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Lecture 5
Cardiovascular System
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Cardiovascular System
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Chambers in the Heart
• Left and right atria
• Left and right ventricles
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Valves of the heart.
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Figure 17.6 Vessels of the heart. A. Anterior.
A
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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THE HEART AS A PUMP:
THE CARDIAC CYCLE OF SYSTOLE AND DIASTOLE
Systole: the ventricles contract
The phase of ventricular contraction in which the ventricles have been filled, then contract to
expel blood into the aorta and pulmonary arteries.
-The right ventricle pumps blood into the pulmonary arteries (pulmonic valve is open)
-The left ventricle pumps blood into the aorta (aortic valve is open)
Diastole: the ventricles relax
The phase of ventricular relaxation in which the ventricles relax and are filled as the atria
contract
-Blood flows from the right atrium → right ventricle (tricuspid valve is open)
-Blood flows from the left atrium → left ventricle (mitral valve is open)
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Heart Sounds
• S1: (lub) –Heard when the AV valve close
• S2 (dub) – occurs wen the aortic and
pulmonic valves closed
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Table 17.1
Characteris
tics of
Heart
Sounds
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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THIRD & FOURTH HEART SOUNDS
• Description:
• Both sounds are low frequency and thus best heard with the bell of the
stethoscope.
• Location:
• Usually best heard over apex with patient in the left lateral position
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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THIRD HEART SOUND S3
• Results from increased atrial pressure leading to increased
flow rates, as seen in congestive heart failure, which is the
most common cause of a S3.
• May be normal physiological finding in patients less than
age 40.
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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FOURTH HEART SOUND S4
Seen in patients with stiffened left ventricles, resulting from
conditions such as hypertension, aortic stenosis, ischemic or
hypertrophic cardiomyopathy.
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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MURMURS
• Murmurs are extra heart sounds that are produced as a result of
turbulent blood flow that is sufficient to produce audible noise.
• Murmurs may also be the result of various problems, such as
narrowing or leaking of valves.
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Table 17.3
Distinguis
hing Heart
Murmurs
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Cardiac Function
• Stroke volume
– Amount of blood that is ejected with each
heartbeat
• Cardiac output
– Amount of blood ejected from the left ventricle
over 1 minute
– Cardiac output: stroke volume x heart rate
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Landmarks for Cardiac Assessment
•
•
•
•
Sternum
Clavicles
Ribs
Second through fifth intercostal spaces
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Physical Assessment of the
Cardiovascular System
• Techniques
– Inspection
– Palpation
– Percussion
– Auscultation
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Specific Areas of the
Cardiovascular Assessment
•
•
•
•
•
Inspection of the face and lips
Inspection of the jugular veins
Inspection of the carotid arteries
Inspection of the hands and fingers
Inspection of the chest and legs
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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INSPECTION OF THE FACE AND LIPS
Skin color changes may indicate cardiovascular
disease. For example, pallor and cyanosis of
lips or extremities are associated with
decreased perfusion.
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Jugular Venous Pressure (JVP)
and Pulsations
• Recall that jugular veins reflect right atrial pressure
• Steps for examination
–
–
–
–
–
Raise the head of the bed or examining table to 30°
Turn the patient’s head gently to the left
Identify the topmost point of the flickering venous pulsations
Place a centimeter ruler upright on the sternal angle
Place a card or tongue blade horizontally from the top of the JVP
to the ruler, making a right angle
– Measure the distance above the sternal angle in centimeters: a
3- to 4-centimeter elevation is normal
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Assessment of central venous pressure.
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
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• Top line – level of the higest visible point
of distention
• Bottom line – level of the sternal angle
• Measure: the vertical distance between
the sternal angle and the highest level of
jugular distention
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Assessing the Carotid Pulse
• Keep the patient’s head elevated to 30°
• Place your index and middle fingers on the right then the left carotid
arteries, and palpate the carotid upstroke
• Never palpate right and left carotid arteries simultaneously
• Listen with the stethoscope for any bruits
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Palpation of the chest
• Using the ball of the hand, palpate for thrills
• Palpation of the chest, including the following
– Precordium at the right and left second
intercostal spaces
– Left third intercostal space
– Left fourth intercostal space
– Left fifth intercostal space at the midclavicular
line
– (Palpate the chest wall in the aortic, pulmonic, left parasternal, and
apical areas)
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Landmarks in precordial assessments.
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Landmarks for palpation of the chest.
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Percussion of the chest
• Percussion of the chest for cardiac border
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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AUSCULTATION
Blood pressure measurement
o Select the proper size cuff
o Position the patient properly
o Make sure there is a brachial pulse
o Apply the cuff correctly
o Assess blood pressure for hypertension
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Auscultation of the chest
• Auscultation of the chest using the
diaphragm and bell in various positions to
include the following locations
– Aortic area at the right second intercostal
space–S2 is louder than S1
– Pulmonic area at the left second intercostal
space–S2 is louder than S1
– Erb’s point at the left third intercostal space–
S1 and S2 are heard equally
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Auscultation of the chest
– Tricuspid area at the left fourth intercostal
space–S1 is louder than S2
– Apex at the left fifth intercostal space at the
midclavicular line–S1 is louder than S2
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Figure 17.22 Auscultating the chest over five key landmarks.
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Figure 17.24 Positions for auscultation of the heart. A. Supine.
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Figure 17.24 (continued) Positions for auscultation of the heart. B. Lateral.
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Figure 17.24 (continued) Positions for auscultation of the heart. C. Sitting.
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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Auscultation of the carotid arteries
• Auscultation of the carotid arteries (using
the diaphragm and bell) for any bruits
Health & Physical Assessment in Nursing, Second Edition
Donita D’Amico • Colleen Barbarito
Copyright ©2012 by Pearson Education, Inc.
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