Cardiovascular HA

Base (location) - 2

2nd intercostal

Left and right of sternal border

Apex (location) - 2

5th intercostal

Left midclavicular line

Carotid Arteries (location) - 2

notch medial to sternocleidomastoid

lateral to trachea

Jugular Vein (location)

internal and external

external is visible at midclavicular line

APETM (Location)

Aortic - 2nd ICS at R sternal border

Pulmonic - 2nd ICS at L sternal border

Erbs Point - 3rd ICS at L sternal border

Tricuspid - 4th ICS at L sternal border

Mitral - 5th ICS at midclavicular line

Teaching Opportunities - 7

• low fat and low sodium diet

• stop smoking

• monitor bp

• exercise

• monitor diabetes

• signs and symptoms to report

• management of cardiovascular disorders

Common Complaints - 12

• chest pain

• dyspnea;orthopnea

• cough

• diaphoresis

• pains/cramps

• skin changes

• fatigue

• edema

• nocturia

• palpitations

• numbness

• functional ability

Risk Factors (Family History) - 1

Sudden cardiovascular death

• women - 65

• men - 55

Risk Factors - 11

• age/family history

• males

• black

• hypertension

• diabetes

• smoking

• alcohol

• obesity

• sedentary lifestyle

• hypercholesterolemia

• removal of lymph nodes which can cause lymphedema

Objective Data - 5

• general survey

• neck vessels

• precordial area

• peripheral pulse

• lymphatic vessels

General Survey - 2

Inspect: skin and respiratory effort

Palpate: warmth and dryness

Neck Vessels - (I-2, P-2, A-1)

Inspect - marked pulsation of carotid, distention of jugular

Palpate - check carotid pulse and grade intensity

Auscultate - listen for bruit

Precordial Area (I-2, P-2, A-4)

Inspect: masses, marked movement

Palpate: thrills/heaves, compare apical and radial pulse

Auscultate: heart sounds, apical pulse, murmurs, rate and rhythm

Peripheral Pulse and Lymphatic Vessels - (I-5, P-5, A-1)

Insect: distention, 6 P’s, hair, nails (clubbing), full ROM

Palpate: skin temp and moisture, pulses, cap refill, lymph nodes

Auscultate: BP

Peripheral Pulses - 6

• radial

• brachial

• femoral

• popliteal

• posterior tibial

• dorsalis pedis

Lymph nodes should be…

less than 2cm

Elderly - 4

• rigid structures

• atherosclerosis

• decreased function

• venous stasis

Gender - 4

• Peripheral artery disease (PAD) in females

• Varicose veins in females

• lymphedema in females

Varicose Veins - 2

• those who are obese

• stands a lot

Chest Pain - 1

not seen in children

Race - 1

• African Americans have highest incidence of high bp and heart disease

Immediate Attentions!! - 7

• cyanosis

• chest pain

• dyspnea

• sweat

• dizziness

• LOC

• low BP

Arterial? - 4

• 6 P’s

• Ulcers are deep and necrotic

• Absent/sparse hair

• thin, taut, shiny skin

Venous? - 6

• pain

• erythema

• difficulty palpating pulse

• ulcers are shallow and pale w more drainage

• edema

• Homan’s sign no longer accurate

Lymph Circulation? - 2

• edema

• pulse intact

Altered Tissue Profusion (ID problems) - 2

• assess peripheral pulse q 4 hours

• circulate

Activity Tolerance (ID problems) - 3

• increase activity

• circulate

• resting periods

Risk of Neuromuscular Dysfunction (ID problems) - 4

• monitor 6 P’s

• monitor peripheral pulses

• move!

• circulate

6 P’s

• pain

• pulselessness

• pallor

• paresthesia

• paralysis

• poikilothermia

Heart Tests - 6

• troponin

• BNP

• ECG

• angiogram

• angioplasty

• EKG

Peripheral Tests - 9

• D-dimer

• PT

• PTT

• platelets

• ESR

• CRP

• arteriogram

• US

• MRI

Lymphatic Tests - 3

• CT

• US

• MRI

Diastole - 1

• ventricles relaxed and filled w blood

Systole - 1

• ventricles contract and close AV valves

Electrical Conduction - 5

SA → AV→bundle of His→pirkunje fibers=ventricular contraction

Examination - 15

• Perform hand hygiene

• Inspect anterior chest wall

• palpate apical pulse

• auscultate apical pulse

• auscultate heart sounds

• calc pulse deficit

• interpret EKG

• palpate temporal and carotid pulses

• inspect jugular veins

• measure BP

• insect upper extremities

• palpate upper extremities

• palpate pulses

• inspect lower extremities

• palpate lower extremeties