Cardiovascular Assessment *
– Precordium– Mediastinum– Apex & Base of Heart– Great Vessels
spring 2012 1
Physical Examination: Precordium
– Inspect the Anterior Chest Area
– Palpate the Apical Impulse• WHERE?• HOW?• WHEN?• WHY?
– Palpate for Abnormal Pulsations
– Auscultate 5 Anterior Areasspring 2012 2
Abnormal Findings
• Ventricular Impulses: *– Lift / Heaves– Accentuated Apical Impulse– Laterally Displaced Apical Impulse
spring 2012 3
Physical Examination: Auscultation Format *
– 1. Note Rate & Rhythm NUMBER! Regular
Irregular
Regularly Irregular
– 2. Identify S1
– 3. Identify S2
– 4. Auscultate for gallops (S3, S4)
– 5. Auscultate for Murmurs
– 6. Position Changesspring 2012 4
http://www.med.ucla.edu/wilkes/intro.html
• The Cardiac Cycle– Systole– Diastole
• Heart Sounds
• Normal Heart Sounds– First Heart Sound S1– Second Heart Sound S2
spring 2012 5
Physical Examination: Auscultation Format *
– 1. Note Rate & Rhythm NUMBER! Regular
Irregular
Regularly Irregular
– 2. Identify S1
– 3. Identify S2
– 4. Auscultate for gallops (S3, S4)
– 5. Auscultate for Murmurs
– 6. Position Changesspring 2012 6
Abnormal Findings
• Abnormal Heart Rhythms– Sinus Bradycardia– Sinus Tachycardia– Sinus Arrhythmia– Atrial Fibrillation– Atrial Flutter– Ventricular Tachycardia– Venticular Fibrillation– Asystole “Flat Line”
spring 2012 7
Cardiac Cycle
spring 2012 8
Some Extra Heart Sounds *
http://www.med.ucla.edu/wilkes/intro.html
– S3 SLOSH-ing –in S1 S2 S3 – S4 a - STIFF’- wall S4 S1 S2– Murmurs
spring 2012 9
Abnormal Findings *
• Murmurs:– 1. Innocent Murmurs– 2. Physiologic Murmurs– 3. Pathologic Murmurs
• Conditions Producing Murmurs:– 1. Stenosis– 2. Regurgitation– 3. Congenital Heart Disease
spring 2012 10
Describing Heart Murmurs
• Attributes of Murmurs1. Location 5. Pitch2. Timing 6. Quality3. Radiation 7. Configuration 4. Intensity
spring 2012 11
More Extra Heart Sounds
– Pericardial Friction Rubs
– Ejection Clicks
spring 2012 12
NECK VESSELS
• Carotid Artery Pulse
• Jugular Venous Pulsation
• CVP vs JVDspring 2012 13
Physical Examination
• Carotid Arteries1.2.
• Jugular Veins1.2.
spring 2012 14
Health History
• Chest Pain• Dyspnea• Orthopnea• Cough• Fatigue• Cyanosis• Pallor• Palpitations• Dizziness
• Edema• Nocturia• Past Cardiac History• Family Cardiac History• Lifestyle and Health Practices
spring 2012 15
Developmental Considerations: Older Adults
• 1.
• 2.
• 3.
• 4.
spring 2012 16
Abnormal Findings: Diseases
• Ventricular Hypertrophy• Angina Pectoris• MI• CHF• Bacterial Endocarditis• Pericarditis• Valvular Heart Disease
spring 2012 17
Assessing Clients Diagnostic or Supportive Devices
• Artificial Cardiac Pacemakers• Hemodynamic Monitoring• Antiembolic Stockings• Chest Tubes• EKG monitoring• Intravenous Catheters• Pneumonic Compressive Stockings• Pulse Oximetry
spring 2012 18
Risk Factors for Heart Disease
• Non-modifiable • Modifiable
spring 2012 19
Health Promotion Measures1.2.3.4.
Nursing Diagnoses
• Decrease Cardiac Output• Altered Tissue Perfusion• Dysfunctional Grieving
spring 2012 20