Cardiac Assessment Notes PDF

Physical Assessment Week #4 notes Cardiovascular & Peripheral Vascular Assessment Brady- : slow Cardi-: heart Hyper-: high, elevated, above normal Myo-: muscle Peri-: surrounding Pulmon-: lung Tachy-: fast Heart: Organ that pumps blood throughout the body via the circulatory system, supplying oxyge...

Physical Assessment Week #4 notes Cardiovascular & Peripheral Vascular Assessment Brady- : slow Cardi-: heart Hyper-: high, elevated, above normal Myo-: muscle Peri-: surrounding Pulmon-: lung Tachy-: fast Heart: Organ that pumps blood throughout the body via the circulatory system, supplying oxygen and nutrients to the tissues and remo ving carbon dioxide and other wastes. Permit the flow of blood between chambers and into blood vessels Atrioventricular valves (AV): Tricuspid, Mitral. Semilunar valves: Pulmonary, Aortic INSPECTION Chest: Abnormalities (Heaves/Lifts). Face, lips, ears, Carotid arteries, Hands and Fingers, Abdomen, Legs, Edema, Cyanosis. JVD: bounding pulse, can be caused due to Fluid volume overload. ASSESSMENT Inspection of the face, lips, ears, and scalp. Inspection of the jugular veins. Inspection of the carotid arteries. Inspection of the hands and fingers. Inspection of the chest, abdomen, legs, and skeletal structure. HEART: Skin tenting, pallor, cyanotic lips and tips of ears, pulses will be weak. AUSCULTATION Auscultation of the chest using the diaphragm and bell in various positions to include the following locations Auscultation of the carotid arteries using the diaphragm and bell Comparison of the apical pulse to a carotid pulse Auscultating on the right side will be aortic. Chest : Aortic, Pulmonic, Erb’s Point, Tricuspid, Mitral, Carotid arteries using the diaphragm and bell, Compare apical pulse to a carotid pulse COMPARISON OF PULSES Auscultate the apical pulse: Simultaneously palpate a carotid pulse. Compare the findings. The two pulses should be synchronous. The carotid artery is used because it is closest to the heart and most accessible DIASTOLE AND SYSTOLE Regurgitation = backflow of the blood in the heart Synopsis =means the opening is smaller than the opening should be. Can be stiff and hardened (usually due to age and not what you eat) Heart sounds S3 may be normal in some patients (children/pregnancy) S4 may be normal in some patients (children/athletes) Best heard at the PMI when patient is laying on their left side. midclavicular Aortic: Second intercostal space to the right of the sternum. Pulmonic: Second intercostal space to the left of the sternum. Tricuspid: Fifth intercostal space to the left of the sternum Apical (mitral): Fifth intercostal space the mid clavicular line PALPATION Chest A/P:Precordium at the right and left second intercostal spaces E: Left third intercostal space T:Left fourth intercostal space M:Left fifth intercostal space at the midclavicular line Carotid pulses (sequentially) Abnormalities Thrills (fingers) - Vibration (Murmurs) Heaves (Palm) - Pressure (RVH) CONDUCTION OF THE HEART PQRT WAVES The atrium is closed in the P! T wave is the re-polirazation! SA NODE is the body’s natural pace maker. CARDIAC ARRHYTHMIAS Normal Sinus Rhythm Originates from SA Node Rate: 60-100 bpm. PR interval & QRS width are with in normal limits (WNL) Normal Sinus Rhythm Sinus Bradycardia Atrial & Ventricular rhythm are regular Rate: Less than 60 bpm PR interval & QRS width are with in normal limits (WNL) Sinus Tachycardia Atrial & Ventricular rhythm are regular Rate: 100 -180 bpm PR interval & QRS width are with in normal limits (WNL) MEASUREMENT OF CARDIAC FUNCTION Stroke Volume (amount of blood ejected with each beat 55-100 mL/beat) = S.V. =Cardiac Output / Heart Rate Cardiac Output (amount of blood ejected from LV in a minute 4-8 L/min) C.O. =Stroke Volume X Heart Rate EJECTION FRACTION: Normal range is 55-60 Anything below 55 the pt is having congestive heart failure or heart issues. Mitral regurgitation, low blood pressure. SIGNS OF HEART FAILURE AND CONGESTIVE HEART FAILURE Weight gain, if the