9/15/2021

Chapter 20: Heart and Neck Vessels

(Cardiovascular system)
Direction of blood flow
RT atrium Tricuspid
Tricuspid RT Ventricle
RT Ventricle Pulmonic (Semi-lunar)
Pulmonic Artery Lungs

Returns Via the Pulmonic Veins to the

LT Atrium Mitral Valve LT Ventricle
LT Ventricle sends it through the Aortic Valve to the Aorta
Aorta to the body
(Jarvis, 2019, p.495)

Palpation - Cardiovascular
• Palpate the carotid arteries
• assess for strength, symmetry and grade of pulses
• Normal Finding = 2+ equal bilaterally

• Both carotids should be assessed at the same time?

• True or False

(Jarvis, 2019, p. 511)

Inspection - Cardiovascular
Inspect the clients anterior chest for skin color, scars,
deformities
• Observe for pulsations at the apical impulse – this is
located in the heart apex at the 4th or 5th Intercostal
space (ICS) at the left mid-clavicular Line (LMCL)

Normal Findings: present or absent in apical impulse with

no heaves or lifts present

(Jarvis, 2019, p.494 & p.512)

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Palpation - Cardiovascular
• Palpate across the precordium (the chest wall)
• Including the aortic, pulmonic, Erb’s point, the tricuspid and the mitral
areas. The same as the auscultations sites
• Palpate for anomalies such as other pulsations and thrills
• Normal Findings: no pulsations except the apical impulse which is
palpable in about half of adults. There should be no heaves or thrills
present.
• **Presence of a palpable thrill may indicate a murmur is present.
• Heave or a Lift is the thrusting of the ventricle with systole
• Thrill is a palpable vibration
(Jarvis, 2019, p.512-513)

Cardiovascular System
Landmarks
• Aortic Valve – 2nd ICS right sternal border
• Pulmonic Valve – 2nd ICS left sternal border
• Erb’s Point – 3rd ICS left sternal border
• Tricuspid Valve – 5th ICS left sternal border
• Mitral Valve – (PMI) – 5th ICS left midclavicular line

(Jarvis, 2019, p. 514)

Auscultation Cardiovascular
• Erbs Point is generally the best place to auscultate an even
lub/dup sound – auscultate for one full minute
• Note:
• Rate and Rhythm
• Identify S1 and S2
• Assess S1 and S2 separately
• Listen for extra heart sounds
• Listen for Murmurs
Auscultate with both bell and diaphragm of the stethoscope in
all five landmark areas in a “Z” pattern starting with the aortic
area and finishing with the site of the apical impulse
(Jarvis, 2019, p.514)

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Characteristics of Normal Heart Sounds

• S1 – LUB
• loudest at the apex – mitral and tricuspid areas
• S2 should be quieter here

• S2 – DUP
• loudest at the base – aortic and pulmonic areas
• S1 should be quieter here

• S1 = S2 at Erb’s Point
(Jarvis, 2019, p. 515)

Auscultation - Cardiovascular
• Murmur
• A swooshing or blowing sound heard on the chest wall
• Innocent murmur
• generally a softer sound, midsystolic
• heard at second or third left intercostal space
• disappears with sitting
• has no valvular or pathological cause
• Functional murmur
• caused by increased blood flow
• for example: anemia, fever, hyperthyroidism
(Jarvis, 2019, p. 498 & 517-518)

Considerations – Older Adult

• CV changes occur due to stiffening of the vasculature
• Prone to arteriosclerosis and atherosclerosis with changes to
vasculature – impaired tissue perfusion and fluid volume excess
• Diastolic blood pressure may decrease after the sixth decade.
Together with a rising systolic blood pressure, this increases the pulse
pressure (the difference between the two)
• Incidence of Cardiovascular Disease (CVD) increases with age
• Orthostatic Hypotension
• Dysrhythmias
• Electrocardiograph
(Jarvis, 2019, p.502-503, 521-522)