Assessment of Heart & Neck Vessels

Taylor, ch 25

Jensen, ch 19

History Collection

Ask about: Risk factors Symptom hx PMH Hospitalizations, dx tests Social hx Health maintenance activities Children’s hx

Risk Factors

Non-modifiable: Age Race Gender Fa hx

Modifiable: HTN CAD DM Smoking Obesity Inactivity Stress BCPs

Symptom history

Chest pain Dyspnea,orthopnea,

DOE, PND Dizziness, syncope Activity intolerance,

fatigue Palpitations Cyanosis, pallor

Edema/wt gain Cough—dry or wet,

productive or non Nocturia, oliguria Extremity pain HAs, nosebleeds,

blurred vision Easy bruising

PMH (MD dx of…)

HTN “Heart problems”, i.e.,

murmurs, arrhythmias, MI, congenital, rheumatic fever

Hyperlipidemia Lung disease Tumors Blood disorders Kidney disease

CVA Thyroid disease Surgery Hospitalizations Dx tests Injuries/accidents Communicable

diseases Meds allergies

History cont’d

Social: ETOH, drugs, tobacco, home and work

environment

HMA: sleep, diet, exercise, stress management,

checkups

Children’s history

Feed and play without tiring? Cyanosis, esp with crying or exertion? Growth up to standard? Position changes during activity? Hx strep, unexplained joint pain, fever? Hx lung problems? HA, nosebleeds? Sib with heart defect? Chromosomal abnormalities?

Physical Assessment--General Skin VS Peripheral pulses Heart—4 techniques Inspection of extremities Lungs Abdomen

Physical Assessment—Heart

Inspect for apical impulse (PMI) Palpate for apical impulse and across

precordium—no other impulse should be felt (thrill)

Percuss starting at 5th space and anterior axillary line and move right

Auscultate—APETM, supine, left side, sitting

Auscultation

Note rate and rhythm Identify S1 and S2 and assess them Listen for extra sounds—split S2, S3,

S4 Listen for murmurs and grade acc’d to

loudness only and if heard on S1 or S2

Physical Assessment—Neck Vessels Inspect carotid and jugular pulsations Perform HJR Palpate carotids (not both at once!) Auscultate carotids for bruit using bell