CVS, PVS AND LYMPH

Amy Johnson MSN, RN

Let’s make a pamphlet

Fold and get ready

CVS

Let’s review A and P Pericardium, epicardium, myocardium, endocardium SVC\IVC, Right atrium, tricuspid valve, right ventricle,

pulmonary valve, pulmonary artery, lungs, pulmonary vein, left atrium, mitral valve, left ventricle, aortic valve to aorta.

S1S2 means what? Lub is what? Dub is what? Systole? Diastole? S3? S4?- Normal in who? Murmurs? Coronary arteries? Conduction system

CVS

Pulmonary circulation Systemic circulation Cardiac cycle- remember for every

electrical conduction there should be a mechanical

Stroke volume-amount of blood ejected with every heart beat

Cardiac output- amount of blood ejected from left ventricle over 1 minute. CO= SV/bpm

Cultural considerations

HTN high risk Obesity Diabetes Smoking

Interview

Potential problems: CP, SOB/cough, fainting, urinating at night, leg cramps or claudication, fatigue

PMH- CP, palpitations, syncope, edema, changes in your legs, dyspnea or cough? CV disease Medications for CV disease Difficulties walking due to pain in legs, if yes tell

me more. Decrease in hair growth on your legs over time

Assessment

Inspection: observe patient: skin color, general appearance, eyes- periorbital edema, sclera, cornea, conjunctiva, lips and oral cavity color, head bobbing? Jugular veins, carotid arteries, fingernails… clubbing , heaves or lifts abnormal , pulsations in the abdominal region anures

Assessment

Palpation: in all auscultation sites, should not feel any pulsation, heaves or vibrations, in PMI area soft vibration approximately 2cm and tapping sensation with each heartbeat. Carotids

Percussion:

Auscultation: Diaphragm and bell

Check for pulse deficit

Cardiac Conundrum

The heart is just a pump. So what could possibly go wrong…

Structural – bad design plumbing, storage containers

Mechanical – bad parts valves, clog

Electrical – bad conductionwiring, current

Abnormal findings

Look up and discuss

PVS

Arteries

Veins

Lymph- epitrochlear node, let’s review the lymph nodes

Anatomy

Arteries – flexible, strong, tough and tense

Carry blood away from the heart

Veins – thinner, passive, have valves

Carry blood back to the heart

Rating a Pulse

4+ Bounding3+ Increased2+ Normal1+ Weak (thready)0+ Absence (not good at all)

Rating edema

Arterial insufficiency

What is it?

Arterial occlusion

What is it?

Jugular veins

Veins in the arm

Veins in the leg

– Deep veins

• Femoral

• Popliteal

– Superficial veins

• Great saphenous

• Small saphenous

– Perforators (connecting veins)

Veins

Varicose Veins

Veins Have Capacitance

They are distensible, can expand and hold more blood when the overall volume increases

This then reduces the stress on the heart.

Venous insufficiency

What is it?

So What Do You Look For?What Do You Ask?

Leg pain or cramps Skin changes on arm or

legs Swelling Lymph node

enlargement Medications Pulses -arteriol issues

Symmetry Capillary Refill Color changes Doppler when you cant feel

pulse

Hair distribution on legs Temp changes

Assessment

Inspect: what?

Palpate: where and how, what do you want to know? Cap refill? Edema? How is rated? Allen’s test? What is it and why do it? No homan’s test, why? Not best practice -VET call DR.

Auscultate: Where and what for? All artery tem, cor

Abnormalities

Let’s look them up.

Compare and contrast

Okay within your pamphlet- we are going to compare and contrast venous insufficiency and arterial

Case Study

56 year old WM with hx of atrial fibrillation, on Coumadin for prevention of thrombosis. He presents in clinic with lower right leg pain, you note on inspection that his right calf is larger than his left. You measure the two calfs and the right calf is 4 cm larger than the left. On palpation you note a 3+ peripheral edema. Upon interview you find that he missed a couple of doses of Coumadin due to running out on a trip.

Where does your critical thinking lead you? What is your priority nursing DX? A secondary DX?

Case study

44 yo male presents to the ED with c/o lower extremity pain since this am, no PMH.

Assess: what do you want to know?

Lympatics

Right Lymphatic Duct Thoracic duct

Lymph nodes

Lymph nodes

Epitrochlear node