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Chapter 14

The Cardiovascular System

Anatomy and Physiology
Location of the Heart and Great
Vessels

Anatomy and Physiology
(cont’d)

Location of the Heart and Great
Vessels

Valves.Anatomy and Physiology (cont’d) Cardiac Chambers. and Circulation .

Anatomy and Physiology (cont’d) • The cardiac cycle – Ventricular pressures • Systole: period of ventricular contraction • Diastole: period of ventricular relaxation .

Anatomy and Physiology (cont’d) • The cardiac cycle (cont’d) – Valve openings and closings .

Anatomy and Physiology (cont’d) • The cardiac cycle (cont’d) – Valve openings and closings (cont’d) .

Anatomy and Physiology (cont’d) • The splitting of heart sounds – Split S2 .

Anatomy and Physiology (cont’d) • The splitting of heart sounds – Split S1 • Earlier mitral and later tricuspid • Heard throughout precordium • Loudest at cardiac apex • Softer tricuspid best at lower left sternal border • Does not vary with respiration .

Anatomy and Physiology (cont’d) Heart Murmurs .

Anatomy and Physiology (cont’d) Relation of Auscultatory Findings to the Chest Wall .

Anatomy and Physiology (cont’d) • Conduction system – SA node – AV node – Bundle of His – Bundle branches – Purkinje fibers .

Anatomy and Physiology (cont’d) • Conduction system (cont’d) .

Anatomy and Physiology (cont’d) • Conduction system (cont’d) .

to contract or shorten – Afterload: degree of vascular resistance to ventricular contraction .Anatomy and Physiology (cont’d) • The heart as a pump – Cardiac output: volume of blood ejected from each ventricle in one minute – Stroke volume: volume of blood ejected with each heartbeat – Preload: the load that stretches the cardiac muscle before contraction – Myocardial contractility: ability of cardiac muscle when given a load.

Anatomy and Physiology (cont’d) • Arterial pressure – Factors influencing arterial pressure • Left ventricular stroke volume • Distensibility of the aorta and the large arteries • Peripheral vascular resistance. particularly at the arteriolar level • Volume of blood in the arterial system .

Anatomy and Physiology (cont’d) • Jugular venous pressure – Reflects right atrial pressure – Best estimated from right internal jugular vein – Right external jugular vein useful for estimating CVP .

Anatomy and Physiology (cont’d) Jugular Venous Pressure (cont’d) .

palpitations – Dyspnea – Orthopnea . left shoulder or arm. and back – Nausea – Diaphoresis – Arrhythmias: skipped beats.The Health History • Common or concerning symptoms – Chest pain – Pain or discomfort radiating to the neck.

The Health History (cont’d) • Common or concerning symptoms (cont’d) – Paroxysmal nocturnal dyspnea – Cough – Edema – Nocturia – Fatigue – Cyanosis – Pallor .

coronary artery disease. fluttering. acute coronary syndrome – Palpitations • Heart skipping. orthopnea. paroxysmal nocturnal dyspnea . pounding – Shortness of Breath • Dyspnea.The Health History (cont’d) • Assessing cardiac symptoms – Chest pain • Angina pectoris. myocardial infarction. racing.

clears at night when patient supine . congestive heart disease. fine crackles and rales – Edema • Dependent edema.The Health History (cont’d) • Assessing cardiac symptoms (cont’d) – Cough • Heart failure. hypoalbuminemia – Nocturia • Dependent edema.

The Health History (cont’d) • Assessing cardiac symptoms (cont’d) – Fatigue • Signals heart is not adequately supplying oxygen – Cyanosis or pallor • Poor oxygenation of body .

Past History • Heart problems? • Heart disease? • Murmurs? • Congenital heart disease/defect? • Rheumatic fever? • Hypertension? • Elevated cholesterol or triglycerides? • Diabetes? .

Family History • • • • • • Coronary artery disease? Hypertension? Sudden death younger than 60? Stroke? Diabetes? Obesity? .

Lifestyle Habits • • • • • Nutrition Smoking Alcohol Exercise Medications. herbs. nutritional supplements . over-the-counter drugs.

Physical Examination • Preparation of the patient – Comfortable and calm – Explain procedure – Examination gown (opened in the front) – Assist to examining table – Cover with drape – Perform examination from patient’s right side .

Physical Examination (cont’d) • Equipment – Stethoscope with a bell and diaphragm – Sphygmomanometer – Two 15-cm rulers – Watch with second hand – Examination light for tangential lighting .

Physical Examination (cont’d) • Blood pressure and heart rate – Review measurements recorded from General Survey and Vital Signs. pallor – Orbital edema – Anxiety: occurs during myocardial infarctions . – Refer to Table 14-1. – Repeat if needed. • Face – Color: cyanosis.

Physical Examination (cont’d) • Great vessels of the neck – Carotid artery pulse • Amplitude and contour .

Physical Examination (cont’d) • Great vessels of the neck – Carotid artery pulse • Thrills and bruits – Brachial artery .

