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Jarvis Chapter 19 ATI Skills Module on Physical Assessment (Adult) - - Cardiac The Circulatory System feature=related.

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Presentation on theme: "Jarvis Chapter 19 ATI Skills Module on Physical Assessment (Adult) - - Cardiac The Circulatory System feature=related."— Presentation transcript:

1 Jarvis Chapter 19 ATI Skills Module on Physical Assessment (Adult) - - Cardiac The Circulatory System feature=related

2 1. 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. 2 Learning Outcomes

3 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. Learning Outcomes (cont’d)

4 Orthostatic hypotension Paroxysmal nocturnal dyspnea (PND) Orthopnea Pulse deficit Pulse pressure Sinus rhythm Sinus arrhythmia Murmur Atrial kick Automaticity Preload Afterload Apical impulse Arrhythmia Bruit Cardiac output Systole Diastole Dyspnea on exertion (DOE) Key Terms

5 Cardiovascular (CV) System

6 Precordium, Apex and Base Slide 19-6 © Pat Thomas, 2006.

7 CV system: heart, blood vessels & blood Heart & great vessels lie between lungs in the thoracic cavity (mediastinum) Apex = bottom of heart; Base = top of heart Great vessels Superior vena cava Inferior vena cava Pulmonary artery  deoxygenated blood from heart to lungs Pulmonary veins  fresh oxygen to heart from lungs Aorta Cardiovascular (CV) System

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11 Valves Atrioventricular (AV) Tricuspid Mitral Semilunar Pulmonic Aortic Heart wall Pericardium  surrounds & protects the heart Myocardium Endocardium Chambers Atria—right and left Ventricles—right and left Structure and Function

12 Chambers and Valves Slide © Pat Thomas, 2006.

13 Cardiac Blood Flow Deoxygenated 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 CO 2 removed & replaced with fresh O 2  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 LUNGS Superior Vena Cava R & L Common Carotid Arteries Left Subclavian Artery Lungs

15 Direction of Blood Flow

16 Composed of 1 heart beat  has 2 phases: 1.Diastole  resting phase of the heart  both ventricles relax & fill with blood  takes up 2/3 of cardiac cycle time (Remember MAP?) 2.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 Cardiac Cycle

17 Automaticity Electrical Conduction Sinoatrial (SA) node  pacemaker Atrioventricular (AV) node Bundle of his Left & right bundle branches Purkinje Fibers Conduction

18 ECG: PQRST P wave: atrial contraction (depolarization) (“atrial kick”) PR interval QRS complex: ventricular contraction (depolarization) T wave: ventricular repolarization Go to: ECG

19 Cardiac Conduction System Right & left bundle branches Purkenjie fibers

20 THE CARDIAC CYCLE

21 1. First heart sound (S1)  closure of atrioventricular (AV) valves (tricuspid & mitral valves); signals beginning of systole 2. Second heart sound (S2)  closure of semilunar valves (pulmonic & aortic valves); signals end of systole 3.Split S2 normal with inspiration 4. Extra heart sounds Third heart sound (S3) Fourth heart sound (S4) 5. Murmurs  sound of blood circulating through heart chambers or valves  usually d/t defects in valves Go to: Heart Sounds

22 Cardiac cycle Diastole Systole Events in the right and left sides

23 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. Cardiac Output (CO)

24 Slide 19-24

25 Neck Vessels Left & right carotid arteries Left & right jugular veins Internal jugular External jugular Increased jugular venous pressure & distention (JVD) signals right-sided heart failure

26 Slide 19-26

27 Incidence of CV disease increases with age. CAD increases sharply with age & accounts for about 50% of deaths in older people Hypertension & heart failure increase with age. Modifiable lifestyle habits: Smoking Diet Alcohol (ETOH) use Exercise patterns Stress Sedentary lifestyle The Aging Adult

28 Non-modifiable hemodynamic changes Systolic BP increases d/t arteriosclerosis (stiffening of arteries)  increased workload on left ventricle leads to thickening of muscle fibers Diastolic 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 rest Decreased ability to increase cardiac output (CO) with exercise The Aging Adult (cont’d)

29 Non-modifiable hemodynamic changes (cont’d) Arrhythmias  may decrease cardiac output and BP  may experience syncope d/t decreased cerebral blood flow Cardiac Arrhythmia: n.php?ani=202&cat=BiologyAutomaticity n.php?ani=202&cat=BiologyAutomaticity ECG changes d/t changes in conduction system: prolonged P-R interval (first-degree heart block) & increased incidence of bundle branch block The Aging Adult (cont’d)

30 Hypertension Smoking High cholesterol levels Obesity Physical inactivity Diabetes Slide Risk Factors for Heart Disease & Stroke

31 Risk 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. Cultural & Genetics

32 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 pallor Subjective Data— Health History Questions

33 Edema  swelling of hands or feet, severity, resolve at night, other s/sx Nocturia  frequency, how long Cardiac history  HTN, high cholesterol, heart disease, rheumatic fever, surgery Family cardiac history  HTN, CAD, sudden death at early age Personal habits (cardiac risk factors) For Aging Adults: Any known heart or lung disease Medications Environment Health History Questions (cont’d)

34 Equipment needed: Stethoscope Carotid arteries Palpate Auscultate for bruits Jugular veins  Inspect for jugular vein distention (JVD)  occurs with right-sided heart failure Precordium Inspect the anterior chest Palpate the apical impulse  4 th or 5 th interspace, midclavicular line Objective Data—The Physical Exam

35 Auscultate the heart sounds First, 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 expiration Listen for extra heart sounds Listen for murmurs n/stethoscope/education/heart-lung-sounds n/stethoscope/education/heart-lung-sounds Palpate radial pulse  calculate pulse deficit if present (difference between apical pulse & radial pulse) Slide Objective Data—The Physical Exam (cont.)

36 Characteristics of normal heart sounds First heart sound (S1) Second heart sound (S2) Split S2  normal splitting is associated with inspiration Extra heart sound Third heart sound (S3) Fourth heart sound (S4) Murmurs The aging adult Slide Objective Data—The Physical Exam (cont.)

37 Auscultatory Areas

38 Slide Clinical Portrait of Heart Failure

39 Slide Sample Charting

40 Slide Sample Charting (cont.)


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