CVS, PVS AND LYMPH Amy Johnson MSN, RN
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