Chapter 19 Heart and Neck Vessels Assessment
-
Upload
guinevere-murphy -
Category
Documents
-
view
166 -
download
4
description
Transcript of Chapter 19 Heart and Neck Vessels Assessment
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 19Heart and Neck Vessels Assessment
Chapter 19Heart and Neck Vessels Assessment
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Structure and Function OverviewStructure and Function Overview
• Anatomy
– Mediastinum
– Landmarks on the anterior thoracic wall
– Intercostals spaces (ICSs), sternal lines, and midclavicular line (MCL)
– Base
– Apex
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Structure and Function Overview (cont.)Structure and Function Overview (cont.)
• Anatomy (cont.)
– Point of maximal impulse (PMI)
– Precordium
– Arterial great vessels
– Venous great vessels
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Structure and Function Overview (cont.)Structure and Function Overview (cont.)
• Neck vessels
– Carotid arteries
– Internal jugular vein
– External jugular vein
• Heart chambers
– Atria
– Ventricles
– Septum
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Structure and Function Overview (con’t)Structure and Function Overview (con’t)
• Valves
– Atrioventricular (AV) valves
• Tricuspid
• Mitral
– Semilunar valves
• Pulmonic
• Aortic
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Structure and Function Overview (cont.)Structure and Function Overview (cont.)
• Heart Wall
– Endocardium
– Myocardium
– Epicardium
– Pericardium
• Coronary arteries and veins
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Sinoatrial (SA) node
– Automaticity
– Intra-atrial pathways
– AV junction
– Bundle of HIS
– Perkinge fibers
Conduction SystemConduction System
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
Tell whether the following question is true or false.
The pulmonic valve is a semilunar valve.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
True
Rationale: Semilunar valves include the pulmonic and aortic valves.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Pulmonary and systemic circulation
• Cardiac cycle
– Systole
– Diastole
– First heart sound (S1)
– Second heart sound (S2)
• Cardiac output
– Preload
– Contractility
– Afterload
PhysiologyPhysiology
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physiology (cont.)Physiology (cont.)
• Cardiac output (cont.)
– Cardiac output = heart rate X stroke volume
– Ways to increase circulating blood (cardiac output)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physiology (cont.)Physiology (cont.)
• Control of heart rate:
– “Fight versus flight” reactions—under control of the sympathetic nervous system; triggers epinephrine and norepinephrine to increase heart rate
– Baroreceptors—”pressure sensors” control heart rate by sensing low and high pressures in the aorta and carotid sinus.
– Chemoreceptors—sense O2, CO2 levels, and pH
– “Rest and digest” reaction—parasympathic control; triggers vagus nerve to slow heart rate
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physiology (cont.)Physiology (cont.)• Relation to ECG
– Pacemaker (SA node)
– Records cellular depolarization
• ECG records the electrical changes of contraction (depolarization) and relaxation (repolarization) as specific waves and intervals
– P wave
– PR interval
– QRS complex
– T wave
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physiology (cont.)Physiology (cont.)
• Heart rhythm
– Arrhythmias—a host of different irregularites
– Atrial fibrillation—one common irregularity in the atria in which they quiver rather than effectively beat
• Jugular pulsations
– Jugular pulse—reflects pressure in the right atrium
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Lifespan ConsiderationsLifespan Considerations
• Pregnant women—blood flow and cardiac output
• Newborns and infants—fetal circulation and changes that occur a few hours after birth. Heart rate is higher and cardiac output lower in infants. Sinus arrhythmia common; PMI at 4th space.
• Children and adolescents—sinus arrhythmia continues. PMI at 5th space about 7 yrs old.
• Older adults—thickening and stiffening of left ventricle; fibrosis and fat deposits on SA node cause irregularities
• Cultural considerations—People of darker color have more risk of death and more modifiable risk factors.
• Gender considerations—women have atypical sx of MI; men have higher risk for heart dz until after menopause, then =.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Subjective Data CollectionSubjective Data Collection
• Areas for health promotion: Healthy People 2020 has specific recommendations:
– early dx and intervention
– reducing modifiable risks, esp. smoking and obesity
– keep BP and cholesterol under control
– better monitoring thru regular MD visits
• Assessment of risk factors—especially modifiable ones
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Subjective Data Collection (cont.)Subjective Data Collection (cont.)
• Focused health history that ask about treatments, lifestyle, and common symptoms
• If symptoms exist ask more pointed questions to assess symptoms
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Objective Data CollectionObjective Data Collection
• Diagnostics—labs, x-ray, ultrasound, stress test, cardiac cath
• Comprehensive physical examination
– Heart sounds
– Jugular venous pressure
– Hepatojugular reflux
– Carotid arteries
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Objective Data Collection (cont.)Objective Data Collection (cont.)
• Comprehensive physical examination (cont.)
– Inspection
– Palpation
– Auscultation
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Objective Data Collection (cont.)Objective Data Collection (cont.)• Comprehensive physical examination (cont.)
– Auscultation of the precordium
• Split heart sound
• Identify rate and rhythm
• Identify S1 and S2
• Extra sounds
• Pericardial friction rub
• Murmurs
• Lifespan considerations
• Documenting abnormal findings
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Evidence-Based Critical ThinkingEvidence-Based Critical Thinking
• Common laboratory and diagnostic testing
• Diagnostic reasoning
– Nursing diagnoses, outcomes, and interventions
– Analyze findings
– Collaboration with other health care providers
– Putting it all together: reflection and critical thinking
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
• A student is learning to compute the cardiac output of his or her patients. What is the formula for computing cardiac output?
A. Pulse pressure x stroke volume
B. Heart rate x stroke volume
C. Pulse pressure x heart rate
D. Stroke volume x diastolic BP
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
• B. Heart rate x stroke volume
• Rationale: Cardiac output = heart rate X stroke volume
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Auscultating Valve SitesAuscultating Valve Sites
• 1=Aortic
• 2=Pulmonic
• 3=Erb’s Point
• 4=Tricuspid
• 5=Mitral
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Palpating and Auscultating PMI (Mitral Valve and Apical Pulse)Palpating and Auscultating PMI (Mitral Valve and Apical Pulse)