Cardiovascular Health Assessment (PDF) - Menoufia University - 2023-2024

Cardiovascular & peripheral vascular systems Prepared by Prof. Wafaa Hassan Abdullah Medical surgical Nursing Faculty of Nursing Menoufia university 2023-2024 11/11/2023 prof. Wafaa Hassan 1  Learning objectives up...

Cardiovascular & peripheral vascular systems Prepared by Prof. Wafaa Hassan Abdullah Medical surgical Nursing Faculty of Nursing Menoufia university 2023-2024 11/11/2023 prof. Wafaa Hassan 1  Learning objectives upon completion of this lecture the student will be able to 1.Verbalize the steps used in performing selected examination procedures in assessing the cardiovascular system. 2. Describe suggested sequencing to conduct a physical health examination in an orderly fashion. 3. Demonstrate appropriate documentation and reporting of health assessment. 11/11/2023 prof. Wafaa Hassan 2 11/11/2023 prof. Wafaa Hassan 3  Overview The cardiovascular system is the lifeline of the body. Its primary function is to act as : transport system, delivering oxygen by way of the red blood cells and delivering nutrients, metabolites, and hormones to every cell in the body. it transports metabolic wastes for detoxification and excretion. The cardiovascular system also contains white blood cells, whose main function is to fight infection. 11/11/2023 prof. Wafaa Hassan 4 Cardiovascular and Peripheral Vascular Systems The cardiovascular system consists of the heart and the central blood vessels (primarily the pulmonary, coronary, and neck arteries and veins). The peripheral vascular system includes those arteries and veins distal to the central vessels, extending all the way to the brain and to the extremities. 11/11/2023 prof. Wafaa Hassan 5  The Heart Heart examinations are usually performed while the client is in a semi reclined position Heart is located behind and left to the sternum The upper part of the heart are called Atria “ right & left atrium”…. Base of the heart The lower part of the heart are called ventricles… Apex of the heart 11/11/2023 prof. Wafaa Hassan 6  Anatomical position of heart. 11/11/2023 prof. Wafaa Hassan 7 11/11/2023 prof. Wafaa Hassan 8  Review of History 1. Personal habits (Smoking, Alcohol intake, Exercise), diet, personal and family history of diabetes, hypertension, hyperlipidemia. 2. Common signs and symptoms of cardiac disease 3. Chest Pain, Fatigue, Fainting; transient loss of consciousness, profuse sweating, palpitations, dyspnea interference with daily living activities , use of pillows, orthopnea, cough, edema, numbness or pain in the extremities. 11/11/2023 prof. Wafaa Hassan 9  Physical examination a.General Assessment: including color, ease of respirations, signs of distress, and both upper extremities in at least two positions a.Inspection of the extremities: including color, hair distribution, capillary refill, skin integrity, venous pattern, and nails. 11/11/2023 prof. Wafaa Hassan 10  Assessment of the lower limb edema (extremities) 11/11/2023 prof. Wafaa Hassan 11  Assessing the heart “Inspection” 1- Inspect and palpate the pericardium for presence of abnormal pulsation as lifts or heaves in case of e.g. valvular regurgitation 2- Inspect and palpate the aortic ,pulmonic , tricuspid , apical area for pulsations or heaves. 11/11/2023 prof. Wafaa Hassan 12  3- Inspect and palpate the epigastric area at base of sternum for abdominal aortic pulsations. 4- Auscultate the heart in 4 anatomic area.( the aortic ,pulmonic , tricuspid , apical area ). 11/11/2023 prof. Wafaa Hassan 13  Landmarks for inspection, palpation, auscultation The apex of the left ventricle usually touches the chest wall near to the fifth left intercostal space ” LICS” which is slightly below left nipple 11/11/2023 prof. Wafaa Hassan 14  Cardiovascular landmarks lines key Lateral thorax Anterior thorax Axillary line (anterior) Axillary line (posterior) Midaxillary line Midclavicular line Midsternal line 11/11/2023 prof. Wafaa Hassan 15  Palpation Palpating the apical pulse Maintain a gentle touch when you palpate To find the apical pulse, use the ball of your hand, then your fingertips, to palpate over the precordium. Note heaves or thrills, fine vibrations that feel like the purring of a cat. 11/11/2023 prof. Wafaa Hassan 16  Percussion Percuss at the anterior axillary line and continue toward the sternum along the fifth intercostal space. The sound changes from resonance to dullness over the left border of the heart, normally at the midclavicular line. The right border of the heart is usually aligned with the sternum and can’t be percussed. 