Presentation on theme: "Heart and Neck Vessels Jarvis Chapter 19"— Presentation transcript:
1 Heart and Neck Vessels Jarvis Chapter 19 ATI Skills Module on Physical Assessment (Adult) - - CardiacThe Circulatory Systemfeature=related
2 Learning Outcomes1. List the significant anatomic features of the heart and their location. 2. Describe the heart sounds & relate the name of the heart sound to the physiologic cause. 3. Describe the structures of conduction and the spread of the cardiac impulse through the heart. 4. Relate the circulation of blood through the heart and great vessels. 5. Discuss the significance of jugular vein assessment.
3 Learning Outcomes (cont’d) 6. Cite the risk factors associated with heart disease and stroke.7. List the hemodynamic changes that occur with aging.8. Perform an accurate objective heart and neck vessels assessment on a client and document findings.9. Discuss cultural/ethnic differences related to heart disease.
4 Key TermsAutomaticity Preload Afterload Apical impulse Arrhythmia Bruit Cardiac output Systole Diastole Dyspnea on exertion (DOE)Orthostatic hypotension Paroxysmal nocturnal dyspnea (PND) Orthopnea Pulse deficit Pulse pressure Sinus rhythm Sinus arrhythmia Murmur Atrial kickCardiac arrhythmia is any of a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. In adults the normal resting heart rate ranges from 60 beats per minute to 100 beats per minute. The normal heart beat is controlled by a small area in the upper chamber of the heart called the sinoatrial node or sinus node. The sinus node contains specialized cells that have spontaneous electrical activity that starts each normal heart beat. In an adult, a heart rate faster than 100 beats/minute is considered tachycardia. A slow rhythm, known as bradycardia (less than 60 beats/min), is usually not life threatening, but may cause symptoms.
7 Cardiovascular (CV) System CV system: heart, blood vessels & bloodHeart & great vessels lie between lungs in the thoracic cavity (mediastinum)Apex = bottom of heart; Base = top of heartGreat vesselsSuperior vena cavaInferior vena cavaPulmonary artery deoxygenated blood from heart to lungsPulmonary veins fresh oxygen to heart from lungsAorta
11 Structure and Function Heart wallPericardium surrounds & protects the heartMyocardiumEndocardiumChambersAtria—right and leftVentricles—right and leftValvesAtrioventricular (AV)TricuspidMitralSemilunarPulmonicAortic
13 Cardiac Blood FlowDeoxygenated blood from body enters superior & inferior vena cava (1) enters right atrium (2) enters right ventricle (3) through tricuspid valve pumped into pulmonary arteries (4) through pulmonic valve goes to lungs where CO2 removed & replaced with fresh O2 re-oxygenated blood returns through pulmonary veins (5) to the left atria (6) enters left ventricle (7) through mitral valve pumped through aortic valve to the aorta (8) fresh oxygenated blood to entire body
14 Superior Vena Cava R & L Common Carotid Arteries Left Subclavian ArterySuperiorVenaCavaLungsLungsLUNGS
16 Cardiac CycleComposed of 1 heart beat has 2 phases:Diastole resting phase of the heart both ventricles relax & fill with blood takes up 2/3 of cardiac cycle time (Remember MAP?)Systole contraction of both ventricles right ventricle pumps blood into the pulmonary arteries to take to the lungs for re-oxygenation and left ventricle pumps re- oxygenated blood into aorta for delivery to the body tissues takes up 1/3 of cardiac cycle time
21 Heart Sounds Third heart sound (S3) Fourth heart sound (S4) 1. First heart sound (S1) closure of atrioventricular (AV) valves (tricuspid & mitral valves); signals beginning of systole2. Second heart sound (S2) closure of semilunar valves (pulmonic & aortic valves); signals end of systoleSplit S2 normal with inspiration4. Extra heart soundsThird heart sound (S3)Fourth heart sound (S4)5. Murmurs sound of blood circulating through heart chambers or valves usually d/t defects in valvesGo to:
22 Cardiac cycleDiastoleSystoleEvents in the right and left sides
23 Cardiac Output (CO)SV (stroke volume) X R (rate) = CO Example: 100ml X 60 HR = 6L/min CO Preload = amount of blood in ventricles before systole (contraction of ventricles) Afterload = resistance of filled aortic artery pressure against which the left ventricle must pump its blood.
