NurseReview.Org - Heart & Neck Vessels


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NurseReview.Org - Heart & Neck Vessels

  1. 1. Heart and Neck Vessels
  2. 2. Cardiovascular System <ul><li>Heart & Blood Vessels </li></ul><ul><li>Pulmonary Circulation </li></ul><ul><li>Systemic Circulation </li></ul>
  3. 3. <ul><li>Precordium – area of chest overlying heart and great vessels. </li></ul><ul><ul><li>Arteries & veins connected to the heart </li></ul></ul><ul><ul><li>Heart & Great vessels are b/t lungs in the middle 1/3 of the thoracic cage = Mediastinum </li></ul></ul>
  4. 4. Heart <ul><li>Location- Heart extends from the 2 nd to 5 th ICS & from the Rt. Sternal border to the Lt. MCL </li></ul><ul><li>Base broader – upside down  </li></ul><ul><li>Apex – points down & to the Lt. </li></ul><ul><li>Rt. Side anterior </li></ul><ul><li>Lt. Side posterior </li></ul><ul><li>4 Chambers </li></ul>
  5. 5. <ul><li>Apical Pulse = during contraction, apex beats against the chest wall. Usually palpable in the Lt., 5 th ICS, MCL </li></ul>
  6. 6. Great Vessels <ul><li>Above Base of the heart </li></ul><ul><li>Superior & Inferior Vena Cava return unoxygenated venous bld. to the Rt atrium </li></ul><ul><li>Pulmonary Artery leaves the Rt. Ventricle, bifurcates & goes to the lungs </li></ul><ul><li>Pulmonary Veins return oxygenated bld. to the Lt. Atrium </li></ul><ul><li>Aorta carries the bld. to the body </li></ul>
  7. 7. <ul><li>The aorta ascends from the Lt. Ventricle arches back @ the sternal angle and descends behind the heart </li></ul><ul><li>Remember arteries always away from the heart; veins always toward the heart </li></ul><ul><ul><li>Pulmonary artery to lungs, pulmonary veins to heart </li></ul></ul>
  8. 8. Heart Wall <ul><li>Pericardium – tough, fibrous, double-walled sac, surrounds & protects the heart </li></ul><ul><ul><li>Has 2 layers containing pericardial fld. </li></ul></ul><ul><ul><li>Adherent to great vessels, esophagus, sternum, & pleurae & is anchored to the diaphragm </li></ul></ul><ul><li>Myocardium- muscular wall of the heart. It doesw the pumping. </li></ul><ul><li>Endocardium – thin layer of endothelial tissue , lines the inner surface of the heart chamber & valves </li></ul>
  9. 9. Chambers of the Heart <ul><li>Right side – pumps blood to the lungs </li></ul><ul><li>Left side – pumps blood to the body </li></ul><ul><li>Septum- impermeable wall </li></ul><ul><li>2 Atria- holding chambers </li></ul><ul><li>2 Ventricles- muscular pumping chambers </li></ul><ul><ul><li>RA; RV; LA; LV </li></ul></ul>
  10. 10. <ul><li>Valves – separate the 4 chambers </li></ul><ul><ul><li>Prevent backflow </li></ul></ul><ul><ul><li>Unidirectional </li></ul></ul><ul><ul><li>Open & close passively in response to pressure gradients in the moving bld. </li></ul></ul>
  11. 11. Heart Valves <ul><li>There are 4 heart valves </li></ul><ul><li>2 Atrioventricular – AV valves- separate the atria & ventricles </li></ul><ul><li>Rt. AV. = tricuspid </li></ul><ul><li>Lt. AV. = mitral (bicuspid) </li></ul><ul><li>Diastole = the heart’s filling phase; AV valves open, ventricles fill with bld. </li></ul><ul><li>Systole = pumping phase, AV valves close to prevent backup </li></ul>
  12. 12. <ul><li>Semilunar valves – b/t ventricles & arteries </li></ul><ul><ul><li>The SL valves are: </li></ul></ul><ul><ul><li>Pulmonic valve- rt. Side of the heart </li></ul></ul><ul><ul><li>Aortic valve – lt. Side of the heart </li></ul></ul><ul><ul><li>These valves open in systole (during pumping) </li></ul></ul>
  13. 13. Cardiac Cycle <ul><li>2 Phases </li></ul><ul><ul><li>Diastole – ventricles relaxed, tricuspid & mitral valves open </li></ul></ul><ul><ul><ul><li>The ventricles fill, the AV valves close= S 1 (lub) or the 1 st heart sound (remember the atria are filled, the ventricles are empty creating the pressure gradient) </li></ul></ul></ul>
