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NurseReview.Org - Heart & Neck Vessels NurseReview.Org - Heart & Neck Vessels Presentation Transcript

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