Health Assessment Exam 2

precordium

area of chest overlying heart/ great vessels

base of heart

broader area of heart’s outline located at 3rd R/L ISC

apex of heart

tip of heart pointing down toward 5th L ICS

pericardium

tough, fibrous, double walled sac that surrounds/protects heart

myocardium

muscular wall of heart

endocardium

thin layer if endothelial tissue that lines inner surface of heart chambers/ valves

heart structure

4 chambers seperated by valves

atrium

thin walled reservoir for holding blood

ventricle

thick-walled, muscular pumping chamber

valves

prevents backflow of blood; unidirectional; open/close passively in response to pressure gradients

atrioventricular valves (AV valves)

open during diastole/ allows for ventricles to fill

tricuspid valve

R AV valve

mitral valve

L AV valve

semilunar valves (SL valves)

open during systole/ blood ejected from heart

pulmonic valve

R SL valve

aortic valve

L SL valve

L sided HF

pulmonary congestion

R sided HF

JVD/ distended abdomen

unoxygenated blood to RA

SVC/ IVC

RA to RV

tricuspid valve

RV to pulmonary artery

pulmonic valve

lungs

blood oxygenated

pulmonary vein to

LA

LA to LV

mitral valve

LV to aorta

aortic valve

aorta to

body

preload

volume/ amount of stretch of heart muscle before contraction

greater the strecth

stronger the contraction

afterload

resistance/ force heart has to pump against to eject blood

arteries

thick, elastic, high pressured; carry blood away from heart; oxygenated blood; deep in body

veins

thin, less elastic, valves; carry blood to heart; deoxygenated blood; more superficial

causes vasconstriction

cold temp, nicotine

causes vasodilation

warm temp, alcohol, fever

conduction pathway

SA node —> AV node —> Bundle of His —> L/R bundle branches —> ventricles

cardiac cycle

systole/ diastole

systole

ventricular contraction

diastole

relaxation/ ventricular refilling

cardiac output (CO)

volume of blood ejected by heart each minute; L

normal adult CO

4-6 L

CO =

SV x HR

SV

preload, afterload, contractility

aortic valve

2nd ICS R sternal border

pulmonic valve

2nd ICS L sternal border

Erb’s point

3rd ICS L sternal border

tricuspid valve

4th ICS L sternal border

mitral valve

5th ICS midclavicular line

mitral valve (AKA)

point of maximal impulse (PMI)

inspection of heart

inspect valves/ PMI

normal findings of inspection of heart

no visible pulsations except for PMI

palpation of heart

assess for pulsations, thrills, heaves

thrills

purr of cat

heaves

forceful thrusting of ventricle during systole

normal findings for palpation of heart

no pulsations (except at PMI). thrills, heaves

position for auscultation of heart

supine, upright/ leaning forward, L lateral

S1 heart sound

“lub”; AV valves close (start of systole)/ coincides w/ pulse

where S1 is loudest at

mitral + tricuspid areas/ apex

S2 heart sound

“dub”; when SL valves close (start of diastole)

where is S2 loudest at

aortic + pulmonic areas/ base of heart

murmurs

gentle, blowing/ swooshing sound that can be heard on chest wall; caused by turbulent flow

how to document murmurs

radiation, timing, pitch, pattern

innocent murmur

always systolic/ not associated w/ heart abnormalities

functional murmur

high out-put states/ increased blood flow in heart

pathological murmur

structural abnormalities

Grade I (murmur)

barely audible

Grade II (murmur)

clearly audible but faint

Grade III (murmur)

moderately loud/ easy to hear

Grade IV (murmur)

loud w/ thrill

Grade V (murmur)

very loud w/ thrill

Grade VI (murmur)

loudest w/ thrill

S3 heart sound

Ken-tuc-ky; place bell over mitral landmark, L lateral position/ exhaling

S3 normal in

children/ young adults

S3 early sign of

fluid volume overload; HF

S4 heart sound

Ten-nes-see; place bell over mitral/tricuspid; L lateral position exhaling

S4 heart sound indication

cardiac decompensation

pericardial friction rub

apex/ L lower sternal border; systolic/diastolic; radiating from anywhere; scratchy/ like sandpaper; high pitched; sitting up/ breath held

modifiable risk factors for CVD

HTN, hyperlipidemia, tobacco use, physical inactivity, diet, T2DM, stress, sedentary lifestyle, abdominal obesity

non-modfiable risk factors for CVD

age, gender, race, family history

DASH diet

< 2,400 mg sodium; < 30% total fat intake; 55-60% carbohydrates

exercise/ cardiovascular health

consult provider before starting program; avoid strenuous activity; stop if there is chest pain, dizziness, faintness

inspection of CV system

observe facial skin color; examine eyes/ periorbital area; inspect lips, buccal mucosa, gums, tongue for color changes; pursed lips/ nasal flaring; use of accessory muscles; JVD

inspection (general appearance)

apple vs. pear; color of skin, nails, gums, conjunctiva; clubbing/ spooning of nails; temperature of skin

Levine’s sign

cleanched fist over chest, sign of MI

apple shape

central obesity; linked to T2DM/ CVD

pear shape

stores fat in hips/ thighs; carries lower CVD risk

+1 (edema)

2 mm; ASAP

+2 (edema)

4 mm; 10-15 sec

+3 (edema)

6 mm; > 1 min

+4 (edema)

8mm; > 2 min

palpation of carotid artery

palpate one at a time

auscultation of carotid artery

use bell to listen for a bruit

jugular vein exam

supine at 30-45 degrees; note distention (R sided HF)

developmental considerations for infants/ children

apical pulse 4th ICS (up to 4 years); HR slows as child gets older; physiologic S3 is commmon

hemodynamic changes w/ aging

gradual increase in systolic BP; decrease in diastolic BP after 40 years; thickening of L ventricular wall; arteriosclerosis

vascular system

transport fluid, deliver oxygen/ nutrients, eliminate waste

arterial circulation

system of thick muscular walls for high speed/ pressure; away from heart

venous circulation

system of thinner walls, low pressure; to heart; valves

subjective data for vascular system

leg pain/ cramps, skin changes/ swelling in arms/legs, lymph node enlargement, medications, smoking history

objective data for vascular system

inspection/palpation, symmetry, check capillary refill

inspection/ palpation of upper extremities

skin (color, temp, texture, turgor), nails (color, clubbing), pulses, capillary refill

modified Allen test

checks ulnar patency