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Wesleyan University-Philippines
FUNCTIONS: effects the circulation of blood around the body transports nutrients and oxygen to the cells/tissues removes waste products
Hollow, cone-shaped, with size of the fist Within the mediastinal cavity
3 Layers:
2 atria and 2 ventricles separated by septum (interatrial and interventricular) Atrioventricular valves separates atrium and ventricle (cusps = leaflets)
Deoxygenated blood SVC/IVC RA TV RV PSLV PA lungs for gas exchange (pulmonary circulation) oxygenated blood PV LA MV/BV LV ASLV A cardiac and systemic circulation
CORONARY CIRCULATION
Coronary arteries from base of the aorta, penetrates all layers of the heart Coronary arteries fill during ventricular relaxation Cardiac veins drain blood from myocardium to the right atrium through coronary sinuses
1. S1 first sound; systole; closure of AV valves; pumps/ejects blood 2. S2 second sound; diastole; closure of SL valves; refilling of blood 3. Depolarization : Repolarization length ratio (1:2)
THE HEART
Measures
tissue perfusion and delivery of O2 and nutrients to the cells volume amount of ejected blood from the ventricles
Stroke
output amount of blood ejected with each contraction (in one minute)
Cardiac CO
THE HEART
Refractoriness non-responsive to new stimulus while in the state of contraction (0-60 mV) (videos: 1-2-3-4)
the heart Carry oxygenated blood (except from pulmonary arteries) Blood moves from higher pressure area to lower pressure area Layers: Tunica intima (mesothelium); media (thicker than veins); and adventitia (externa, for anchoring)
Distribute deoxygenated blood (except from pulmonary veins) Pressure is too low, passive Layers: Tunica intima (valves to prevent backflow); media (thinner than artery); and adventitia (same with artery)
STRUCTURES:
Blood cells Plasma (serum; plasma CHON-Ig, Albumin; sugar; clotting factors, etc)
FUNCTIONS: Transports oxygen, nutrients, hormones, and metabolic wastes for elimination
GENERAL SURVEY/APPEARANCE: Stature and body build slender, medium-build, stocky or muscular)
Posture, gait, & movement erect & upright no diff. with position changes coordinated, balanced movement
PHYSICAL ASSESSMENT (I.P.P.A.): CARDIOVASCULAR AND PERIPHERAL VASCULAR SYSTEM VITAL SIGNS Ht. & Wt. Males 5 = 106 lbs (6 lbs for every 1 inch) Females 5 = 100 lbs (5 lbs for every 1 inch)
TPR Temp. = 36.8-37.5 oC Pulse = 60-100 bpm; regular; +2 RR 12-20 cpm; eupnic/regular; tidal volume / not too deep nor shallow BP 90/60 to 140/90
THORAX / CHEST
Inspection of Chest shape and size Normal (elliptical) AP diameter twice smaller than Lat./Transverse diameter
Palpation of posterior chest N = evenly spaced spinous process, no pain nor tenderness
Pigeon chest (Pectum carinatum) anterior projection; protruding sternum; narrow transverse diameter; no abnormal physiological effect (just altered body image)
Funnel chest (Pectum excavatum) decreased AP diameter; congenital; danger is compression of the great vessels (Vena cavae, pulmonary, aorta)
Midsternal line line running thru the center of the sternum Midclavicular line vertical; from the clavicle midpoint Axillary line Anterior A.L. ant. axillary fold Midaxillary A.L. apex of the axilla Posterior A.L. - post axillary fold
CHEST LANDMARKS
Vertebral line along the spinous processes Scapular line inferior angle of scapula Supra-sternal notch hallow curve at the base of neck Sternum Manubrium (joins clavicle & 1st pair of ribs) Body joins 2nd to 7th pair of ribs Angle of Louis junction bet. sternum & manubrium; main guide in locating ribs (2nd) & ICS; position of carina; used to measure JVD Xyphoid process
CHEST INSPECTION PMI at 5th ICS L midclavicular line Inspect = thrust (normal) ***Heave = excessive thrust (abnormal) When Palpated = thrill When Auscultate = murmur (aka heart murmur) blowing or whooshing, graded
CHEST PALPATION AND AUSCULTATION PRECORDIUM: Pulmonic area 2nd ICS L para-sternal line; S2 Aortic area 2nd ICS R para-sternal line; S2 Mitral/bicuspid/apical area - 5th ICS L midclavicular line; S1 Tricuspid area 5th ICS L para-sternal line; S1
CHEST AUSCULTATION (S1, S2, S3 & S4) HEART SOUNDS: S1 lubb; systole S2 dubb; diastole
normal in child or young adult abN=30 yrs & above (L sided heart failure, pulmonary congestion, intracardiac shunting of blood, MI, anemia, or thyrotoxicosis)
S4 a.k.a atrial or pre-systolic gallop heard louder in inspiration (bell) La-lubb-dubb (ten-nes-see) Heard prior to S1 abN = MI, HPN, CAD, cardiomyopathy, anemia, elevated L ventricular pressure or aortic stenosis
Normal = symmetrical; 2+ thrust; No sound/bruit (elastic arterial wall) abN = asymmetrical (r/t stenosis, thrombosis, arteriosclerosis); decreased pulse dec. CO; increased pulse cardiomegaly
1. 2. 3. 4.
Done in Semi-Fowlwers position Normal = not visible (normal R side heart); For distended jugular vein assess external JVD/JVPressure Steps:
Semi-Fowlers position measure vertical height lowest point at Angle of Louis; highest point at visible distension, measure vertically Interpret: Normal = 3-4 cm; abN = <3 DHN, bleeding; >5 R sided heart failure
Pulsations obliterated by pressure Pulsations not obliterated by above the clavicle. pressure above the clavicle. Level of pulse wave decreased on inspiration; increased on expiration. No effects of respiration on pulse.
Usually two pulsations per systole One pulsation per systole. (x and y descents). Prominent descents. Pulsations sometimes more prominent with abdominal pressure. Descents not prominent. No effect of abdominal pressure on pulsations.
PHYSICAL ASSESSMENT (I.P.P.A.): CARDIOVASCULAR AND PERIPHERAL VASCULAR SYSTEM PERIPHERAL VASCULAR SYSTEM Peripheral pulses (arteries):
Normal = symmetrical; 2+; no thrill / bruit abN = asymmetrical (impaired circulation); 0 or 1+ (impaired CO); 3+ (HPN, inc. CO, circulatory overload)
Normal = symmetrical; non tender; - dependent position distended; - limbs elevated veins collapse; except elderly abN = (+) Homans sign upon dorsiflexion (thrombophlebitis); painful, warm, swollen and tender (varicosities)
Peripheral Perfusion: assess color, temperature, edema, and lesions on skin of hands and feet capillary refill (immediate return test) Normal = pinkish/fair; not warm/cold; no edema; not too dry/not too moist
PERIPHERAL VASCULAR SYSTEM Perform Buergers test Steps: 1.Supine 2.Raise a limb 30 cm or 1 foot above heart move it up & down 3.Sit up and dangle feet observe color return
Normal = returns within 10-15 sec. abN = delayed venous filling (arterial insufficiency)
PERIPHERAL VASCULAR SYSTEM Capillary refill test (blanch test): Normal = 2-3 seconds abN = >4sec. arterial insufficiency
abN = cyanotic (venous insufficiency); - dusky red color & cool skin (arterial insufficiency); - brown pigmentation around ankles, skin shiny, thin, fragile (chronic arterial or venous insufficiency)
***All data collected should be documented (esp. abnormal findings) in the clients record sheet (chart).
The End