HEALTH ASSESSMENT

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  • Heart

    Hollow, muscular, four-chambered organ located in the middle of the thoracic cavity between the lungs in the space called the mediastinum
  • Heart
    • Vertically extends from the left 2nd ICS (base) to the left 5th ICS (apex)
  • Precordium
    Area of the chest wall overlying the heart and adjacent structures
  • Heart chambers

    • Four chambers: Right and left atria, Right and left ventricles
  • Great vessels

    • Superior and inferior vena cava
    • Pulmonary artery
    • Pulmonary veins
    • Aorta
  • Pulmonary Circulation

    Right side of the heart pumps blood to the lungs for gas exchange
  • Systemic circulation

    Left side of the heart pumps blood to all other parts of the body
  • VALVES

    Entrance and exit of each ventricle are protected by one-way valves that direct the flow of blood through the heart
  • Types of valves
    • Atrioventricular (AV) valves
    • Semilunar valves
  • AV valves

    • Tricuspid valve
    • Bicuspid (mitral) valve
  • Semilunar valves

    • Pulmonic valve
    • Aortic valve
  • Neck Vessels
    1. Carotid Arteries supply the neck and head with oxygenated blood
    2. Jugular Veins return blood to the heart from the head and neck
  • Arteries

    Carry oxygenated, nutrient-rich blood from the heart to the capillaries
  • Major Arteries of the Arm
    • Brachial artery
    • Radial artery
    • Ulnar artery
  • Major Arteries of the Leg
    • Femoral artery
    • Popliteal artery
    • Dorsalis pedis artery
    • Posterior tibial artery
  • Veins
    Carry deoxygenated, nutrient-depleted, waste-laden blood from the tissues back to the heart
  • Types of veins

    • Deep veins
    • Superficial veins
    • Perforator (or Communicator) veins
  • Electrical conduction of the heart
    1. Cardiac muscle cells can spontaneously generate an electrical impulse
    2. Impulse starts from the SA node, then to the AV node, down to the bundle of His until it reaches the Purkinje fibers in the myocardium
  • SA node

    • Located on the posterior wall of the right atrium near the junction of the superior and inferior vena cava
    • Generates impulses about 60-100 per minute
  • AV node

    • Located in the lower interatrial septum
    • Generates impulses about 40-60 per minute
  • Bundle of His
    Generates impulses about 40-60 per minute
  • Purkinje fibers
    Generates about 20-40 per minute
  • Cardiac cycle refers to the filling and emptying of the heart’s chambers
  • Areas for listening to the heart
    • A-ortic (right 2nd ICS)
    • P-ulmonic (left 2nd ICS)
    • E-rb’s point (left 3rd ICS)
    • T-ricuspid (lower left sternal border 4th ICS)
    • M-itral (Left 5th ICS, medial to midclavicular line)
  • Heart sounds are produced by valve closure
  • Normal heart sounds are characterized as “lub dub” (S1 and S2)
  • Extra heart sounds include S3 (ventricular gallop) and S4 (atrial gallop)
  • Murmurs result from turbulent blood flow in the heart
  • Cardiac output is the amount of blood pumped by the ventricles during a given period of time
  • Stroke volume is the amount of blood pumped from the heart with each contraction
  • The normal adult cardiac output is 5 to 6 L/min
  • Auscultation involves positioning on the client’s right side, using the diaphragm for high-pitched sounds, and the bell for low-pitched sounds or gallops
  • Collecting subjective data

    1. Ask if the patient experiences symptoms
    2. Use Coldspa to explore the symptoms
    3. Ask for other symptoms
    4. History present illness
    5. Personal Health History
    6. Family History
    7. Lifestyle and Health Practices
  • Collecting objective data: physical examination
    1. Prepare the patient
    2. Inspect the neck vessels
    3. Observe the jugular venous pulse while patient is in supine position with the head of bed elevated to 30 degrees
    4. Palpate the carotid arteries
    5. Palpate each carotid artery alternately by placing the pads of the index and middle fingers medial to the sternocleidomastoid muscle on the neck. Note amplitude and contour of the pulse, elasticity of the artery, and any thrills
    6. Auscultating the carotid pulse
    7. Place the bell of the stethoscope over the carotid artery and ask the client to hold his breath for a moment so that breath sounds do not conceal any vascular sounds
    8. Inspect the heart(precordium)
    9. Inspect pulsations
    10. Place client in supine position with HOB elevated between 30-45 degrees
    11. Stand on the client’s right side and look for apical impulse
    12. Palpate the apical impulse
    13. Use one or two finger pads to palpate the apical impulse (4th to 5th ICS at the midclavicular line)
    14. Auscultate the heart
    15. Auscultate heart rate and rhythm Place the diaphragm of the stethoscope at the apex and listen closely to the rate and rhythm of the apical impulse
    16. Inspect the arms
    17. Observe arm size and venous pattern; also look for edema; discoloration of the hands and arms
    18. Palpate fingers, hands and arms
    19. Palpate to assess temperature and capillary refill time
    20. Palpate the brachial, radial, and ulnar pulse
    21. Inspect legs for edema
    22. Inspect the legs for unilateral or bilateral edema. Note veins, tendons, and bony prominences
    23. Palpate legs for edema
    24. If edema is noted during inspection, palpate the area to determine if it is pitting or nonpitting
    25. Palpate for temperature of the feet and legs
    26. Use the backs of your fingers
    27. Palpate the femoral, popliteal, posterior tibial and dorsalis pedis pulses
    28. Inspect for varicosities and thrombophlebitis
    29. Ask the client to stand because varicose veins may not be visible when the client is supine and not as pronounced when the client is sitting
  • ASSESSMENT OF THE HEART AND PERIPHERAL VASCULATURE
    1. Anatomic Overview of the Heart
    2. Heart chambers
    3. VALVES
    4. Neck Vessels
  • Heart

    Hollow, muscular, four-chambered organ located in the middle of the thoracic cavity between the lungs in the space called the mediastinum
  • Precordium

    Area of the chest wall overlying the heart and adjacent structures
  • Heart chambers

    • Four chambers: Right and left atria, Right and left ventricles
  • Pulmonary Circulation

    Right side of the heart pumps blood to the lungs for gas exchange
  • Systemic circulation

    Left side of the heart pumps blood to all other parts of the body