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Assessment of Heart & Neck Vessels

Assessment of Heart & Neck Vessels. Taylor, ch 25 Jensen, ch 19. History Collection. Ask about: Risk factors Symptom hx PMH Hospitalizations, dx tests Social hx Health maintenance activities Children’s hx. Non-modifiable: Age Race Gender Fa hx. Modifiable: HTN CAD DM Smoking

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Assessment of Heart & Neck Vessels

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  1. Assessment of Heart & Neck Vessels Taylor, ch 25 Jensen, ch 19

  2. History Collection • Ask about: • Risk factors • Symptom hx • PMH • Hospitalizations, dx tests • Social hx • Health maintenance activities • Children’s hx

  3. Non-modifiable: Age Race Gender Fa hx Modifiable: HTN CAD DM Smoking Obesity Inactivity Stress BCPs Risk Factors

  4. Chest pain Dyspnea,orthopnea, DOE, PND Dizziness, syncope Activity intolerance, fatigue Palpitations Cyanosis, pallor Edema/wt gain Cough—dry or wet, productive or non Nocturia, oliguria Extremity pain HAs, nosebleeds, blurred vision Easy bruising Symptom history

  5. HTN “Heart problems”, i.e., murmurs, arrhythmias, MI, congenital, rheumatic fever Hyperlipidemia Lung disease Tumors Blood disorders Kidney disease CVA Thyroid disease Surgery Hospitalizations Dx tests Injuries/accidents Communicable diseases Meds allergies PMH (MD dx of…)

  6. History cont’d • Social: • ETOH, drugs, tobacco, home and work environment • HMA: • sleep, diet, exercise, stress management, checkups

  7. Children’s history • Feed and play without tiring? • Cyanosis, esp with crying or exertion? • Growth up to standard? • Position changes during activity? • Hx strep, unexplained joint pain, fever? • Hx lung problems? • HA, nosebleeds? • Sib with heart defect? • Chromosomal abnormalities?

  8. Physical Assessment--General • Skin • VS • Peripheral pulses • Heart—4 techniques • Inspection of extremities • Lungs • Abdomen

  9. Physical Assessment—Heart • Inspect for apical impulse (PMI) • Palpate for apical impulse and across precordium—no other impulse should be felt (thrill) • Percuss starting at 5th space and anterior axillary line and move right • Auscultate—APETM, supine, left side, sitting

  10. Auscultation • Note rate and rhythm • Identify S1 and S2 and assess them • Listen for extra sounds—split S2, S3, S4 • Listen for murmurs and grade acc’d to loudness only and if heard on S1 or S2

  11. Physical Assessment—Neck Vessels • Inspect carotid and jugular pulsations • Perform HJR • Palpate carotids (not both at once!) • Auscultate carotids for bruit using bell

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