Cardiac: 12 s Concept Overview Perfusion: Mechanisms that…

Cardiac: 12 s Concept Overview Perfusion: Mechanisms that… Cardiac: 12 s Concept OverviewPerfusion:Mechanisms that facilitate and impair perfusion of oxygenated blood.All tissues require perfusion of oxygenated blood.All of these physiologic concepts are interrelated.Anatomy & physiology review: Basic Normal Heart SoundsS1- the first heart sound “Lub” closure of the mitral and tricuspid valvesHear best at apical areaBeginning of systoleS2- the second heart sound “Dub”closure of the aortic and pulmonic valvesHear best at aortic areaEnd of systoleOne “lub’ & one ‘dub” = one beatObjective Data: Cardiac Inspection & PalpationInspect and palpate upper extremities for:SymmetrySkin integrityColor and temperatureCapillary refillPalpate brachial and radial pulses for:RateRhythmAmplitudeContourInspect and palpate lower extremities for skin turgor and symmetry.Objective Data: Cardiac Inspection, Palpation,  & AuscultationInspect anterior chest wall for:ContourPulsationsLiftsHeavesRetractionsPalpate apical pulse for location.Auscultate S1 and S2 heart sounds for:RateRhythmPitchSplittingObjective Data: Obtaining an apical heart rateStart with stethoscope over PMIRequires concentration / eliminate noiseMay use diaphragm Use the bell of the stethoscope to pick up murmurs, abnormal soundsAssess intensity & regularityPositioning- supine, semi-fowlers, sideAuscultate/Count for 1 minuteAnatomic Landmarks Heart Sounds”All Patients Take Medicine”Objective Data: Extra Heart SoundsBest heard with the bell of the stethoscopeBest heard at the apical site with the pt lying on the left sideS3 and S4Murmurswhooshing or blowing soundResults from turbulent blood flow or abnormal openings within the heartObjective Data: Central vessels assessmentPreparationEquipmentWhy are our central vessels so important?Carotid arteriesPalpate for strong pulseAuscultate for a bruitIf bruit: palpate for a thrillJugular veinsCheck for distention/pulsationsHOB 45* angleCommon Problems & Conditions:HypertensionThrombophlebitisAneurysmValvular Heart DiseaseAngina PectorisMyocardial InfarctionHeart FailureExamples of Documentation Let’s Practice!Skin warm, dry, & intact. Capillary refill brisk and < 2 seconds.Apical pulse 60 regular and strong. Blood pressure 126/82No edema noted to upper and lower extremities.Patient denies pain at this time. No visible palpations or heavesApical pulse non-palpable at PMINo extra heart sounds or murmurs per auscultationCarotid pulses strong, equal bilaterally.  No bruit heard.Jugular veins flat and non-distended bilaterally in sitting position.Health Science Science Nursing NURB 231

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