Cardio

Physical Assessment

The Cardiovascular and Peripheral Vascular Systems

Anatomy of the Heart  Lies at the

mediastinum  Base, upper portion, lies toward the back  Apex, lower portion, points anteriorly  Point of maximal impulse (PMI)

Heart Sounds  S1 – occurs when the

atrioventricular valves close, “lub”  S2 – occurs when the semilunar vlaves close, “dub”  Systole – is the period in which the ventricles contract  Diastole – is the period in which ventricles relax

S1

S2

Anatomy of the Heart  Anatomic sites of • • • • •

precordium Aortic area Pulmonic area Tricuspid area Mitral or apical area Epigastric area

Central Vessels  Carotid arteries • Common carotid artery • External and internal carotid artery  Jugular veins • •

Internal jugular vein External jugular vein

Assessing the Heart and Central Vessels  Inquire if the client has any history of the

following: • • • • • • •

Family history of incidence and age of heart disease High cholesterol levels High blood pressure Stroke Obesity Congenital heart disease Hypertension

Assessing the Heart and Central Vessels  Simultaneously inspect and palpate the

precordium for the presence of abnormal pulsations, lifts or heaves. Locate the valve areas of the heart

Assessing the Heart and Central Vessels  Auscultate the heart in all four

anatomic sites: aortic, pulmonic, tricuspid and apical (mitral) • • • • • •

Eliminate room noise Client in supine position with head elevated 30 to 45 degrees Use both the diaphragm and the bell to listen to all areas Distinguish both s1 and s2 sounds Concentrate on one particular sound at a time in each area Reexamine the heart while in the upright position

Carotid Arteries  Palpate the carotid artery,

using extreme caution  Auscultate the carotid artery •

•

•

Turn the client’s head slightly away from the side being examined Auscultate the carotid artery on one side and then the other Listen for the presence of bruit

Jugular Veins  Inspect the jugular veins for distention, client

is placed in a semi-Fowler’s position with head supported on a small pillow  If jugular distention is present, assess the jugular venous pressure

Lifespan Considerations  Infants: • •

S2 may be heard when the child takes a deep breath Murmurs may be heard in newborns

 Children • • •

Heart sounds may be louder S3 is present in about 1/3 of all children PMI is higher and more medial in children under 8 years old

Lifespan Considerations  Elders • • •

Cardiac output and strength of contraction decrease S4 heart sound is considered normal in older adults Sudden emotional and physical stresses may result in cardiac arrhythmias and heart failure

Assessing the Peripheral Vascular System  Inquire if the client has any history of the

following: • • • • • • • •

Past history of heart disorders Varicosities Arterial disease Hypertension Lifestyle Activity patterns Smoking Use of alcohol

Assessing the Peripheral Vascular System  Palpate the peripheral

pulses on both sides of the client’s body to determine symmetry of pulse volume

Assessing the Peripheral Vascular System  Inspect the peripheral veins in the arms and

legs for the presence and/or appearance of superficial veins  Assess the peripheral leg veins for signs of phlebitis •

Homan’s test

Assessing the Peripheral Vascular System  Inspect the skin of the hands and feet for

color, temperature, edema, and skin changes  Assess adequacy of arterial flow • • •

Buerger’s Test Capillary refill test Allen Test

Lifespan Considerations  Infants: •

Compare strength of the femoral pulses with the radial and apical pulse

 Elders • •

Overall effectiveness of blood vessels decreases Assessment should always include upper and lower extremities’ temperature, color, pulses, edema, skin integrity and sensation

The best and the most beautiful things in the world cannot be seen nor even touched. They must be felt by the heart….. Be a nurse with a pure heart.