11/11/2023 prof. Wafaa Hassan 17 Technique of percussion 11/11/2023 prof. Wafaa Hassan 18  The precordium It is the chest area overlying the heart is inspected and palpated for the presence of abnormal pulsations lift / heaves Rising of sternal border with each heartbeat ▪ Lift/ heaves can occur with forceful cardiac action ▪ It can be confirmed by palpation with palm Abnormalities: Over activity of left ventricle produces heave lateral to the apex Enlargement of right ventricle produces heave near to the sternum 11/11/2023 prof. Wafaa Hassan 19  lift / heaves 11/11/2023 prof. Wafaa Hassan 20  Auscultating Heart sounds Heart sounds can be heard by Auscultations The first heart sound S1 occurs with atrio-ventricular valves closed when ventricles sufficiently filled Characteristics: dull, low pitched sound described as lub in one second or less depending on heart rate 11/11/2023 prof. Wafaa Hassan 21  The second heart sound S2 occurs after the ventricles empty and semi lunar valves close Characteristics: short in duration , high pitched sound described as dub S1 & S2 “ lub dub “ occurs 11/11/2023 prof. Wafaa Hassan 22  The two heart sounds are audible in the peri-cordial area, but they are best heard over the: ▪ aortic * pulmonic ▪ tricuspid * apical areas Each area is associated with the closure of heart valve A = aortic listening post P = pulmonic listening post T = tricuspid listening post M = mitral listening post E = “Erb’s point” 11/11/2023 prof. Wafaa Hassan 23 11/11/2023 prof. Wafaa Hassan 24  Normally: S3 is best heard S1 usually heard in all sites at the apex when the usually louder at apical area patient is lying on his left side S2 usually heard in all sites usually louder at base of heart. S3 in children and young adults S4 in many older adults. 11/11/2023 prof. Wafaa Hassan 25  Difference between Systole and Diastole Systole Diastole Systole is the period in Diastole is the period in which the ventricles which the ventricles contract. relax. It begins with S1 and It starts with S2 and ends at S2 ends at the subsequent It is normally shorter S1 than diastole 11/11/2023 prof. Wafaa Hassan 26 Relationship of heart sounds to systole and diastole Systole S1 S2 Mitral , tricuspid Aortic , pulmonic valve close valves close Diastole 11/11/2023 prof. Wafaa Hassan 27  Vascular system Assessing general appearance First, take a moment to assess the patient’s general appearance. Is he overly thin? Obese? Alert? Anxious? Note skin color, temperature, turgor, and texture. Are his fingers clubbed? (Clubbing is a sign of chronic hypoxia caused by a lengthy cardiovascular or respiratory disorder.) If the patient is dark-skinned, inspect his mucous membranes for pallor 11/11/2023 prof. Wafaa Hassan 28  Assessing the neck vessels Inspection Inspecting the neck vessels can provide information about blood volume and pressure in the right side of the heart. 11/11/2023 prof. Wafaa Hassan 29  CAROTID ARTERIES: Palpate the carotid artery cautiously Palpate only one carotid artery and avoid exerting too much pressure and massaging area? Why ? It may cause fainting or dizziness to the client Ask the client to turn the head slightly toward the side being examined. 11/11/2023 prof. Wafaa Hassan 30  Auscultation Auscultate the carotid artery for presence of bruit. Ask the client to turn the head slightly away from the side being examined listen to presence of bruit if present gently palpate the artery to determine the presence of thrill. 11/11/2023 prof. Wafaa Hassan 31  Bruit is blowing or swishing sound Bruit “‫“ لغط‬ It is commonly developed with older adults It is due to: narrowing of the arterial lumen Condition of anemia Hyperthyroidism which elevates cardiac output.  Thrill It is a vibrating sensation like the water running from the hose It is frequently accompanies by bruit It indicates turbulence in blood flow due to a valvular dysfunction. JUGULAR VEINS: 3- Inspect the jugular veins for distention while the client is placed in semi-fowler's position with head support on small pillow. Normally , veins not visible ( right side of heart is functioning normally ). 11/11/2023 prof. Wafaa Hassan 34 4- If jugular distention is present , assess the jugular venous pressure. - Bilateral measurements above 3 to 4 cm are considered elevated indicated right side heart failure. 5- Documentation. 11/11/2023 prof. Wafaa Hassan 35  How the nurse can assess adequacy of Right side heart & venous pressure? Normally external neck veins are distended and visible when a person lying down vice versa Why?..... Because of gravity encourages venous drainage By inspection the jugular veins for pulsations and distention Bilateral jugular vein distention (JVD) may indicate right sided heart failure 11/11/2023 prof. Wafaa Hassan 37