pt is gaining MORE than 2-3 pounds\ per day it is NOT NORMAL!! (especially with elderly pt’s) Daily weights. Same scale, same clothes same time of day (first thing in the morning) GREEN, YELLOW, RED ZONES Chest pain for MORE than 10 min with shortness of breath you call 911 it’s an emergency!!! (passing out) is an emergency! If pt is using and sleeping in an Adjustable bed or using multiple pillows could be indicator of Heart failure!! CARDIAC LIFESPAN CONSIDERATION Infant and Children Fetus receives oxygen and nutrients from the mother through fetal circulation. Changes occur in the newborn's cardiovascular system in the first few days of life (fetal shunts close) Infant's heart rate initially as high as 110–160 bpm (normal FHT) Older Adult Loss of ventricular compliance and vascular rigidity (hardening) Conduction system loses automaticity Pregnant Heart is displaced to the left and upward. Blood volume increases 30% to 50%. Cardiac output and stroke volume increase. Resting pulse may increase. Murmurs (s3) may be auscultated. As you get older you get hypertension due to losing the elasticity of the blood vessels. CONGENITAL ABNORMALITIES Septal Defects: Openings between the right and left atria or right and left ventricles Congenital Heart Disease: Coarctation of the aorta, Patent ductus arteriosus, Tetralogy of Fallot HOLE IN THE HEART INFO! PFO! MEDICAL TERMINOLOGY Echocardiogram – for valve issues Cardiac catheter- to check coronary arteries EKG - …. ABG Hyper-: high, elevated, above normal Hypo- Below or deficient -itis: inflammation Sclerosis: hardening Thrombo- : clot Vaso- : vessel or duct LIFESPAN CONSIDERATIONS Infants and children ▪ Delaying blood pressure measurements until 3 years of age. (Unless special circumstances) Using an appropriately sized cuff, increase with age ▪ Increased pulse rate with fever ▪ Lymphatic system develops rapidly from birth until puberty. Pregnancy Monitoring blood pressure throughout pregnancy for hypertension Observing for hypotension during the third trimester Varicosities in the legs and rectal area Hemorrhoids Older Adult Increase in blood pressure Decrease in pulse with some irregularities Enlarged calf vessels ASEESMENT OF PULSES YOU ARE ASSESSING AN ARTERY!! Know the locations of each of your pulses! ASSESSING PERIPHERAL PULSES Assess Peripheral pulses by palpating with gentle pressure over the artery. Use the pads of your first three fingers. Note the following characteristics: RATE: the number of beats per minute RYTHEM: the regularity of the beats SYMMETRY: pulses on both sides of the body should be similar AMPLITUDE: the strength of the beat, assessed on a scale of 0 to 4 Grading the Force: 4 + = Strong and bounding/throbbing 3 + = Full pulse, increased 2 + = Normal, easily palpable 1 + = Weak, barely palpable 0+ = Absent, not palpable To confirm the pulse on the foot use a DOPLER!!!. Do not press hard because it will obstruct blood flow DICTROTIC NOTCH= closure of the AV valve TESTING ARTERIAL & VENOUS INSUFFICIENCY NO LONGER DO HOMAN’S SIGN ANYMORE!!! Since it would dislodge a clot!! THE DVT CAN GO STRAIGHT TO THE LUNGS! PERIPHERAL VASCULAR DISEASE (PVD) Ruddy color is : brown-reddish color! No hair on the arterial leg. Peripheral arterial.-emergency… Peripheral venous.- VARICOSE VEINS Veins that have become dilated and have a diminished rate of blood flow and increased intravenous pressure RAYNAUD DISEASE Condition in which arterioles in fingers develop spasms, causing intermittent skin pallor or cyanosis then rubor. If there is No good pulse aux reading with the fingers. So take the reading on the earlobe or the bridge of the nose. Symptoms: Skin color changes, cold or numb skin, warm, tingling or throbbing skin, painful sores on your fingers. DEEP VEIN THROMBOSIS (DVT) DVT: DO NOT check for Holman’s sign Use: warfarin or other blood thinning medications / anticoagulants. If it gets into the lungs its called = pulmonary embolism. Also assessment of the lungs! Because if the clot goes up it will be a pulmonary embolism.