Physical Examination (cont’d) • Great vessels of the neck – Jugular venous pressure • Head of bed: elevated 30 degrees • Hypovolemic: may need to be flat • Hypervolemic: may need to be higher • Note height of head of bed in record .

.Physical Examination (cont’d) • Jugular venous pressure (cont’d) – Refer to page 359.

jugular venous pressure will remain elevated. .Physical Examination (cont’d) • Hepatojugular reflux • If heart failure is present.

.Physical Examination (cont’d) • The heart – Positioning patient • Supine • Turning to left side • Sitting and leaning forward – Correlate findings with jugular venous pressure and carotid pulse.

The Physical Examination (cont’d) Sequence of the Cardiac Examination .

– Palpation .Physical Examination (cont’d) • The heart (cont’d) – Inspection • Apical pulse • See Table 14-3.

Physical Examination (cont’d) Apical Pulse .

Physical Examination (cont’d) • Apical pulse (cont’d) – Location – Diameter .

Physical Examination (cont’d) Apical Pulse (cont’d) .

ECG.Physical Examination (cont’d) • The heart (cont’d) – Percussion • Rarely used to estimate cardiac size • X-rays. and echocardiography provide more accurate measurements .

Physical Examination (cont’d) • The heart (cont’d) – Auscultation • Overview • Know your stethoscope .

Physical Examination (cont’d) • The heart (cont’d) – “Inching” your stethoscope – Importance of timing S1 and S2 .

Physical Examination (cont’d) .

Physical Examination (cont’d) • The heart (cont’d) – Listening for heart sounds • S1 (see Table 14-4) • S2 (see Table 14-5) • Split S2 • Extra sounds in systole (see Table 14-6) • Extra sounds in diastole (see Table 14-7) • Systolic and diastolic murmurs (see Tables 14-8 thorugh 14-11) .

Physical Examination (cont’d) • The heart (cont’d) – Correctly identifying heart murmurs • Tips for identifying heart murmurs – Time the murmur. – Locate where it is the loudest – Conduct any necessary maneuvers – Shape – Grade intensity – Associated features .

– May indicate heart failure – To be covered in detail in Chapter 15 • Integrating cardiovascular assessment – Correlate complaints with findings. and legs.Physical Examination (cont’d) • Peripheral edema – Inspect feet. . ankles. – Put together information to form hypothesis of patient complaint’s.

Recording Your Findings
• Structures
• Colors
• Auscultations
• Pulsations
• Palpations
• Heart sounds

Health Promotion
• Topics
– Coronary heart disease
– Stroke prevention
– Hypertension prevention and management
– Hyperlipidemia prevention and
management

Health Promotion
(cont’d)

• Key roles for nurse
– Screening patients for disease and risk factors
– Teaching patients relationship of risk factors to
disease
– Educating patients on lifestyle changes to reduce risk
factors
– Encouraging patients to adhere to healthy lifestyles
and medical regimens to reduce the incidence of
disease morbidity

Health Promotion (cont’d) Blood Pressure Classification .

Health Promotion (cont’d) • Risk reduction – Coronary heart disease risk factors • Modifiable risk factors – Diabetes – Systolic and/or diastolic hypertension – Smoking – Obesity – Physical inactivity .

Health Promotion (cont’d) • Risk reduction (cont’d) – Coronary heart disease risk factors (cont’d) • Nonmodifiable factors – Increasing age – History of cardiovascular disease – Family history of early heart disease .

Health Promotion (cont’d) • Hypertension risk factors – Modifiable risk factors • Obesity • Physical inactivity • Smoking • Microalbuminuria • Excess dietary sodium • Insufficient intake of potassium • Excess alcohol consumption .

Health Promotion (cont’d) • Hypertension risk factors (cont’d) – Nonmodifiable factors • Age • Family history of hypertension or CVD .

waist circumference (of BMI) – Smoking – History of cardiovascular disease or diabetes . weight.Health Promotion (cont’d) • Risk factors used to assess the 10-year coronary heart disease risk score – Age – Gender – Height.

and HDL cholesterol – Triglycerides – Family history of early heart disease .Health Promotion (cont’d) • Risk factors used to assess the 10-year coronary heart disease risk score (cont’d) – Systolic and diastolic blood pressure – Total cholesterol. LDL.

Health Promotion (cont’d) .

Health Promotion (cont’d) Healthy Lifestyles .

Health Promotion (cont’d) Healthy Lifestyles (cont’d) .

Health Promotion (cont’d) • Healthy eating – Healthy fats • Foods high in monounsaturated fat • Foods high in polyunsaturated fat • Foods high in omega-3 .

Health Promotion (cont’d) • Healthy eating (cont’d) – Unhealthy Fats • Foods high in trans fat • Foods high in cholesterol • Foods high in saturated fat .

pulmonary.Health Promotion (cont’d) • Counseling about weight and exercise – Dietary factors are associated with 4 of the 10 leading causes of death. at least 30 minutes on most days of the week. – Encourage exercising. . – Discuss principles of healthy eating. – Evaluate any cardiovascular. or musculoskeletal conditions before selecting an exercise regimen.