ADULT I L13-14 PPP W16.pptx - NUR 1211C ADULT HEALTH...

NUR 1211C ADULT HEALTH NURSING
LECTURE 13-14
CARDIOVASCULAR SYSTEM: THE HEART
8
th
Edition: Ch. 33, 34, 35
7
th
Edition: Ch. 35, 36, 37

Chapter (33) (35)
Assessment
of the
Cardiovascular System

Surface Anatomy of the Heart

Blood Flow Through the Heart

Cardiac Valves
1. Tricuspid valve
2. Mitral valve
3. Pulmonic valve
4. Aortic valve

Mean Arterial Pressure (MAP)
•
Must be at least 60 mm Hg to maintain adequate
blood flow through coronary arteries and perfuse
major organs (brain)
•
Formula:
SBP + 2DSP
3
For example: If a patient’s BP is 110/70, the MAP is:
110 + 2(70) = 110 + 140 = 250 = 83
3 3 3

Sequence of Events During the Cardiac Cycle

Mechanical Properties
of the Heart
•
Stroke volume
•
Heart rate
•
Cardiac output
•
Preload : venous return and heart compliance
(elasticity)
•
Afterload : Impedance: peripheral vascular
resistance 
•
Myocardial contractility

Mechanical Properties of the Heart (cont’d)
•
Cardiac Index (CI) = Cardiac Output ÷ Body
Surface Area (BSA)
•
CI normal range = 2.7 to 3.2 L/min/m
2
BSA

Cardiac Output
•
Amount of blood pumped from left ventricle
per minute
•
Heart Rate × Stroke Volume

Arterial System
•
Blood pressure is force of blood exerted
against vessel walls

Blood Pressure Regulation
•
Autonomic nervous system:
–
Baroreceptors
–
Chemoreceptors—hypercapnia
•
Renal system
•
Endocrine system
•
External factors also affect BP

Cardiovascular System Assessment
•
Patient history
•
Nutritional history
•
Family history and genetic risk
•
Modifiable and nonmodifiable risk factors for cardiovascular
disease
•
Current health problems
–
Pain, discomfort
–
Dyspnea, DOE, orthopnea, PND
–
Fatigue
–
Palpitations
–
Edema
–
Syncope
–
Extremity pain

Point to Remember…
•
Best indicator of fluid balance is weight
•
2.2 lb = 1 kg = 1 L of fluid

Cardiovascular System
Physical Assessment
•
General appearance
•
Skin
–
Cyanosis, rubor; pallor
•
Extremities
–
Clubbing, edema
•
Blood pressure
–
Hypotension and hypertension
–
Postural (orthostatic) hypotension

Precordium
•
Assessment:
–
Inspection: point of maximal impulse
–
Palpation and percussion: not done by the nurse
–
Auscultation
•
Normal heart sounds: S
1
and S
2
caused by closure of atrioventricular
valves and semilunar valves; indicate the beginning and end of systole
•
Paradoxical splitting: (S
2
) early closure of pulmonic valve or delay in
aortic valve closure; caused by MI, left bundle-branch block, aortic
stenosis, aortic regurgitation, and right ventricular pacing.
•
Pericardial friction rub: Sign of friction between both layers of
pericardium, indicate pericarditis, and can be heard despite the
patient hold breath (if it stops while holding breathing, it is a pleural
rub). Usually heard on precordium.

Precordium (cont’d)
•
Assessment (cont’d)
–
Auscultation
•
Gallops and murmurs: S
3
is a ventricular gallop, heard at the
beginning of diastole, caused by fast ventricular filling in a
noncompliant ventricle; it is a normal finding in people younger
than 35, and a sign of heart failure in older people.