Heart and neck vessels assessment

Daytonite, BSN, RN · May 19, 2009

there is a list of heart diseases on the national heart lung and blood institute (http://www.nhlbi.nih.gov/) (http://www.nhlbi.nih.gov/health/public/heart/index.htm). the american heart association also lists the 4 common diseases as cad which includes heart attack, stroke, high blood pressure and heart failure (http://www.americanheart.org/presenter.jhtml?identifier=2873). you can find the statistics on what heart diseases kill people in this country here:

http://www.cdc.gov/heartdisease/statistics.htm - heart disease facts and statistics
http://www.disastercenter.com/cdc/
http://www.americanheart.org/presenter.jhtml?identifier=4478 - aha cardiovascular disease statistics
http://www.americanheart.org/presenter.jhtml?identifier=1200026 - aha current statistics on deaths caused by heart disease

go to family practice notebook (use search box and input a disease) http://www.fpnotebook.com/index.htm for the diagnosing exams, labs, medical treatment and medical management of specific diseases. pathophysiology of specific diseases can be found in the merck manual (http://www.merck.com/mrkshared/mmanual/sections.jsp) and in the articles on emedicine (http://www.emedicine.com/). nursing considerations and interventions are based upon the signs and symptoms of each disease and nursing assessment which consists of:

taking into account how the disease affects their ability to perform their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming)
the pathophysiology, signs and symptoms and complications of their medical condition
the signs, symptoms and side effects of the medications/treatments/tests that will be ordered

there are only a handful of nursing diagnoses that have to do with the function of the heart and lungs:

decreased cardiac output
ineffective tissue perfusion
activity intolerance
fatigue
ineffective breathing pattern
impaired gas exchange
ineffective airway clearance

and then there would be the diagnoses related to the complications:

self-care deficits
risk for injury
risk for falls

nursing diagnosis information can be found on these 2 websites:

the nursing care can be found in your nursing textbooks.

Jjearkwein · May 20, 2009

when doing physical assessment on neck vessels and heart.. we'll use ipa right..

Physical exam

3 techniques, 3 positions, 5 sites

*Use IPA

*sitting, then supine, then L lateral recumbent (prn)

*IPA sites

im confused at the positions.... are all those position correct/should i just pcik one or should i do it all???

cjcsoon2bnp, MSN, RN, NP · May 20, 2009

I was taught that for physical assessment of the heart you as the nurse would do the following:

Auscultate heart sounds by listening at five sites (aortic, pulmonary, erbs point, tricuspid and mitral) with both the diaphragm (for S1 and S2 sounds) along with the bell (for S3 and S4 sounds and murmurs) in sitting up, left side lying and supine positions.
Auscultate and palpate for an apical pulse noting the heart rate and rhythm.
Visual inspect the chest for cardiac pulsations.
Inspect and measure jugular venous pressure.
Auscultate and palpate the carotid arteries using the bell (noting any S3 and S4 sounds and murmurs.)

I'm not exactly sure if that's what your asking but that's what I would include as a nurses' cardiac assessment.

!Chris :specs:

Daytonite, BSN, RN · May 20, 2009

ipa. . .are you talking about inspection, palpation and then auscultation? my textbook of physical diagnosis: history and examination by mark h. swartz, m.d. indicates that the proper sequence for examination of the neck is iap. inspection consists of noting symmetry, pigmentation changes, presence of edema or the presence of a dilated and tortuous vessel. the vessel assessed in the neck is the carotid artery. while the patient is lying supine with head slightly elevated on a pillow and turned away from the side being evaluated, auscultate for a carotid bruit by placing your stethoscope over the carotid artery and asking the patient to hold their breath. normal is for no bruit to be heard. atherosclerotic disease of the carotid artery or loud murmurs that originate from the heart will be heard as bruits in the carotid arteries. then move on to palpating the pulses. pulses are graded by amplitude:

0 absent

1 diminished

2 normal

3 increased

4 bounding

my mosby's expert 10-minute physical examinations by cindy tryniszewski (editor) says this about the assessment of the vascular structures of the neck. . .again, have the patient lie down with head elevated on a pillow. they suggest palpation before auscultation unlike the physician's textbook. by feel, note the contour, rate and rhythm of pulsations along the carotid artery and auscultate for bruits. locate and distinguish between the internal and external jugular veins which they say you cannot see unless the patient is elevated at least 45 degrees since the external jugular veins lie posterior to the internal jugular veins and appear just above the clavicles. i would not consider this a sitting position. you will see the internal ones pulsate when there are pressure changes in the right atrium when the patient lies down. internal jugular pulsations are only visible and not palpable and diminish with inspiration when the person sits upright.

health assessment made incredibly visual also suggests assessing the neck vessels in this order: inspection, palpation, percussion and auscultation. "pulsation of the internal jugular vein changes in response to position and breathing. . .normally protrudes when the patient is lying down and lies flat when he stands." a bruit is "a blowing, swishing sound. . .that results from turbulent blood flow." they show a picture of a man whose carotid artery is being ausculatated while in a sitting position, but the text does not mention anything about position for the examinations except the jugular veins.

neither text says anything about examining the patient in a sitting or left lateral recumbent position. a reference which you can look at for yourself online is the ucsd practical guide to clinical medicine: http://meded.ucsd.edu/clinicalmed/introduction.htm and the examination of the jugular and carotid arteries is done under the heart examination here and includes pictures: http://meded.ucsd.edu/clinicalmed/heart.htm. it also stresses performing auscultation before palpation.

cjcsoon2bnp, MSN, RN, NP · May 21, 2009

neither text says anything about examining the patient in a sitting or left lateral recumbent position. a reference which you can look at for yourself online is the ucsd practical guide to clinical medicine: http://meded.ucsd.edu/clinicalmed/introduction.htm and the examination of the jugular and carotid arteries is done under the heart examination here and includes pictures: http://meded.ucsd.edu/clinicalmed/heart.htm. it also stresses performing auscultation before palpation.

i had learned to position the patient in a sitting and leaning slightly forward position allows you to bring the base of the heart closer to the chest wall for auscultation and positioning the patient in left lateral recumbent position brings the apex of the heart closer to the chest wall for auscultation. all i know is that is what i learned...

!chris :specs: