N210 Week-3 Lecture Oxygenation & Perfusion Assessment

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N210 Week-3 Lecture Oxygenation & Perfusion Assessment
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2015-10-12 15:00:32
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N210 Week Lectuer Oxygenation Perfusion Assessment
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  1. 1. Discuss specific assessments performed during examination of a patient’s perfusion status
    • • Perfusion: oxygenated capillary blood passes through the tissues of the body
    • a. Palpate the apical impulse
    • 1. Localize the apical impulse using one finger pad
    • b. Palpate across the precordium
    •  Gently palpate using the palmar aspects of your four fingers
    • • Apex
    • • Left sternal border
    • • Base
    • Auscultate Heart Sounds
    • 1. Use the anatomic locations (look at diagram in question #3)
    • 2. Follow routine:
    • • Note rate and rhythm
    • • Identify S1 and S2
    • • Assess S1 and S2 separately
    • • Listen for extra heart sounds
    • • Listen for murmurs
    • Anterior Chest
    • a. Palpate the apical impulse
    • b. Palpate across the precordium
    • Heart Sounds
    • a. Second right interspace - Aortic valve area
    • b. Second right interspace - Pulmonic valve area
    • c. Left lower sternal interspace - Tricuspid valve area
    • d. Fifth interspace around left midclavicular line - Mitral valve area
  2. 2. Describe normal heart sounds (S1and S2) and the location in which they are heard best
    • • First heart sound (S1) is caused by closure of the AV valves
    •  S1 signals the beginning of systole
    •  You can hear it over the entire precordium, although it is loudest at the apex
    • • Second Heart Sound (S2) is associated with closure of the semi lunar valve
    •  You can hear it with the diaphragm over the entire precordium, although it is loudest at the base
    • Splitting of S2
    • • A split S2 is a normal phenomenon that occurs toward the end of inspiration in some people
    • • Recall that closure of the aortic and pulmonic valves is nearly synchronous
    • • Because of the effects of respiration on the heart, inspiration separates the time of the two valves’ closure, and the aortic valve closes .06 seconds before the pulmonic valve
    • • Instead of one “DUP”, you hear a split sound-“T-DUP”
    • • During expiration synchrony returns, and the aortic and pulmonic components fuse together
    • • A split S2 is heard only in the pulmonic valve area, the second left interspace
    • • the split S2 occurs about every 4th heartbeat fading in with inhalation and fading out with exhalation
  3. 3. Describe extra heart sounds S3 and S4
    • S3
    • • due to rapid ventricular filling: ventricular gallop
    • • S1 – S2-S3 (“ken—tuc-ky”)
    • • may be present in CHF
    • S4
    • • due to slow ventricular contraction: atrial gallop
    • • S4-S1 – S2 (“Ten-nes—see)
    • • may be present in MI, HTN, CAD
  4. 4. Define murmurs and the specific assessment of a client with a murmur.
    •  turbulent blood flow within the heart
    •  blowing, swooshing sound that occurs with turbulent blood flow in the heart or great vessels
    •  listen for murmurs in same auscultatory sites: APETM
    • • Grade
    • -1/5 – 5/5
    •  1: barely audible
    •  2: clearly audible, but faint
    •  3: moderately loud
    •  4: loud, associated with a thrill palpable on chest wall
    •  5: very loud
    •  6: loudest
  5. 5. Discuss specific assessments performed during examination of the peripheral vascular system (Taylor , 674)(Jarvis , 149)
    • *This requires the checking of Circulation
    • o Inspect in this order:
    • 1) Arms
    • 2) Legs
    • 3) Leg Veins
    • o Inspect and Palpate the ARMS
    • 1. Note color of skin and nail beds
    •  Temperature, texture
    •  Turgor of skin, lesions
    • 1. Note the symmetry of both arms
    • 1. Check Capillary Refill
    •  Depress and blanch nail beds and release
    • • Note the time for color return
    • * **Consider it normal if it refills within 1-2 seconds
    • * **Room temp., decreased body temp., peripheral edema, smoking can skew your findings
    • * ***Refill lasting more than 1-2 seconds indicates vasoconstriction or decreased cardiac output
    • 4) Palpate both radial pulses
    •  Note rate, rhythm
    •  Grade force on a point scale
    • • 3+ increased
    • • 2+ NORMAL
    • • 1+ weak
    • • 0 absent
    • o Inspect and Palpate the Legs
    • 1. Inspect both legs together noting:
    •  Skin color, hair, venous pattern, size (swelling or atrophy)
    •  Lesions and ulcers
    •  Venous Pattern
    • • they are normally flat and barely visible
    • • Note varicosities ( twisted, enlarged superficial veins)
    •  Leg Symmetry
    •  Palpate leg temperature along the legs and down the feet
    •  Palpate the peripheral arteries (Grade on 3 Point Scale)
    • • Femoral: upper portion of thigh
    • • Popliteal: difficult to palpate, behind the knee cap
    • • Dorsalis pedis:
    • • Posterior tibial: between the malleolus & achilles
    •  Check for Pretibial edema
    • • Depress pretibial area of medical malleolus for 5 sec.
    • • If Pitting Edema exists rate as follows:
    •  1+ Mild Pitting, slight indentation, no swelling of leg
    •  2+ Moderate pitting, indentation subsides rapidly
    •  3+ Deep Pitting, indentation remains, leg is swollen
    •  4+ Very Deep pitting, indentation lasts, leg is grossly swollen
  6. 6. Review the structure and function of the respiratory system (Taylor , 1398)
    • • Nose —> Terminal Branchioles: the pathway for transportation and exchange of oxygen and carbon dioxide
    • • Split into Upper and Lower
    • • Upper Airway
    •  Nose, Pharynx, Larynx and Epiglottis
    • • Function: warm, filter and humidify inspired air
    • • Lower Airway aka Trachiobronchial Tree
    •  Trachea, (R)(L) Stem of Bronchi, segmental bronchi, terminal bronchioles
    • • Function: conduction of air, mucociliary clearance, and production of pulmonary surfactant
  7. C. Breathing through the nose can falsely produce abnormal breath sounds
  8. 10. Discuss and describe adventitious breath sounds and identify conditions/disease in which these may be present (Ch. 38, pp. 1411)
    • A. Adventitious breath sounds (extra, abnormal sounds of breathing)
    • 1. Examples: crackles or wheezing
    • 2. Crackles
    • a. Usually heard on inspiration, are soft, high-pitched, discontinuous (intermittent) popping sounds
    • b. Produced by fluid in the airways or alveoli and delayed reopening of collapsed alveoli
    • c. Occur during inflammation or congestion
    • d. Associated with pneumonia, heart failure, bronchitis, and COPD
    • 3. Wheezes
    • a. Continuous musical sounds
    • b. Produced as air passes through airways constricted swelling, narrowing, secretions, or tumors
    • c. Associated with asthma, tumors, or buildup of secretions

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