Download GAC Module 7.pptx

9/18/12
A Guide to Geriatric Nursing
Assessment In A Skilled Nursing
Care Center
Instructor: Christine O’Rourke BSN, RN, MSN, FNP-C
This module has been prepared for the ongoing education of
registered nurses. Nursing autonomy of practice and nursing
career development places a priority on a lifelong commitment to
the principles of education and professional development. The
knowledge base of nursing theory and practice is expanding and
while care has been taken to ensure the accuracy and timeliness
of the information presented in this module and series, clinicians
are advised to always verify the most current national guidelines
and recommendations and to practice in accordance with
professional standards of care used with regard to the unique
circumstances that apply in each practice situation.
Therefore, the authors, presenters, producers and consultants of
this educational module cannot accept responsibility for error or
omissions, or for any consequence or liability, injury and/or
damages to persons or property from application of the
information in this module/series and make no warranty,
expressed or implied, with respect to the contents.
MODULE 7
•  Heart
BASE
APEX
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HEART
Purpose & Function
•  A muscle that contracts and relaxes rhythmically
to insure proper circulation of blood to the body
for survival
•  4 chambers
•  RT/LT atria
BASE
•  RT/LT ventricles
APEX
•  2 atrioventricular valves
•  Tricuspid
•  Mitral
•  2 semilunar valves
•  Pulmonic
•  Aortic
HEART
Purpose & Function
•  Autonomous
•  SA node
•  AV node
•  Bundle of His
•  Purkinje fibers
•  Cardiac Cycle
•  Systole
•  Diastole
HEART
Geriatric Changes
• 
• 
• 
• 
• 
Heart size decreases
Left ventricular wall thickens
Valves fibrose and calcify
Heart rate slows
Delayed myocardial contractility
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PHYSICAL ASSESSMENT
Inspection
Heart
•  Apical impulse
•  Midclavicular line
•  5th left intercostal space
•  Skin
•  Cyanosis or venous distention
•  Nail beds
•  Cyanosis and capillary refill time
PHYSICAL ASSESSMENT
Palpation
Heart
•  Apical Impulse - gentle & brief
•  Sequence
•  Apex
•  Left sternal border
•  Base
•  PMI
•  Thrill
•  Carotid pulse
•  Synchronous with S1
PHYSICAL ASSESSMENT
Auscultation
Heart
•  5 cardiac areas
•  Aortic valve – 2nd right intercostal space at right
sternal border
•  Pulmonic valve – 2nd left intercostal space at left
sternal border
•  Second pulmonic – 3rd left intercostal space at left
sternal border
•  Tricuspid – 4th left intercostal space along lower left
sternal border
•  Mitral (apical) – 5th left intercostal space at the
midclavicular line, at the apex
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PHYSICAL ASSESSMENT
Auscultation
Heart
•  Heart Sounds
•  S1 - closure of the AV valves, beginning of systole,
heard best toward apex, lower in pitch and
longer than S2
•  S2 - closure of the semilunar valves, end of systole,
heard best in aortic and pulmonic area, higher
pitch and shorter than S1
The Auscultation Assistant – Heart Sounds
http://www.wilkes.med.ucla.edu/
See post test # 7 document
REFERENCES
•  Seidel, H., Ball, J., Dains, J., & Benedict, W.
(2006). Heart. Mosby’s Guide to Physical
Examination. 414-458.
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