At the end of this lab, the students will be able to:
1. Demonstrate the ability to safely & accurately
complete heart & neck vessels assessment.
2.Demonstrate the ability to accurately
document heart & neck vessels assessment data in organized manner. Equipment Needed I . Marking Pen 2. Small centimeter 3. Stethoscope with diaphragm & bell 4. Alcohol swab 5- Watch with second hand Preparation 1. To evaluate the carotid arteries, the client can be sitting. 2. To assess the jugular veins & the pericardium, the person should be supine with the head & chest slightly elevated. 3. Stand on the client's right side. 4. The room should be warm. 5. Ensure the female's privacy by keeping her breasts draped. 6. Gently displace the breast upward, or ask the client to hold it out of the way. Subjective data: 1. Cough 2. Nocturia 3. Dyspnea 4. Fatigue 5. Past cardiac history 6. Orothopnea 7. Cyanosis or pallor 8. Family cardiac history 9. Edema 10.Chest pain 1 1. Personal habits The Neck Vessels
Palpate the carotid artery
- Palpate each carotid artery medial to the
sternomastoid muscle in the neck.
- Avoid excessive pressure on the carotid sinus area.
- Palpate gently.
- Palpate only one carotid artery at a
time. - Feel the contour & amplitude of the pulse.
- Compromise finding to the other side.
Normal finding : Contour is smooth with rapid upstroke & slower down stroke. Strength is 2+ or moderate. Findings should be same bilaterally Auscultation of the carotid artery - Keep the neck in a neutral position. - Lightly apply the bell of the stethoscope over the carotid artery at three levels: o Angle of jaw. o Mid – line area. o Base of the neck. - Ask the client to take a breath. Exhale & hold it briefly while you listen. Normally no sound present Inspect the Jugular Venous Pulse - Put the client in supine position anywhere from 30-40 degree angle. - Remove the pillow to avoid flexing of the neck. - Turn the client's head slightly away from the examined side. - Direct strong light onto the neck. - Note the external jugular veins overlying the stemomastoid muscle. - Look for pulsation of internal jugular veins in the area of suprasternal notch Internal jugular vein pulsations 3cm above sternal angel JUGULAR VEIN MEASURMENT ASSESSMENT ASSESSMENT OF ODEMA Palpate the Apical impulse: - localize the apical impulse using one finger pad. - Ask the client to "exhale & then hold". - Role the client midway to the left. Note the following: Location ✓ Size ✓ Amplitude ✓ Apical impulse occupy only on intercostals space, the 5*, & be at or medial to the MCL. *2cm. Note: apical impulse is not palpable in obese or in clients with thick chest wall. PALPATION Palpate across the precordium - Using the palm aspect of your four fingers, gently palpate the apex. - Search for any pulsation : Normally no pulsation Percussion - place your stationary finger in the client's 5th ICS over on left side of chest near the anterior axillary line. - Slide your hand toward yourself, percussing as you go. - Note the change of sound. . The left border of cardiac dullness is at the midclavicular line in the 5' interspace, & slopes toward the sternum progress upward, so that by the 2"d interspace the border of dullness coincides with the left sternal border. Auscultation - clean the end pieces with alcohol swab. - After you place the stethoscope, try closing your eyes briefly to get out any distraction. - Begin with the diaphragm end piece & note the following: Rate & rhythm Identify S1 & S2 Listen for murmurs Normal finding: Rate range from 60-IOO bpm, & the rhythm is regular. Sl is louder than S2 at the apex, & S2 is louder than S1 at the base. Should not be heard. S1 : produced by click of the ateroventracular valve S2 : produced by click of the semiluner valve After auscultating in supine position, role the client toward his \ her left side. - Listen with the bell at the apex. - Ask the client to sit up, lean forward slightly, & exhale. - Listen with the diaphragm firmly pressed at the base, right, & left side. - Check for the soft high- pitched sound. Where to place your stethoscope
As with palpation of the heart, auscultation should
proceed in a logical manner over 5 general areas on the anterior chest, beginning with the patient in the supine position. Examined with diaphragm, including:
1- Aortic region at the 2nd intercostal spaces at the
right
2- Pulmonic region at the 3rd intercostal spaces at the
left 3- Erb’s point at the 4th intercostal spaces
4- Tricuspid region at the 5th intercostal spaces
at the left border of sternum
5- Mitral region (near the apex of the heard
between the 5th intercostal spaces in the mid- clavicular line) (apex of the heart). AUSCULTATION
