Health Assessment Cardiovascular System PDF

Cardiovascular System ===================== Objectives - Obtain an accurate history of the cardiovascular system - Perform an assessment of the cardiovascular system - Identify the landmarks and key auscultation sites of the precordium - Describe the normal heart sounds and their origin...

Cardiovascular System ===================== Objectives - Obtain an accurate history of the cardiovascular system - Perform an assessment of the cardiovascular system - Identify the landmarks and key auscultation sites of the precordium - Describe the normal heart sounds and their origins - Describe extra heart sounds and their origins - Examine the jugular veins and carotid arteries of the neck - Appropriately prepare and position the patient for the cardiovascular assessment - Discuss risk factors for coronary heart disease - Discuss risk reduction and health promotion strategies to reduce coronary heart disease **The Cardiovascular System** - Structures - Heart - Blood vessels - Main functions - Deliver oxygen and nutrients to body cells - Remove waste products - Maintain perfusion to organs and tissues - Location of the Heart and Great Vessel  ***[Anatomy and Physiology]*** **The Heart Wall** - **Pericardium** - Outer protective layer - **Myocardium** - Middle muscular layer - **Endocardium** - Inner smooth layer **Murmurs** - **Regurgitation** → valves not closing like they should → [hearing backflow] - **Stenotic** (**stenosis**) → stiffening of the valves **The Cardiac Cycle** - **Ventricular pressures**  - **Systole**: period of ventricular contraction - **Diastole**: period of ventricular relaxation - How do you view conduction: - ECG/EKG, telemetry - Cardiac circulation **Electrical Components of the Heart** - **Electrical Conduction:** - **SA Node (Sinoatrial)** - Where electrical impulse starts (in R atrium) - "Pacemaker" → sets the HR (how many times does the SA fire) - **AV Node (Atrioventricular)** - Holds conduction to allow ventricles to fill - Bundles of His (AV Bundle) - Getting into ventricles; Big kick - Bunch Branches - Purkinje fibers - ECG (not tested) - P wave - function of atria - T wave - repolarization **Mechanical Function → "Heart is a pump"** - **Cardiac output:** *[volume ejected]* from each ventricle in [one minute] **(Think end outcome)** - **[Preload]**: - load that **[stretches]** cardiac muscle before contraction - **Think volume** - Stretch of muscle prior to contraction; ex. Volume increases stretch (filling pressure) - **[Myocardial contractility]**: - ability of cardiac muscle when given a load, to contract or shorten - **Think contraction** - **[Afterload]**: - degree of vascular [resistance] to ventricular contraction - **think resistance and ventricular workload** **Peripheral Vascular System** - **Vascular network** - Arteries and veins - **Central Vessels** (Patency ⇒ important in brain perfusion!!) - **Neck Vessels** - Present on both sides of neck - Purpose → circulation/ blood flow to and from the brain - **Made up of** - **Carotid arteries** - Palpate one at a time!!! - **Jugular veins** - Made up of: - **External jugular** - *[superficial vein]* - **Internal jugular** - *[deep vein]* - Function: - Return blood to SVC (Superior Vena Cava) - ***[Sitting Upright]* ⇒ veins are [flat]** - ***[Lying Flat]* ⇒ veins are [distended]** - Jugular venous pressure is a good indication of **central venous pressue** - Issue with blood flow or pumping - Pulses can be felt easily over Carotid Arteries - **Peripheral vessels** ***[THE HEALTH HISTORY]*** **[Symptoms]** +-----------------------------------+-----------------------------------+ | **Common or Concerning Sx** | **Assessing Cardiac Sx** | +-----------------------------------+-----------------------------------+ | - Chest pain (Angina) or | - **Chest pain** | | discomfort | | | | - Angina pectoris, coronary | | - Obstruction of oxygen | artery disease, | | (area is not getting | myocardial infarction, | | enough oxygen) | acute coronary syndrome | | | | | - Pain/discomfort radiating to | - **Palpitations** | | neck, L shoulder or arm, and | | | back | - Heart skipping, racing, | | | fluttering, pounding | | - Arrhythmias: skipped beats, | | | palpitations | - **Shortness of Breath** | | | | | - Dyspnea | - Dyspnea, orthopnea, | | | paroxysmal nocturnal | | - Cough | dyspnea | | | | | - Orthopnea | - **Cough** | | | | | - Edema | - Heart failure, fine | | | crackles, and rales | | - Fatigue | | | | - **Edema** | | - Cyanosis | | | | - Dependent edema, | | - Pallor | congestive heart dz, | | | hypoalbuminemia | | | | | | - **Nocturia** | | | | | | - Dependent edema, *[clears | | | at night when pt | | | supine]* | | | | | | - **Fatigue** | | | | | | - Signals heart is not | | | adequately supplying | | | oxygen | | | | | | - **Cyanosis or pallor** | | | | | | - Poor oxygenation of body | +-----------------------------------+-----------------------------------+ **[History]** +-----------------------+-----------------------+-----------------------+ | **PMH - Past Medical | **Family History** | **Social History** | | History** | | | +-----------------------+-----------------------+-----------------------+ | - Heart problems? | - **Coronary artery | - Nutrition | | | disease** | (typical diet) | | - Heart disease? | | | | | - **Hypertension** | - Smoking | | - Murmurs? | | | | | - **Sudden death | - Alcohol | | - Congenital heart | younger \