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Class notes NRSG1304

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Abdominal Health Assessment

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  • March 8, 2023
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  • 2022/2023
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Heart and Neck Vessels (Cardiovascular System)
Direction of Blood Flow in Heart
Return via the Pulmonic Veins




Cardiac Cycle: Rhythmic movement of blood through the heart p.497




 Phases:
o Diastole – ventricles relax and fill with blood , 2/3rd of the cardiac cycle
o Systole – heart’s contraction, blood pumped from the ventricles and fills the
pulmonary and systemic arteries, 1/3rd of the cardiac cycle

Heart Sounds
 First heart sounds (S1) – closure of the AV valves(mitral and tricuspid valve close),
beginning of systole,
 Second Heart sounds (S2) – closure of the SL valves (aortic and pulmonic valve), end of
systole

, Extra Heart Sounds:
 3rd Heart Sound – ventricles resistant to filling during the early rapid filling phase , occurs
after S2
 4th heart sound – occurs at the end of diastole, when the ventricle is resistant to filling at
presystole

Characteristics of sound
 Frequency (pitch) – high pitched or low pitched
 Intensity – loud or soft
 Duration – very short for heart sounds, silent periods are longer
 Timing – systole or diastole

Palpation
Carotid arteries (p.511)
 Assess for strength, symmetry, and grade of pulses
o Normal finding = 2+ equal bilaterally
o Abnormal Finding = bruit indicates turbulence with a local vascular cause such as
atherosclerotic narrowing
 Carotids should be assessed one at a time

Inspection
Clients’ anterior chest for skin color, scars, deformities (p.494 and 512)
 Observe for pulsation at the apical impulse (located in the heart apex at the 4th or 5th ICS
at the left MCL
o Normal Finding = present or absent in apical impulse with no heaves or lifts
present
o Abnormal Finding = a heave or lift is a sustained forceful thrusting of the
ventricle systole

Palpation (p.512-513)
 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)
o Normal findings = no pulsations except the apical impulse which is palpable in
about half of adults. There should be no heaves or thrills present
o Abnormal Finding = a heave or lift is a sustained forceful thrusting of the
ventricle systole
 Presence of a palpable thrill may indicate a murmur is present
 Cardiac enlargement – left ventricular dilation displaces impulse down
and to the left and increases size more than one costal vertebral space
(from 5th to 6th ICS)  occurs with heart failure and cardiomyopathy
 Left ventricular hypertrophy – sustained impulse with increased force and
duration but no change in location

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