Cardiovascular Part 2

Palpate Carotid Artery:

Gently, one at a time. Note pulse strength (2+ normal).

Abnormal: Diminished/absent pulse, thrills (vibrations).

Auscultate Carotid Artery

Use bell at angle of jaw, mid-cervical area, base of neck. Ask patient to hold breath.

Abnormal: Bruits (blowing, swooshing sound indicating turbulent blood flow).

Inspect Jugular Venous Pulse (JVP)

Position supine 30-45 degrees. Observe pulsations of internal jugular veins.

Abnormal: Elevated JVP (>2cm above sternal angle) indicates increased right-sided heart pressure (e.g., heart failure).

Hepatojugular Reflux:

Apply pressure to RUQ. Normal: JVP rises briefly then recedes.

Abnormal: Sustained JVP elevation indicates heart failure

Inspect Anterior Chest (Precordium):

Observe for apical impulse (PMI - Point of Maximal Impulse). Usually 4th-5th ICS, MCL.

Abnormal: Visible heave/lift (ventricular hypertrophy), displaced PMI.

Palpate Apical Impulse

Use one finger pad. Note location, size (1-2 cm), amplitude, duration.

Abnormal: Displaced, enlarged (>1 ICS), sustained impulse (volume overload, hypertrophy).

Palpate Across Precordium

Use palmar aspects of fingers. Abnormal: Thrills (palpable murmurs).

Auscultation of the Heart (Supine, Left Lateral, Sitting)

Use diaphragm then bell, in a Z-pattern covering all auscultatory areas (Aortic, Pulmonic, Erb's Point, Tricuspid, Mitral).

Auscultation of the Heart (Supine, Left Lateral, Sitting): Rate & Rhythm

Normal 60-100 bpm, regular rhythm.

Abnormal: Tachycardia, bradycardia, irregular rhythms (dysrhythmias).

Auscultation of the Heart (Supine, Left Lateral, Sitting): S1 (Lub):

Closure of AV valves (mitral, tricuspid). Loudest at apex. Marks beginning of systole.

Auscultation of the Heart (Supine, Left Lateral, Sitting): S2 (Dub):

Closure of semilunar valves (aortic, pulmonic). Loudest at base. Marks end of systole.

Auscultation of the Heart (Supine, Left Lateral, Sitting): (EXTRA HEART SOUNDS) S3 (Ventricular Gallop):

Occurs in early diastole, immediately after S2. Due to rapid ventricular filling into a dilated ventricle. Sounds like "Ken-tuck-y." Normal in children/young adults, abnormal in older adults (indicates heart failure).

Auscultation of the Heart (Supine, Left Lateral, Sitting): (EXTRA HEART SOUNDS) S4 (Atrial Gallop):

Occurs at end of diastole, just before S1. Due to atria contracting and pushing blood into a noncompliant (stiff) ventricle. Sounds like "Ten-nes-see." Always abnormal (e.g., HTN, CAD, aortic stenosis).

Auscultation of the Heart (Supine, Left Lateral, Sitting): Murmurs

Gentle, blowing, swooshing sounds. Caused by turbulent blood flow through valves or septal defects. Described by frequency/pitch, intensity/loudness, duration, timing (systolic/diastolic).

Abnormal: Indicates valve disease or structural heart defects.

Nursing Priorities Related to Hypertension (Prioritized)

1. Patient Education on Medication Adherence: Crucial for long-term BP control and preventing complications. Explain purpose, dosage, side effects, and importance of consistent use.

2. Lifestyle Modifications Education: Diet (DASH diet, low sodium), exercise, weight management, smoking cessation, stress reduction. These are foundational for BP control and overall cardiovascular health.

3. Monitoring for Complications: Educate on signs/symptoms of target organ damage (e.g., vision changes, headache, chest pain, numbness/tingling, kidney issues) and importance of regular follow-up. Early detection prevents severe, irreversible damage.

4. Regular BP Monitoring: Teach proper technique for home BP monitoring and importance of regular checks. Empowers patients and provides valuable data for healthcare providers.

Cardiovascular Adaptations for Special Populations- Pregnant Women:

• Blood volume, stroke volume, cardiac output, and pulse rate increase.

• BP lowest in 2nd trimester, rises afterward.

• Apical impulse higher and lateral.

• Increased loudness of S1, easily heard S3.

• Systolic murmurs common (90%), disappear post-delivery.

Cardiovascular Adaptations for Special Populations  Infants and Children:

• Fetus: Oxygenation via placenta. Foramen ovale shunts blood from right to left atrium; ductus arteriosus shunts blood from pulmonary artery to aorta.

• Post-birth: Foramen ovale closes within 1 hour; ductus arteriosus closes within 10-15 hours (up to 2-3 days).

• Heart position more horizontal; apex at 4th ICS, moves to 5th ICS by age 7.

• Heart rate fluctuates widely (70-170 bpm).

• Murmurs common in first 2-3 days due to shunt closure.

• Venous hum common in healthy children (no pathologic significance).

• Heart murmurs common throughout childhood.

Cardiovascular Adaptations for Special Populations Aging Adult:

• Systolic BP increases (arteriosclerosis).

• Left ventricular wall thickness increases.

• Decreased ability to augment cardiac output during exercise.

• Diminished sympathetic response.

• Orthostatic hypotension more common.

• S4 often present without cardiac disease.

• Systolic murmurs common (>50%).

• ECG changes: prolonged PR, prolonged QT, bundle branch block.

• Increased incidence of CAD, HTN, HF.