the supine position?
What is the normal classification of JVD in the supine position?
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What is the significance of a gross tracheal deviation?
What is the significance of a gross tracheal deviation?
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What is the primary characteristic of apneustic breathing pattern?
What is the primary characteristic of apneustic breathing pattern?
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What does a paradoxical increase in JVP during inspiration indicate?
What does a paradoxical increase in JVP during inspiration indicate?
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What is the primary cause of cor pulmonale?
What is the primary cause of cor pulmonale?
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What is the normal response of JVP during spontaneous inspiration?
What is the normal response of JVP during spontaneous inspiration?
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What is the primary indicator of venous hypertension?
What is the primary indicator of venous hypertension?
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What is the primary cause of a slight tracheal deviation?
What is the primary cause of a slight tracheal deviation?
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What is the primary purpose of assessing JVP?
What is the primary purpose of assessing JVP?
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What is the primary purpose of applying firm hand pressure over the abdomen during the abdominojugular reflux test?
What is the primary purpose of applying firm hand pressure over the abdomen during the abdominojugular reflux test?
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Why is it recommended to position the patient semi-recumbent during the assessment of JVP?
Why is it recommended to position the patient semi-recumbent during the assessment of JVP?
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What is the significance of a positive abdominojugular reflux test?
What is the significance of a positive abdominojugular reflux test?
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What is the recommended duration of pressure application during the abdominojugular reflux test?
What is the recommended duration of pressure application during the abdominojugular reflux test?
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What is the primary effect of applying pressure over the abdomen during the abdominojugular reflux test?
What is the primary effect of applying pressure over the abdomen during the abdominojugular reflux test?
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Why is it necessary to observe the JVP during quiet breathing?
Why is it necessary to observe the JVP during quiet breathing?
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What is the recommended pressure to be applied over the upper middle quadrant of the abdomen during the abdominojugular reflux test?
What is the recommended pressure to be applied over the upper middle quadrant of the abdomen during the abdominojugular reflux test?
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What is the primary reason to avoid directly pressing over the liver during the abdominojugular reflux test?
What is the primary reason to avoid directly pressing over the liver during the abdominojugular reflux test?
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What happens to the JVP in some normal subjects during the HJR maneuver?
What happens to the JVP in some normal subjects during the HJR maneuver?
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What is the significance of a positive HJR test?
What is the significance of a positive HJR test?
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What is the position of the patient during the JVD test?
What is the position of the patient during the JVD test?
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What is the normal response of the JVP in a normal heart?
What is the normal response of the JVP in a normal heart?
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What is the significance of a right ventricle that can't handle increased blood volume?
What is the significance of a right ventricle that can't handle increased blood volume?
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What is the position of the patient during the HJR test?
What is the position of the patient during the HJR test?
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What is a common abnormality that produces a positive HJR test?
What is a common abnormality that produces a positive HJR test?
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What is the significance of an elevated JVP that stays elevated for more than 3 cm?
What is the significance of an elevated JVP that stays elevated for more than 3 cm?
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Study Notes
Heart Failure and Jugular Venous Pressure
- In a normal heart, the JVP rises for several seconds but then returns to normal.
- In some normal subjects, the HJR maneuver may decrease the JVP for several seconds due to reduced venous return.
Abnormal Conditions
- In abnormal conditions, the heart is unable to increase its output, and the JVP rises >3 cm and stays elevated.
- Common abnormalities that produce a positive HJR test include:
- Tricuspid regurgitation
- Heart failure due to other non-valve failure causes
- Constrictive pericarditis
- Right ventricular infarction
- Restrictive cardiomyopathy
- Pulmonary hypertension and right heart failure
HJR Test
- The HJR test is performed with the patient supine but the head elevated to 45 degrees.
- Abdominojugular reflux (or HJR) is an abnormal distension of the neck veins seen when firm hand pressure is applied over the abdomen.
- Pressing directly over the liver may cause discomfort, so instead, the physician may ask the patient to hold their breath or perform a Valsalva maneuver.
Performing the HJR Test
- The patient is positioned supine with the head elevated to 45 degrees (semi-recumbent).
- Observe the height of the blood column and pulsations in the right jugular veins during quiet breathing.
- Press with about 30-40 mmHg on the upper middle quadrant (center of the abdomen) for 10 seconds to 1 minute.
- If the JVP level increases >3 cm above the baseline and remains elevated for >10 seconds, the HJR test is positive (+).
Physiology of the HJR Test
- Pressure on the abdomen increases venous return to the vena cava and the right atrium.
- A normal (competent) heart quickly increases cardiac output to compensate for the increased venous return.
Physical Examination
Face and Neck
- Face assessment helps identify distress, anxiety, LOC, state of mind, and oxygenation.
- Look for nasal flaring, pursed lip breathing, and cyanosis of the lips and tongue.
- Neck assessment to determine trachea position:
- Normally the trachea remains in the midline during breathing.
- Gently palpate the thyroid cartilage to assess tracheal deviation.
Neck Vein Assessment
- Neck vein assessment indicates right atrial pressure:
- In normal subjects, the internal jugular vein is visibly distended with blood (JVD) in the supine position.
- When the bed is elevated to >45°, the column of blood normally falls to about 3-4 cm above the sternum.
- JVD should decrease during spontaneous inspiration.
- A paradoxical increase in JVD during inspiration is called Kussmaul's sign.
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Description
Learn how to assess the face and neck to identify signs of distress, anxiety, and oxygenation. This quiz covers nasal flaring, pursed lip breathing, cyanosis, tracheal deviation, and neck vein assessment.
