Question

II. Cardiovascular System

Health Assessment: Heart and Neck Vessels

a. Anatomical landmarks for assessing the heart and neck vessels

b. Physical assessment techniques for assessing the heart and neck vessels

c. Normal and Abnormal Findings: Inspection, Palpation, Percussion, Auscultation

d. Heart Sounds and Murmurs: Normal and Abnormal findings and clinical significance

e. (application)Jugular Venous Pressure: Normal and Abnormal findings and clinical significance / CHF

f. Assessing Murmurs

g. Peripheral vascular pulses

Answer 1

Cardiovascular System Health Assessment: Heart and Neck Vessels.

a. Anatomical landmarks for assessing the heart and neck vessels are:

The heart is a hollow muscular pump, which lies in the middle mediastinum. On its surface, it has several distinctive features which are of anatomical importance.

heart in its anatomical orientation, the heart has 5 surfaces, formed by different internal divisions of the heart:

Anterior (sternocostal) – Right ventricle.

Posterior – Left atrium.

Inferior – Left and right ventricles.

Right pulmonary – Right atrium.

Left pulmonary – Left ventricle.

Neck vessels has carotid artery(right and left common carotid artery) and jugular veins (internal and external),pulse of these veins reflects integrity of heart muscles.

2) Physical assessment techniques for assessing the heart and neck vessels are-

#observe the jugular veinous pulse by standing on the right side of patient and patient in supine position torso elevated 30-45degrees.

Normal-the jugular veinous pulse is not normally visible when patient is sitting upright.

Abnormal findings-fully distended jugular veins and increased central venous pressure.

#heart inspection -patient is in supine position with head of the bed elevated between 30-45 degress,observe apical pulse and any abnormal pulsations.

Normal-apical pulse may or may not be visible.

Abnormal-pulsations called as heaves or lifts other than apical pulsations is considered abnormal.

3)PalpationPalpate the apical impulse. 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 impulse in the mitral area.

normal-apical impulse is palpated in the
mitral area and may be the size of a
nickel (1 to 2 cm). Amplitude is usually small—like a gentle tap.

abnormal-The apical impulse may be impossible
to palpate in clients with pulmonary
emphysema. If the apical impulse is
larger than 1 to 2 cm.

4)heart sounds and murmurs-Auscultate heart rate and rhythm. Place the diaphragm ofstethoscope at the apex and listen
closely to the rate and rhythm of the apical impulse.Auscultate for murmurs. A murmur
is a swishing sound caused by turbulent blood flow through the heart
valves or great vessels. Auscultate for
murmurs across the entire heart area.
Use the diaphragm and the bell of the
stethoscope in all areas of auscultation because murmurs have a variety
of pitches.

normal-

Normally no murmurs are heard. However, innocent and physiologic midsystolic murmurs may be present in healthy heart.

abnormal-indicate mitral valve stenosis. A friction rub may also be heard during
the diastolic pause.

5)The jugular venous pressure  reflects pressure in the right atrium (central venous pressure); the venous pressure is estimated to be the vertical distance between the top of the blood column and the right atrium.