27 The Aging Adult Smoking Diet Alcohol (ETOH) use Exercise patterns Incidence of CV disease increases with age.CAD increases sharply with age & accounts for about 50% of deaths in older peopleHypertension & heart failure increase with age.Modifiable lifestyle habits:SmokingDietAlcohol (ETOH) useExercise patternsStressSedentary lifestyle
28 The Aging Adult (cont’d) Non-modifiable hemodynamic changesSystolic BP increases d/t arteriosclerosis (stiffening of arteries) increased workload on left ventricle leads to thickening of muscle fibersDiastolic pressure does not increase but increased systolic pressure leads to increased pulse pressure (difference between diastolic & systolic BP)No change in resting heart rate or cardiac output at restDecreased ability to increase cardiac output (CO) with exercise
29 The Aging Adult (cont’d) Non-modifiable hemodynamic changes (cont’d)Arrhythmias may decrease cardiac output and BP may experience syncope d/t decreased cerebral blood flowCardiac Arrhythmia:n.php?ani=202&cat=BiologyAutomaticityECG changes d/t changes in conduction system: prolonged P-R interval (first-degree heart block) & increased incidence of bundle branch block
30 Risk Factors for Heart Disease & Stroke Hypertension Smoking High cholesterol levels Obesity Physical inactivity Diabetes
31 Cultural & GeneticsRisk factors for stroke and heart disease High blood pressure (HTN) -- black adults #1 Smoking Cholesterol – black adults lower than white & Mexican-Americans Obesity (BMI >30) or overweight (BMI >25) – All in 70%: blacks; Mexican-Americans; whites. Asians 25% Physical inactivity Diabetes Type 2 – increasing across all age & ethnic groups; American Indians >2x the rate of U.S. adults overall.
32 Subjective Data— Health History Questions Chest pain onset, location, radiation, character, exertional or at rest, other s/sx, NTG Dyspnea exertional or at rest, positional, constant or intermittent, awakens at night (paroxysmal nocturnal dyspnea occurs with heart failure) Orthopnea # of pillows used when supine Cough duration, frequency, productive Fatigue onset, related to time of day Cyanosis or pallorChest pain: Any chest pain or tightness? Edition Change: diaphoresis, pallor, palpitations, dyspnea, nausea, tachycardia, or fatigue should be considered to be equivalent to angina.Dyspnea: Any shortness of breath?Orthopnea: How many pillows do you use when sleeping or lying down?Cough: Do you have a cough?Fatigue: Do you seem to tire easily? Able to keep up with your family and co-workers?Cyanosis or pallor: Ever noted your facial skin to turn blue or ashen?
33 Health History Questions (cont’d) Edema swelling of hands or feet, severity, resolve at night, other s/sxNocturia frequency, how longCardiac history HTN, high cholesterol, heart disease, rheumatic fever, surgeryFamily cardiac history HTN, CAD, sudden death at early agePersonal habits (cardiac risk factors)For Aging Adults:Any known heart or lung diseaseMedicationsEnvironmentEdema: Any swelling of your feet and legs?Nocturia: Do you awaken at night with an urgent need to urinate? How long has this been occurring? Any recent change?Cardiac history: Any history of hypertension, elevated blood cholesterol or triglycerides, heart murmur, congenital heart disease, rheumatic fever or unexplained joint pains as child or youth, recurrent tonsillitis, anemia?Family cardiac history: Any family history of hypertension, obesity, diabetes, coronary artery disease (CAD), sudden death at younger age?
34 Objective Data—The Physical Exam Equipment needed: StethoscopeCarotid arteriesPalpateAuscultate for bruitsJugular veins Inspect for jugular vein distention (JVD) occurs with right-sided heart failurePrecordiumInspect the anterior chestPalpate the apical impulse 4th or 5th interspace, midclavicular line
35 Objective Data—The Physical Exam (cont.) Auscultate the heart soundsFirst, identify S1 and S2 (S1 is louder than S2 at the apex & coincides with carotid artery pulse; S2 is louder at the base)Note the rate and rhythm rhythm should be regular but sinus arrhythmia occurs normally in young adults & children increases with inspiration, slows with expirationListen for extra heart soundsListen for murmursPalpate radial pulse calculate pulse deficit if present (difference between apical pulse & radial pulse)
36 Objective Data—The Physical Exam (cont.) Characteristics of normal heart soundsFirst heart sound (S1)Second heart sound (S2)Split S2 normal splitting is associated with inspirationExtra heart soundThird heart sound (S3)Fourth heart sound (S4)MurmursThe aging adult