The Cardiovascular

The Cardiovascular  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 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 arotid 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  Simultaneously inspect and palpate the precordium for the presence of abnormal pulsations, lifts or heaves. Locate the valve areas of the heart  Auscultate the heart in all four anatomic sites: aortic, pulmonic, tricuspid and apical (mitral) o Eliminate room noise o Client in supine position with head elevated 30 to 45 degrees o Use both the diaphragm and the bell to listen to all areas o Distinguish both s1 and s2 sounds o Concentrate on one particular sound at a time in each area o Reexamine the heart while in the upright position Carotid arteries  Palpate the carotid artery, using extreme caution  Auscultate the carotid artery

o Turn the client’s head slightly away from the side being examined o Auscultate the carotid artery on one side and then the other o 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 Consideration  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 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

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  Palpate the peripheral pulses on both sides of the client’s body to of pulse volume determine symmetry  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  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.