1. Chapter 19Heart and Neck Vessels Assessment

2. Structure and Function Overview
Anatomy
Mediastinum
Landmarks on the anterior thoracic wall
Intercostals spaces (ICSs), sternal lines, and midclavicular line (MCL)
Base
Apex

3. Structure and Function Overview (cont.)
Anatomy (cont.)
Point of maximal impulse (PMI)
Precordium
Arterial great vessels
Venous great vessels

4. Structure and Function Overview (cont.)
Neck vessels
Carotid arteries
Internal jugular vein
External jugular vein
Heart chambers
Atria
Ventricles
Septum

5. Structure and Function Overview (con’t)
Valves
Atrioventricular (AV) valves
Tricuspid
Mitral
Semilunar valves
Pulmonic
Aortic

6. Structure and Function Overview (cont.)
Heart Wall
Endocardium
Myocardium
Epicardium
Pericardium
Coronary arteries and veins

7. Conduction System Sinoatrial (SA) node Automaticity
Intra-atrial pathways
AV junction
Bundle of HIS
Perkinge fibers

9. Question
Tell whether the following question is true or false. The pulmonic valve is a semilunar valve.

10. Answer
True Rationale: Semilunar valves include the pulmonic and aortic valves.

11. Physiology Pulmonary and systemic circulation Cardiac cycle Systole
Diastole
First heart sound (S1)
Second heart sound (S2)
Cardiac output
Preload
Contractility
Afterload

12. Physiology (cont.) Cardiac output (cont.)
Cardiac output = heart rate X stroke volume
Ways to increase circulating blood (cardiac output)

13. 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

14. 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

15. 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

16. Lifespan 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 =.

17. Subjective 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

18. 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

19. Objective Data Collection
Diagnostics—labs, x-ray, ultrasound, stress test, cardiac cath
Comprehensive physical examination
Heart sounds
Jugular venous pressure
Hepatojugular reflux
Carotid arteries

20. Objective Data Collection (cont.)
Comprehensive physical examination (cont.)
Inspection
Palpation
Auscultation

21. 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

22. Evidence-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

23. Question
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

24. Answer B. Heart rate x stroke volume
Rationale: Cardiac output = heart rate X stroke volume

25. Auscultating Valve Sites
1=Aortic
2=Pulmonic
3=Erb’s Point
4=Tricuspid
5=Mitral

26. Palpating and Auscultating PMI (Mitral Valve and Apical Pulse)

27. Assessing for Jugular Vein Distention (JVD) and Hepatojugular Reflux (HJR)