HEART-AND-NECK-VESSEL.pptx powerpoint presentation

This is about the anatomy and physiology of heart and blood vessel

1. Heart and Neck Vessels

2. Gathers equipment Stethoscope with bell and diaphragm Small pillow Penlight or movable exam light Watch with second hand 2 centimeter rulers

3. Explains procedure to the client Assists client to put on gown

4. NECK VESSELS Inspects jugular venous pulse. stand on the right side of the client. The client should be in supine position with the torso elevated 30- 45 degrees. Make sure the head and torso are on the same plane. Ask the client to turn the head slightly to the left. Shine a tangential light source onto the neck to increase visualization of pulsations .

5. Measures jugular venous pressure. . by watching for distention of the jugular vein. It is normal for the jugular veins to be visible when the client is supine to evaluate jugular vein distention position the client in a supine position with the head of the bed elevated 30, 45, 60 and 90 degrees.

6. At each increase of the elevation, have the client’s head turned slightly away from the side being evaluated. Using a tangential lighting, observe for distention, protrusion or bulging.

7. Auscultates carotid arteries for bruits. Auscultate the carotid arteries if you suspect cardiovascular disease or if the client is middle aged or older Place the bell of the stethoscope over the carotid artery and ask the client to hold his/ her breath for a moment so breath sounds do not conceal any vascular sounds. Always auscultate the carotid arteries before palpating.

8. NORMAL No blowing or swishing or other sounds are heard

9. ABNORMAL A bruit, a blowing or swishing sound.

10. 4. Palpates each carotid artery for amplitude and contour of the pulse, elasticity of the vessel and thrills

11. NORMAL Pulses are equally strong; 2+ or normal, no variation in strength from beat to beat Contour are normally smooth Arteries are elastic and no thrills are noted.

12. Abnormal Pulse inequality Weak pulses Bounding pulses Variations in strength

13. The strength of the pulse is evaluated on a scale from 0-4 as follows Pulse Amplitude Scale Absent 1+ Weak 2+ Normal 3+ Increased 4+ Bounding

14. HEART /PRECORDIUM 1. Inspects for visible pulsations with the client in supine position with head of the bed elevated 30 and 45 degree angle.

15. HOW? Assist the client with the head of the bed elevated between 30 and 45 degrees. Stand on the client’s right side and look for the apical pulse and any abnormal pulsations.

16. NORMAL The apical pulse may or may not be visible. The apical pulse is a result of the left ventricle moving outward during systole.

17. ABNORMAL Present of pulsation (heaves or lifts) may occur as a result of an enlarged ventricle from an overload of work.

18. 2. Palpates apical pulse for location, size, strength and duration of pulsation.

19. HOW? Remain on the client’s right side and ask the client to remain supine. Use the palmar surfaces of your hand to palpate the apical pulse in the mitral area (fourth or fifth intercostal space at midclavicular line.) After locating the pulse use one finger for more accurate palpation

20. If this pulsation cannot be palpated, have the client assume a left lateral position. This displaces the heart toward the left chest wall and relocates the apical pulse further to the left.

21. NORMAL Apical pulse is palpated in the mitral area. in obese clients or clients with large breasts, the apical pulse may not be palpable. In older clients the apical pulse may be difficult to palpate because of increased anteroposterior chest diameter.

22. ABNORMAL Apical pulse may be impossible to palpate especially to client with emphysema.

23. The apical pulse was originally called the point of maximal impulse (PMI). However the term is not used anymore because a maximal impulse may occur in other areas of the precordium as a result of abnormal conditions.

24. 3. Palpates for abnormal pulsation or vibrations at apex, left sternal border and base.

