Denise Coffey MSN RN CARDIO VASCULAR LYMPHATIC SYSTEM

Denise Coffey MSN, RN CARDIO VASCULAR & LYMPHATIC SYSTEM ASSESSMENT NRS 102

Anatomy Review

Anatomy Review � Chambers �Atria right and left �Ventricles right and left � Valves �Atrioventricular ○ Tricuspid ○ Mitral �Semilunar ○ Pulmonic ○ Aortic

Review Anatomy

Heart sounds � Direction of blood flow � Cardiac cycle �Diastole �Systole �Events in the right and left sides � Heart sounds �First heart sound �Second heart sound �Effect of respiration

Heart Sounds � Extra heart sounds � Third heart sound � Fourth heart sound Murmurs � Characteristics of sound � � Frequency (pitch) � Intensity (loudness) � Duration � Timing � Conduction

Neck vessels �Carotid artery �Jugular veins ○ Internal ○ External

Review Anatomy

Subjective Data Collection Chest pain Dyspnea Orthopnea Cough Fatigue Cyanosis or pallor Edema Nocturia Cardiac history Family cardiac history Personal habits (cardiac risk factors)

Objective Data Collection � Carotid arteries �Palpate �Auscultate for bruit � Jugular veins �Inspect the jugular venous pulse

Objective Data Collection Auscultate the heart sounds � Identify auscultatory areas � � Note the rate and rhythm �Identify S 1 and S 2 �Listen to S 1 and S 2 separately �Listen for extra heart sounds �Listen for murmurs

Landmarking for Heart Sounds

Peripheral Vascular System Arteries Temporal artery Carotid artery Arteries in the arm Brachial Ulnar Radial Arteries in the leg Femoral Popliteal Dorsalis pedis Posterior tibial

Peripheral Vascular System Veins Jugular veins Veins in the arm Veins in the leg Deep veins Femoral Popliteal Superficial veins Great saphenous Small saphenous Perforators (connecting veins)

Peripheral Vascular System

Peripheral Vascular System

Peripheral Vascular System

Lymphatic System

Subjective Data � Leg pain or cramps � Skin changes on arm or legs � Swelling � Lymph node enlargement � Medications

Objective Data

Objective Data Legs—Inspect and palpate Skin and hair Symmetry Temperature Calf muscle Inguinal lymph nodes Femoral pulse Popliteal pulse Posterior tibial pulse Dorsalis pedis pulse Pretibial edema Leg veins Assess while patient stands

Objective Data Femoral Pulse

Objective Data Popliteal Pulse

Objective Data Posterior Tibial

Objective Data Dorsalis Pedis

Objective Data Pitting Edema

Abnormalities � Arms �Raynaud’s syndrome �Lymphedema � Legs �Arteriosclerosis—ischemic ulcer �Venous (stasis) ulcer �Superficial varicose veins �Deep vein thrombophlebitis Occlusions � Aneurysms �