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Cardiac Assessment Narrated F 24

SLCC Med Surg Videos・62 minutes read

The heart is divided into four chambers with the right side collecting venous blood for oxygenation and the left side distributing oxygenated blood to the body. Various factors like demographics, medical history, symptoms, and physical examinations play a crucial role in assessing and diagnosing heart health.

Insights

The heart has four chambers: right atrium, right ventricle, left atrium, and left ventricle, each serving distinct functions in oxygenating and distributing blood throughout the body.
A comprehensive cardiac assessment involves a detailed examination of various factors like medical history, vital signs, skin conditions, and pulse characteristics to identify potential heart issues and inform appropriate care strategies.
Effective communication and patient education are vital components of cardiovascular care, helping to address fears, provide clarity, and ensure patient and family understanding of heart-related conditions and treatments.

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Recent questions

What are the four chambers of the heart?
RA, RV, LA, LV

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Summary

00:00

Heart anatomy and health factors explained

The heart is divided into four chambers: right atrium, right ventricle, left atrium, and left ventricle.
The right side of the heart collects venous blood for oxygenation in the lungs.
The left side of the heart distributes oxygenated blood to the body.
The heart valves prevent premature blood flow between chambers.
Blood exits the heart through the semilunar valves.
History provides insight into a patient's heart health.
Demographics like age and gender impact cardiovascular risk.
Family history can indicate predisposing factors for heart disease.
Past medical history, medications, and lifestyle habits influence heart health.
Allergies and socioeconomic factors can impact cardiovascular care.

18:10

Identifying and Differentiating Cardiac Symptoms and Signs

Differentiating stable and unstable angina based on the circumstances of onset and duration
Using a 0-10 scale to assess pain objectively, with the goal of zero for cardiac patients
Identifying additional signs and symptoms like nausea, vomiting, diaphoresis, and pale complexion
Noting complaints of severe fatigue, impending sense of doom, rapid heart rate, and muscle weakness
Considering dyspnea on exertion and changes in activity levels as potential indicators of heart failure
Observing patients' preferred body positions, such as orthopneic position, for clues to cardiac or respiratory issues
Recognizing paroxysmal nocturnal dyspnea as a sign of fluid buildup in the lungs
Monitoring weight gain, especially in relation to fluid retention and cardiac workload
Assessing for extremity pain as a symptom of ischemia, with different causes like arterial or venous insufficiency
Conducting orthostatic blood pressure measurements to evaluate medication effects and disease impact

36:06

Assessing Vital Signs and Skin Conditions

To assist unstable individuals, have someone stand behind them when they rise to prevent balance issues.
Postural hypertension is identified by a systolic blood pressure drop of over 10-15 and a diastolic drop of over 10, accompanied by a 10-20% heart rate increase.
Abnormal vital signs include paradoxical blood pressure, with a systolic drop exceeding 10 mmHg, indicating conditions like pulmonary hypertension or cardiac tamponade.
Assess individuals' appearance, hygiene, and living conditions to gauge their well-being and ability to perform daily tasks.
Signs of increased lipid levels include arcus senilis and xanthelasma, indicating high cholesterol levels.
Skin examination involves assessing color, temperature, and texture, with Table 25-3 in the book offering valuable information on skin color changes and underlying issues.
Skin color changes like pallor, rubor, and icterus can indicate conditions like anemia, venous congestion, or liver problems.
Stasis dermatitis, a rusty rash on the lower legs, signifies chronic venous insufficiency due to blood pooling.
Skin turgor, tested by pinching and observing the skin's return, indicates hydration levels and decreases with age.
Observing jugular vein pulsations can estimate right-sided heart function and central venous pressure, crucial for diagnosing conditions like heart failure or pulmonary hypertension.

54:39

Assessing Circulation in Extremities for Health

Poor circulation to extremities can lead to numbness, muscle fatigue, and paralysis due to decreased oxygen reaching the nerves.
Clubbing of fingers or toes can indicate chronic hemoglobin desaturation, often seen in conditions like heart failure or respiratory disorders.
Checking for clubbing involves aligning the nails of the fourth fingers and looking for a flattened angle, indicating potential issues.
Prolonged capillary refill time can suggest inadequate arterial perfusion, with normal reperfusion occurring within two to three seconds.
Peripheral edema, found in feet, ankles, or legs, can be assessed by applying pressure and observing indentation, often linked to cardiac issues or low protein levels.
Dependent edema, due to gravity and inactivity, is common in lower extremities, while pitting edema involves indentations that can be rated based on depth and duration.
Pulse amplitude reflects blood pressure and arterial circulation, with absent, diminished, normal, or bounding pulses being assessed through palpation.
Checking pulses bilaterally and using a doppler if pulses are not palpable can help assess arterial circulation accurately.
Pulsus alternans, alternating weak and strong arterial pulses, can indicate ventricular systolic impairment.
A systematic approach to examining the heart includes inspecting, palpating, and auscultating the aortic area at the second intercostal space to the right of the sternum.

01:12:54

Cardiac Assessment: Locations, Palpation, and Auscultation

The aortic area is located to the right of the sternum, while the pulmonic area is to the left.
Erb's point is found on the left side of the sternum at the third intercostal space.
The tricuspid area is situated at the fourth and fifth intercostal spaces on the left side of the sternum.
The mitral or apical area is at the left fifth intercostal space along the midclavicular line.
The apical impulse is a normal finding, felt as a light pulsation, 1 to 2 centimeters in diameter, at the onset of the first heart sound.
The nurse uses the palm of the hand to locate the apical impulse and assess its size and quality with finger pads.
Palpation should only be palpable in about one intercostal space; stretching or enlargement over more spaces may indicate left ventricular hypertrophy.
Abnormal movements or vibrations other than the apical impulse should be noted during palpation.
During auscultation, the nurse listens for the apical pulse rate, rhythm regularity, and any pulse deficit.
Heart sounds S1 and S2, known as lub dub, are produced by the closure of the AV and semilunar valves respectively, corresponding with ventricular systole and diastole.

01:31:03

Identifying and Managing Cardiovascular Murmurs

Murmurs are caused by turbulent blood flow through the valves, classified based on timing in the cardiac cycle as systolic and diastolic.
Systolic murmurs correlate with the pulse and ventricular systole, identified by placing a finger on one side of the carotid pulse while listening.
Systolic murmurs can be normal in some cases, like during pregnancy or with high fevers, but can also indicate valvular disorders.
Diastolic murmurs do not correlate with pulses, always considered abnormal and usually indicating a valvular disorder.
Pericardial friction rubs caused by inflammation or infection, heard as grating or friction, usually with the bell of the stethoscope.
Respiratory effort assessment crucial in cardiovascular assessment, looking for signs like air hunger, noisy breathing, or retractions.
Different breath sounds like crackles, wheezes, or gurgling can indicate heart failure, with placement within lobes important.
Assessing sputum consistency, coloration, and amount is vital for diagnosing infections or other conditions.
Mental status assessment crucial as confusion or disorientation can indicate heart dysfunction or ischemia, especially in the elderly.
Providing clear explanations and reassurances to patients and families is essential to alleviate fear and anxiety associated with cardiovascular threats.

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