Question

Hi, I'm a med-surg assignment based on assessment of the cardiac system. I need 2 sentences for each question listed below. There should be a total of 10 sentence. Thank you.
1. Inspects for JVD
2. Palpates over valves for thrills
3.Uses bell and diaphragm to auscultate over all 5 valves- aortic, pulmonic, erbs point, tricuspid, and mitral. Identifies correctly and gives correct location.
4. identifies heart sounds.
5. evaluate heart for rate and rhythm

Answer 1

1) ans)Inspects for JVD:

Once you have determined that you are seeing the venous waves then measure the jugular venous pressure:

Identify JVP at the highest point of pulsation

Extend card or ruler horizontally from highest pulsation point , cross with ruler placed on the sternal angle (Angle of Louis), (let's say it was 8cm).

Add 5 cm (to get to the center of the atrium) and then report the JVP as "the jugular venous pressure was 13 cm of water" (not mercury).

The jugular vein pulsations usually have two elevations and two troughs. The first elevation (a wave) corresponds to the slight rise in atrial pressure resulting from atrial contraction. The first descent (x descent) reflects a fall in atrial pressure that starts with atrial relaxation. The second elevation (v wave) corresponds to ventricular systole when blood is entering the right atrium from the vena cavae while the tricuspid valve is closed. Finally, the second descent (y descent) reflects falling right atrial pressure as the tricuspid valve opens and blood drains from the atrium into the ventricle.

2)Palpates over valves for thrills

Palpation of the precordium starts by trying to locate the apex beat. Start by doing this with your entire hand and gradually become more specific until it is felt under one finger and describe its location anatomically.

The normal location is in the 5th intercostal space in the mid-clavicular line. It is quite common however, to not feel the apex beat at all

Palpate for any heaves or thrills. A thrill is a palpable murmur whereas a heave is a sign of left ventricular hypertrophy. A thrill feels like a vibration and a heave feels like an abnormally large beating of the heart. Feel for these all over the precordium.

3)Ans)

Auscultation of a heart begins with two critical items: a stethoscope and a patient. Knowledge about both these elements is key to assessing the health of a heart. Classic stethoscopes have two sides of the chestpiece—the diaphragm and the bell. The larger, flatter side is the diaphragm and is used for listening to higher pitched sounds. The bell is the smaller, concave side that allows for auscultation of lower pitched sounds like some heart murmurs. When performing a cardiac exam, auscultation should be performed with the diaphragm and then repeated with the bell.

The locations of auscultation center around the heart valves. The aortic, pulmonic, tricuspid, and mitral valves are four of the five points of auscultation. The fifth is Erb’s point, located left of the sternal border in the third intercostal space. The aortic point is located at right of the sternal border in the second intercostal space

The pulmonic point is to the left of the sternal border in the second intercostal space. The sound that emits from the aortic and pulmonic points is the S2 “dub” of the typical “lub-dub” heart beat. The S1 and S2 sounds are present in normal heart beat patterns.

The tricuspid point is found right of the sternal border in the fourth intercostal space, and the mitral point is located midclavicular on the left side of the chest in the fifth intercostal space. Both the tricuspid and the mitral points are where the S1 “lub” can be heard. The base of the heart is where the aortic and pulmonic S2 sound will be loudest. The apex is where the tricuspid and mitral S1 sound is loudest upon auscultation. The apex region will also be where S3 and S4 sounds (extra heart sounds not usually noted in normal assessments) and mitral stenosis murmurs may be auscultated, if present.

4)identifies heart sounds:

In a healthy adult, the heart makes two sounds, commonly described as 'lub' and 'dub. ' The third and fourth sounds may be heard in some healthy people, but can indicate impairment of the heart function. S1 and S2 are high-pitched and S3 and S4 are low-pitched sounds

5)evaluate heart for rate and rhythm:

Cardiovascular Function Electrocardiography (ECG) and direct and indirect blood pressure are used to monitor cardiovascular function. Electrocardiography is used to evaluate heart rate and rhythm.

When the cardiac rhythm is regular, the heart rate can be determined by the interval between two successive QRS complexes. On standard paper with the most common tracing settings, the heart rate is calculated by dividing the number of large boxes (5 mm or 0.2 seconds) between two successive QRS complexes into 300. For example, if the interval between two QRS complexes is two large boxes, then the rate is 150 beats per minute (bpm) (300 ÷ 2 = 150 bpm)