25. HOW? Use your palmar surfaces to palpate the apex, left sternal border and base

26. NORMAL No pulsations or vibrations are palpated in the area of the apex, left sternal border or base

27. ABNORMAL A thrill, which feels similar to purring cat, or a pulsation is usually associated with higher murmur.

28. 4. Auscultates heart sounds for rate and rhythm (apical and radial pulses, pulse rate deficit, S1 and S2) if irregular rhythm is detected

29. How? for the rate- Place the diaphragm of the stethoscope at the apex and listen

30. NORMAL Rate should be 60-100 beats per minute with regular rhythm Pulse rate in females is 5 to 10 beats per minute faster than in males.

31. ABNORMAL Bradycardia Tachycardia Irregular rhythms should be referred for further evaluation. These types of irregular patterns may predispose the client to decreased cardiac output, heart failure or emboli

32. For the Rhythm of the apical pulse. If you detect an irregular rhythm, auscultate for a pulse rate deficit. This is done by palpating the radial pulse while you auscultate the apical pulse. Count for a full minute.

33. NORMAL The radial and apical pulse rates should be identical.

34. ABNORMAL Pulse deficit is noted. (difference between the apical and radial pulses) may indicate atrial fibrillation, atrial flutter, premature ventricular contractions.

35. 5. Auscultate to identify s1 and s2 for sound location and strength pattern (louder/softer at locations and with respirations, splitting of S2)

36. HOW? Auscultate the first heart sound (s1 or “lub”) and the second heart sound (s2 or “dubb”) Remember these two sounds make up the cardiac cycle.

37. If you have difficulty differentiating s1 from s2, palpate the carotid pulse: the harsh sound that occurs with the carotid pulse is s1.

38. S1 starts systole and s2 starts diastole. The space or systolic pause between s1 and s2 is of short duration thus s1 and s2 occur very close together. Whereas, the space or diastolic pause, between s2 and the start of another s1 is of longer duration.

39. NORMAL S1 corresponds with each carotid pulsation and is loudest at the apex the heart. S2 immediately follows after s1 and is loudest at the base of the heart.

40. Use the diaphragm of the stethoscope to best hear S1 Use the diaphragm of the stethoscope to best hear S2. Ask the client to breath normally. Do not ask the client to hold his or her breath. Breath holding will cause any normal or abnormal split to subside.

41. If you are experiencing difficulty differentiating s1 from s2 palpate the carotid pulse; the harsh sound that occurs with the carotid pulse is S1.

42. 6. Auscultates for extra heart sounds (clicks, rubs) and murmurs (systolic or diastolic, intensity grade, pitch, quality, shape or pattern, location, transmission, effect of ventilation and position).

43. Use the diaphragm first then the bell to auscultate the entire area. Note the characteristics like location, timing of any extra sound heard. Auscultate during the diastolic pause ( space heard between end of S2 and the next S1

44. While auscultating keep in mind that development of a pathologic S3 may be the earliest sign of heart failure

45. NORMAL No sounds are heard

46. ABNORMAL Ejection sounds or clicks associated with mitral valve prolapse A friction rub may also be heard during systolic pause.

47. video

48. Auscultate for murmurs

49. murmur - Is a swishing sound sound caused by turbulent blood flow through the heart valves or great vessels.

50. HOW? Auscultate for murmurs across the entire heart. Use the diaphragm and the bell of the stethoscope in all areas of auscultation because murmurs have a variety of pitches

51. NORMAL no murmurs are heard.

52. ABNORMAL With murmurs

53. 7.Auscultates with the client in the left lateral position and with the client sitting up, leaning forward and exhaling.

54. HOW? Ask the client to assume a left lateral position. Use the bell of the stethoscope and listen at the apex of the heart

55. NORMAL S1 and S2 heart sounds are normally present.

56. ABNORMAL An S3 or S4 heart sound or a murmur of mitral stenosis that was not detected with the client in the supine position may be revealed when the client assumes the left lateral position.

57. Ask the client to sit up , lean forward and exhale. Use the diaphragm of the stethoscope and listen over the apex and along the sternal border.

58. NORMAL S1 and s2 heart sounds are normally present

59. ABNORMAL Murmur of aortic regurgitation may be detected when the client assumes this position.