Download - Chapter 19 Heart and Neck Vessels Assessment

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Chapter 19Heart and Neck Vessels Assessment

Chapter 19Heart and Neck Vessels Assessment


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


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

• Anatomy (cont.)

– Point of maximal impulse (PMI)

– Precordium

– Arterial great vessels

– Venous great vessels



• Neck vessels

– Carotid arteries

– Internal jugular vein

– External jugular vein

• Heart chambers

– Atria

– Ventricles

– Septum


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

• Valves

– Atrioventricular (AV) valves

• Tricuspid

• Mitral

– Semilunar valves

• Pulmonic

• Aortic



• Heart Wall

– Endocardium

– Myocardium

– Epicardium

– Pericardium

• Coronary arteries and veins


• Sinoatrial (SA) node

– Automaticity

– Intra-atrial pathways

– AV junction

– Bundle of HIS

– Perkinge fibers

Conduction SystemConduction System


QuestionQuestion

Tell whether the following question is true or false.

The pulmonic valve is a semilunar valve.


AnswerAnswer

True

Rationale: Semilunar valves include the pulmonic and aortic valves.


• Pulmonary and systemic circulation

• Cardiac cycle

– Systole

– Diastole

– First heart sound (S1)

– Second heart sound (S2)

• Cardiac output

– Preload

– Contractility

– Afterload

PhysiologyPhysiology


Physiology (cont.)Physiology (cont.)

• Cardiac output (cont.)

– Cardiac output = heart rate X stroke volume

– Ways to increase circulating blood (cardiac output)



• 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


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



• 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


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 =.


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


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


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


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

• Comprehensive physical examination (cont.)

– Inspection

– Palpation

– Auscultation


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


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


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


AnswerAnswer

• B. Heart rate x stroke volume

• Rationale: Cardiac output = heart rate X stroke volume


Auscultating Valve SitesAuscultating Valve Sites

• 1=Aortic

• 2=Pulmonic

• 3=Erb’s Point

• 4=Tricuspid

• 5=Mitral


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


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