  14. 14. Cardiac cycle <ul><ul><li>Systole- ventricles are full, heart contracts, bld is pumped to lungs & body </li></ul></ul>
  15. 15. Heart Sounds <ul><li>S1 – 1 st heart sound </li></ul><ul><li>S2 – 2 nd heart sound </li></ul><ul><li>Extra Sounds </li></ul><ul><ul><li>3 rd heart sound – S3 – Ventricular Gallop </li></ul></ul><ul><ul><li>4 th heart sound – S4 – Atrial Gallop </li></ul></ul>
  16. 16. Heart Murmurs <ul><li>What are they? </li></ul><ul><li>What causes a heart murmur? </li></ul>
  17. 17. Heart Automaticity <ul><li>Conduction </li></ul><ul><li>SA node – pacemaker </li></ul><ul><li>AV node </li></ul><ul><li>ECG </li></ul><ul><li>Electrical impulse slightly precedes mechanical events. </li></ul>
  18. 18. Pumping Ability <ul><li>4-6 liters blood/min. </li></ul><ul><ul><li>Cardiac output </li></ul></ul><ul><ul><li>Stroke volume </li></ul></ul>
  19. 19. Neck Vessels <ul><li>Carotid Artery </li></ul><ul><li>Jugular Veins </li></ul><ul><ul><li>Internal </li></ul></ul><ul><ul><li>External </li></ul></ul><ul><li>Jugular Venous Pressure </li></ul><ul><ul><li>Measurement </li></ul></ul><ul><ul><li>Angle of Louis </li></ul></ul><ul><ul><li>Normal JVP = 2cm or < </li></ul></ul>
  20. 20. Peripheral Vascular System <ul><li>Blood and Lymph Transportation </li></ul><ul><li>Disease of Vascular System causes problems with delivery of nutrients & oxygen to tissues and removal of wastes. </li></ul>
  21. 21. Arteries <ul><li>Oxygenated blood to all body tissues </li></ul><ul><li>Strong & tough </li></ul><ul><li>Elastic fibers </li></ul><ul><li>Muscle fibers </li></ul>
  22. 22. Pulses <ul><li>Temporal </li></ul><ul><li>Carotid </li></ul><ul><li>Brachial </li></ul><ul><li>Radial </li></ul><ul><li>Ulnar </li></ul><ul><li>Femoral </li></ul><ul><li>Popliteal </li></ul>
  23. 23. Pulses <ul><li>Dorsalis pedis </li></ul><ul><li>Posterior tibial </li></ul><ul><li>Veins </li></ul><ul><ul><li>Greater # </li></ul></ul><ul><ul><li>Closer to skin surface </li></ul></ul>
  24. 24. Lymphatics <ul><li>Separate vessel system </li></ul><ul><li>Excess fluid from tissue </li></ul><ul><li>Prevents edema </li></ul>
  25. 25. Worksheet # 6
  26. 26. Subjective Data <ul><li>Chest pain </li></ul><ul><li>Dyspnea, orthopnea, cough, fatigue, cyanosis, pallor, edema, nocturia </li></ul><ul><li>Past Cardiac History </li></ul><ul><li>Last EKG </li></ul><ul><li>Family history </li></ul><ul><li>Personal habits </li></ul>
  27. 27. <ul><li>Leg pain / cramps </li></ul><ul><li>Swelling or skin changes </li></ul><ul><li>Lymph node enlargement </li></ul><ul><li>Medications </li></ul>
  28. 28. Objective Data <ul><li>Measure B/P in both arms – lying, sitting, standing </li></ul><ul><li>Palpate pulses bilaterally </li></ul><ul><ul><li>Temporal </li></ul></ul><ul><ul><li>Carotid * important to only palpate one side at a time * </li></ul></ul><ul><ul><li>Brachial </li></ul></ul><ul><ul><li>Radial </li></ul></ul><ul><ul><li>ulnar </li></ul></ul>
  29. 29. <ul><ul><li>Femoral </li></ul></ul><ul><ul><li>Popliteal </li></ul></ul><ul><ul><li>Dorsalis pedis </li></ul></ul><ul><ul><li>Posterior tibial </li></ul></ul>
  30. 30. Jugular Venous Pressure JVP <ul><li>Supine- HOB 30-45 degrees, remove pillow </li></ul><ul><li>Turn head away from examiner, shine light across neck to highlight pulsation </li></ul><ul><li>Locate Angle of Louis & position a vertical ruler on reference point </li></ul><ul><li>2 nd ruler horizontal to level of pulsation </li></ul>
  31. 31. <ul><li>Read level on vertical ruler </li></ul><ul><li>Normal JVP = 2cm. or < </li></ul><ul><li>Inspect Precordial Area for </li></ul><ul><ul><li>Retraction or Bulging </li></ul></ul><ul><ul><li>pulsation </li></ul></ul>
  32. 32. <ul><li>Palpate – use palmar aspect of fingers or ulnar surface of hands to search for other pulsations </li></ul><ul><ul><li>Sternoclavicular </li></ul></ul><ul><ul><li>Epigastric </li></ul></ul><ul><ul><li>Aortic – right 2 nd interspace </li></ul></ul><ul><ul><li>Pulmonary – lt. 2 nd interspace </li></ul></ul>
