Assessment of the Heart, Great vessels of the neck, and Peripheral Vascular system
Great vessels of the neck
Jugular veins

Carotid arteries
JVD
Anatomy of the Heart
Assessment
Position client supine
Then head elevated at 45 degrees

INSPECTION:
Lifts, heaves
PMI (assess location)
Palpation
Physical Landmarks
Suprasternal notch
Sternum
Manubriosternal angle – Angle of Louis
Intercostal Spaces
Auscultation: Auscultatory Sites
Auscultatory Sites: Cont.
Heart Sounds – S1…(Lub)…
S1: Closure of AV valves (mitral and tricuspid valves: M1 before T1)
Correlates with the carotid pulse
Can be split but not often

Heart Sounds – S2…(Dub)…


S2: Closure of Semilunar valves (aortic & pulmonic)

May have a split sound (A2 before P2)
Heart Sounds – Cont.
Base (R/L 2nd ICS)
S2 louder than S1
Apex
S1 louder than S2

Normal physiologic S2 Split
Best heard at pulmonic area during inspiration

Fixed split (no variation with inspiration)
Extra Heart Sounds
S3…
Due to Rapid ventricular filling: ventricular gallop
S1 -- S2-S3 (Ken--tuc-ky)

S4…
Due to slow ventricular contraction: atrial gallop
S4-S1 — S2 (Ten-nes—see)
Murmurs
Grade I :barely audible
Gr II : audible but quiet and soft
Gr III : moderated loud, without thrust or thrill
Gr IV : loud, with thrill
Gr V : louder with thrill, steth on chest wall
Gr VI : loud enough to be heard before steth on chest

turbulent blood flow within the heart


Listen for murmurs in the same auscultatory sites APETM



Peripheral Vascular Assessment
Skin temp
Color
Pulses
Cap refill
edema
Peripheral Pulses
Documentation of Pulses
Capillary Refill
Edema
Pitting edema
Assessing for Edema
Depress
pretibial area & medial malleolus for 5 seconds
Grade pitting edema
1+ to 4+
Deep Vein Thrombosis (DVT)
Assessment Guide: Gas Transportation


Cap refill
Upper extremities: 2 sec
Lower extremities: 2 sec
Skin/Mucous Membranes: Other (bleeding, infection)
Skin /mucous membranes pink
note vascular lesions (purpura, ecchymoses, petechiae)
redness and inflammation
Interventions in use
Venodyne/leg compression machine; elevated LEs on pillow; thigh high tedhose in use
Med List: Digoxin, Atenolol, Zestril, etc.



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