Heart and Neck Vessels PDF

Heart and Neck Vessels Chapter 20  Structure and Function Subjective Data—Health History Questions Objective Data—The Physical Exam Abnormal Findings Structure and Function Position and surface landmarks Precordium Mediastinum Apex and base of heart Right an...

Heart and Neck Vessels Chapter 20  Structure and Function Subjective Data—Health History Questions Objective Data—The Physical Exam Abnormal Findings Structure and Function Position and surface landmarks Precordium Mediastinum Apex and base of heart Right and left cardiac borders Great vessels Precordium, Apex and Base Mediastinum Cardiovasc ular & Pulmonary System Chambers and Valves Direction of Blood Flow (Cardiac Cycle) Video Link – Blood flow through the heart in 2 minutes https://youtu.be/jBt5jZSWhMI Cardiac Cycle & Heart Sounds Heart Sounds: “lub-dub” S1: “lub” Start of systole, caused by the close of AV valves Louder at apex Use diaphragm Carotid artery pulse Electrical conduction: R- wave S2: “dub” Closure of the semilunar valves Louder at the base Can auscultate with diaphragm Extra Heart Sounds S3 (third heart sound): Listen with the diaphragm, then oDuring diastole the bell oVentricular gallop Cover all auscultatory areas oGenerally silent S4 (fourth heart sound): oMost common extra sound is oDuring diastole a mid-systolic click in systole oAtrial gallop Video Link: Abnormal Heart sounds and Murmurs: Which heart sounds should worry you https://youtu.be/6iG3lqO1gf0 Webpage Link: S3 Heart Sounds Introduction https://www.easyauscultation.com/s3-heart-sounds Heart Murmurs Turbulent blood flow causes a blowing or Document findings swooshing noise in the heart or great by: vessels Timing May be heard on the chest wall Loudness Aside from “innocent” murmurs, murmurs are abnormal Pitch Graded by the intensity of the sound Pattern o grade 1- Faint Quality o grade 2 - Quiet Location o grade 3 - Moderately loud Radiation o grade 4 - Loud o grade 5 - Very loud Posture o grade 6 – Loudest -Heard without stethoscope Webpage Link – Demonstrations: Heart Sounds and Murmurs https://depts.washington.edu/physdx/heart/demo.html It’s Electric! Electrical Activity The heart has a unique ability to generate its own electrical impulses: this is called “automaticity” The electrical activity initiates the sequence of the mechanical action of the cardiac cycle Specialized cells in the SA node serve as the “pacemaker” Pathway of electrical stimulus: SA (sinoatrial) node to internodal pathways to AV( atrioventricular) node (delays the impulse) to Bundle of HIS to the right and left bundle branches to the Purkinje fibers embedded in the ventricles. Video Link – Conducting System of the Heart https://youtu.be/te_SY3MeWys  Heart Cycle and Electrical Activity Cardiac cycle- 2 phases Diastole and Systole o Diastole  Ventricles relax and fill with blood  2/3rd of cardiac cycle o Systole  Hearts contraction. Blood pumped from ventricles and fills pulmonary and systemic arteries  1/3rd of cardiac cycle. Events in the right and left sides Rhythmic flow of blood through heart is cardiac cycle Conduction- Pumping Ability  Structure and Function (cont.) Neck vessels Carotid artery Jugular veins Internal External Venous pulse and pressure Put it all together… Track the blood flow Do at home as through the Cardio- a review for the Pulmonary System, exam name all the vessels, chambers, valves and events in the cycle Subjective Data— Health History Questions Chest pain Nocturia Dyspnea Cardiac History Orthopnea Family Cardiac Cough history Fatigue Modifiable risk Edema factors Cyanosis or pallor Objective Data—The Physical Exam Preparation Position and draping Room preparation Order of examination Equipment needed Marking pen Small centimeter ruler Stethoscope with diaphragm and bell end pieces Alcohol swab Objective Data—The Physical Exam (cont.) Carotid arteries Palpate Auscultate for bruit: - middle-aged, older or demonstrates signs and symptoms of cardiovascular disease - Listen with the bell to each side separately for a bruit (a blowing, swishing sound; abnormal) Auscultation locations: 1. Angle of the jaw 2. Midcervical area 3. Base of neck Objective Data—The Physical Exam (cont.) Precordium Inspect the anterior chest Palpate the apical impulse (5th ICS MCL; use one finger pad) Palpate across the precordium (feel for lifts, heaves, thrills, pulsations) Percuss to outline the cardiac borders* Objective Data—The Physical Exam (cont.) General appraisal of precordium for additional pulsations: Use the carotid artery pulsation as a guide Use palmar aspect of four fingers and palpate: Apex Left sternal border Base Objective Data—The Physical Exam (cont.) Auscultate the heart sounds Identify auscultatory areas o Note the rate and rhythm  Sinus arrhythmia  Pulse deficit o Identify S1 and S2  S1 is louder than S2 at the apex  S1 coincides with carotid artery pulse  S1 coincides with R wave on electrocardiogram o Listen to S1 and S2 separately o Listen for extra heart sounds o Listen for murmurs Auscultatory Areas  Objective Data—The Physical Exam (cont.) Jugular veins oInspect the jugular venous pulse Assess for Jugular Vein Distention (JVD): oA technique used to assess central venous pressure oJudges the heart’s efficiency as a pump oBe careful NOT to mistake JVD with the internal jugular pulsation  Jugular Venous Distention (JVD) Position patient supine at a 30-45’ angle Remove pillow to decrease flexing the neck Turn head slightly from area being assessed Look for pulsating internal jugular veins near the suprasternal notch, or origin of the sternomastoid muscle near the clavicle Be careful not to confuse the carotid pulse with the internal jugular Developmental Variations Infants Fetal shunt closure may take up to 48 Apical pulse palpation changes hours 70-100 bpm Heart more horizontal in infant than Venous hum adult. Apical pulse may be palpable at Innocent murmurs 4th intercostal space, lateral to midclavicular line. HR 100-180 bpm after birth; 120-140 bmp average Sinus arrhythmias with respirations Developmental Variations Pregnant female Aging adult Blood volume increases by 30- Gradual rise in systolic blood 50% = Increased resting heart pressure d/t thickening & rate stiffening of large arteries Mild hyperemia (increased Orthostatic hypotension cutaneous blood flow to eliminate Avoid pressure on carotid artery excess heat) Decreased visibility of JVD Increased volume of S1, Ectopic beats exaggerated S1 split Heart murmurs Sample Charting Sample Charting (cont.) Abnormal Findings Abnormal Pulsations on the Precordium oThrill at the base oLift (heave) at the sternal border oVolume overload at the apex oPressure overload at the apex Video Link - Cardiovascular - Palpation of the precordium and PMI https://youtu.be/I6fyemtqRvs Abnormal Findings Congenital Heart Defects Patent ductus arteriosus Atrial septal defect Ventricular septal defect Tetralogy of Fallot Coarctation of the aorta Congenital Heart Defects (cont.) Patent Ductus Arteriosus Tetralogy of Fallot Coarctation of the Aorta Atrial and Ventricular Septal Defect NANDA Diagnoses r/t the Cardiac Assessment Pain (acute) Risk for unstable blood pressure Decreased Cardiac Output Activity intolerance Risk for Decreased Cardiac Risk for activity intolerance Perfusion Decreased Cardiac Perfusion Obesity Risk for Ineffective Tissue Perfusion Risk for overweight Ineffective Peripheral Tissue Overweight Perfusion Readiness for enhanced Risk for Shock nutrition Anxiety Risk-prone health behavior Ineffective Coping Fatigue