Download - Chapter 19 Heart and Neck Vessels Assessment

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Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 19Heart and Neck Vessels Assessment

Chapter 19Heart and Neck Vessels Assessment

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Structure and Function OverviewStructure and Function Overview

• Anatomy

– Mediastinum

– Landmarks on the anterior thoracic wall

– Intercostals spaces (ICSs), sternal lines, and midclavicular line (MCL)

– Base

– Apex

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Structure and Function Overview (cont.)Structure and Function Overview (cont.)

• Anatomy (cont.)

– Point of maximal impulse (PMI)

– Precordium

– Arterial great vessels

– Venous great vessels

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Structure and Function Overview (cont.)Structure and Function Overview (cont.)

• Neck vessels

– Carotid arteries

– Internal jugular vein

– External jugular vein

• Heart chambers

– Atria

– Ventricles

– Septum

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Structure and Function Overview (con’t)Structure and Function Overview (con’t)

• Valves

– Atrioventricular (AV) valves

• Tricuspid

• Mitral

– Semilunar valves

• Pulmonic

• Aortic

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Structure and Function Overview (cont.)Structure and Function Overview (cont.)

• Heart Wall

– Endocardium

– Myocardium

– Epicardium

– Pericardium

• Coronary arteries and veins

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• Sinoatrial (SA) node

– Automaticity

– Intra-atrial pathways

– AV junction

– Bundle of HIS

– Perkinge fibers

Conduction SystemConduction System

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QuestionQuestion

Tell whether the following question is true or false.

The pulmonic valve is a semilunar valve.

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AnswerAnswer

True

Rationale: Semilunar valves include the pulmonic and aortic valves.

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• Pulmonary and systemic circulation

• Cardiac cycle

– Systole

– Diastole

– First heart sound (S1)

– Second heart sound (S2)

• Cardiac output

– Preload

– Contractility

– Afterload

PhysiologyPhysiology

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Physiology (cont.)Physiology (cont.)

• Cardiac output (cont.)

– Cardiac output = heart rate X stroke volume

– Ways to increase circulating blood (cardiac output)

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Physiology (cont.)Physiology (cont.)

• Control of heart rate:

– “Fight versus flight” reactions—under control of the sympathetic nervous system; triggers epinephrine and norepinephrine to increase heart rate

– Baroreceptors—”pressure sensors” control heart rate by sensing low and high pressures in the aorta and carotid sinus.

– Chemoreceptors—sense O2, CO2 levels, and pH

– “Rest and digest” reaction—parasympathic control; triggers vagus nerve to slow heart rate

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Physiology (cont.)Physiology (cont.)• Relation to ECG

– Pacemaker (SA node)

– Records cellular depolarization

• ECG records the electrical changes of contraction (depolarization) and relaxation (repolarization) as specific waves and intervals

– P wave

– PR interval

– QRS complex

– T wave

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Physiology (cont.)Physiology (cont.)

• Heart rhythm

– Arrhythmias—a host of different irregularites

– Atrial fibrillation—one common irregularity in the atria in which they quiver rather than effectively beat

• Jugular pulsations

– Jugular pulse—reflects pressure in the right atrium

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Lifespan ConsiderationsLifespan Considerations

• Pregnant women—blood flow and cardiac output

• Newborns and infants—fetal circulation and changes that occur a few hours after birth. Heart rate is higher and cardiac output lower in infants. Sinus arrhythmia common; PMI at 4th space.

• Children and adolescents—sinus arrhythmia continues. PMI at 5th space about 7 yrs old.

• Older adults—thickening and stiffening of left ventricle; fibrosis and fat deposits on SA node cause irregularities

• Cultural considerations—People of darker color have more risk of death and more modifiable risk factors.

• Gender considerations—women have atypical sx of MI; men have higher risk for heart dz until after menopause, then =.

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Subjective Data CollectionSubjective Data Collection

• Areas for health promotion: Healthy People 2020 has specific recommendations:

– early dx and intervention

– reducing modifiable risks, esp. smoking and obesity

– keep BP and cholesterol under control

– better monitoring thru regular MD visits

• Assessment of risk factors—especially modifiable ones

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Subjective Data Collection (cont.)Subjective Data Collection (cont.)

• Focused health history that ask about treatments, lifestyle, and common symptoms

• If symptoms exist ask more pointed questions to assess symptoms

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Objective Data CollectionObjective Data Collection

• Diagnostics—labs, x-ray, ultrasound, stress test, cardiac cath

• Comprehensive physical examination

– Heart sounds

– Jugular venous pressure

– Hepatojugular reflux

– Carotid arteries

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Objective Data Collection (cont.)Objective Data Collection (cont.)

• Comprehensive physical examination (cont.)

– Inspection

– Palpation

– Auscultation

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Objective Data Collection (cont.)Objective Data Collection (cont.)• Comprehensive physical examination (cont.)

– Auscultation of the precordium

• Split heart sound

• Identify rate and rhythm

• Identify S1 and S2

• Extra sounds

• Pericardial friction rub

• Murmurs

• Lifespan considerations

• Documenting abnormal findings

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Evidence-Based Critical ThinkingEvidence-Based Critical Thinking

• Common laboratory and diagnostic testing

• Diagnostic reasoning

– Nursing diagnoses, outcomes, and interventions

– Analyze findings

– Collaboration with other health care providers

– Putting it all together: reflection and critical thinking

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QuestionQuestion

• A student is learning to compute the cardiac output of his or her patients. What is the formula for computing cardiac output?

A. Pulse pressure x stroke volume

B. Heart rate x stroke volume

C. Pulse pressure x heart rate

D. Stroke volume x diastolic BP

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AnswerAnswer

• B. Heart rate x stroke volume

• Rationale: Cardiac output = heart rate X stroke volume

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Auscultating Valve SitesAuscultating Valve Sites

• 1=Aortic

• 2=Pulmonic

• 3=Erb’s Point

• 4=Tricuspid

• 5=Mitral

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Palpating and Auscultating PMI (Mitral Valve and Apical Pulse)Palpating and Auscultating PMI (Mitral Valve and Apical Pulse)

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Assessing for Jugular Vein Distention (JVD) and Hepatojugular Reflux (HJR)Assessing for Jugular Vein Distention (JVD) and Hepatojugular Reflux (HJR)