  33. 33. <ul><ul><li>Right ventricular – lt. Lower sternal border, 5 th interspace </li></ul></ul><ul><ul><li>Apical – 5 th interspace left MCL </li></ul></ul>
  34. 34. Percussion <ul><li>To outline heart’s borders </li></ul><ul><li>Limited benefit with lg. Breasts, obese, muscular chest wall </li></ul><ul><li>Readily available </li></ul>
  35. 35. Percuss for Cardiac Enlargement <ul><li>Lt. Anterior axillary line 5 th intercostal space & toward the sternal border </li></ul><ul><li>Resonance over lung – dull over heart </li></ul><ul><li>Normal – lt. Border of cardiac dullness 5 th interspace MCL: @ 2 nd interspace dullnes coincides with the lt. Sternal border </li></ul><ul><li>2 nd interspace to 5 th MCL </li></ul>
  36. 36. Auscultate <ul><li>Inch stethoscope in a Z pattern from base of heart, across & down to Apex </li></ul><ul><ul><li>Aortic – 2 nd rt. Interspace </li></ul></ul><ul><ul><li>Pulmonary – 2 nd lt. Interspace </li></ul></ul><ul><ul><li>Erb’s Point – 3 rd lt. Interspace </li></ul></ul><ul><ul><li>Tricuspid – 5 th interspace lt. Lower sternal border </li></ul></ul><ul><ul><li>Apical – 5 th interspace lt. MCL APE To Man </li></ul></ul>
  37. 37. Note during auscultation <ul><li>Rate </li></ul><ul><li>Rhythm </li></ul><ul><li>S1- Apex S2 – Base </li></ul><ul><li>Other sounds? </li></ul><ul><li>Murmurs </li></ul>
  38. 38. <ul><li>Auscultate </li></ul><ul><ul><li>Left side lying </li></ul></ul><ul><ul><li>Sitting leaning forward </li></ul></ul><ul><li>Observe skin, mucus membranes, nails and chest </li></ul>
  39. 39. <ul><li>Carotid Arteries </li></ul><ul><ul><li>Bruits </li></ul></ul><ul><ul><li>Neck in neutral position </li></ul></ul><ul><ul><li>Bell over carotid @ 3levels </li></ul></ul><ul><ul><ul><li>Angle of jaw </li></ul></ul></ul><ul><ul><ul><li>Midcervical area </li></ul></ul></ul><ul><ul><ul><li>Base of neck </li></ul></ul></ul>
  40. 40. Peripheral Vascular System <ul><li>Arms </li></ul><ul><ul><li>Inspect </li></ul></ul><ul><ul><ul><li>Skin color, nail beds </li></ul></ul></ul><ul><ul><ul><li>Temperature </li></ul></ul></ul><ul><ul><ul><li>Texture & turgor </li></ul></ul></ul><ul><ul><ul><li>Lesions, edema, clubbing (160 degree angle base = Normal) </li></ul></ul></ul><ul><ul><ul><li>Capillary refill <2sec. </li></ul></ul></ul><ul><ul><ul><li>symmetry </li></ul></ul></ul>
  41. 41. Palpate <ul><li>Rate, rhythm, elasticity, force </li></ul><ul><li>Grade force as : 1 - 4 </li></ul><ul><ul><li>0 = absent </li></ul></ul><ul><ul><li>4 = bounding </li></ul></ul><ul><li>Brachial, radial, ulnar </li></ul><ul><li>Edema </li></ul>
  42. 42. Allen Test <ul><li>Used to determine the patency of the ulnar & radial artery </li></ul><ul><ul><li>Hands on knees, palms up </li></ul></ul><ul><ul><li>Compress both radial arteries </li></ul></ul><ul><ul><li>Instruct to open & close fists several times </li></ul></ul><ul><ul><li>Open hands. </li></ul></ul><ul><ul><ul><li>Results = pink color – ulnar artery patent </li></ul></ul></ul><ul><ul><ul><li>Repeat occluding ulnar artery </li></ul></ul></ul>
  43. 43. Legs <ul><li>Inspect </li></ul><ul><ul><li>Symmetry </li></ul></ul><ul><ul><li>Color </li></ul></ul><ul><ul><li>Hair distribution </li></ul></ul><ul><ul><li>Venous pattern </li></ul></ul><ul><ul><li>Measure calf circumference </li></ul></ul>
  44. 44. Palpate Legs <ul><li>Femoral </li></ul><ul><li>Popliteal </li></ul><ul><li>Dorsalis pedis </li></ul><ul><li>Posterior tibial </li></ul><ul><li>Inguinal lymph nodes </li></ul>
  45. 45. <ul><li>Edema </li></ul><ul><ul><li>Grade scale 1+ to 4+ </li></ul></ul><ul><ul><ul><li>1+ slight indentation = 1cm. </li></ul></ul></ul><ul><ul><ul><li>2+ moderate = 2cm </li></ul></ul></ul><ul><ul><ul><li>3+ deep = 3cm. </li></ul></ul></ul><ul><ul><ul><li>4+ very deep = 4cm </li></ul></ul></ul><ul><ul><ul><li>( more accurate to classify by depth) </li></ul></ul></ul>