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