Physical Assessment

The Cardiovascular and Peripheral

Vascular Systems
Anatomy of the Heart
 Lies at the
mediastinum
 Base, upper portion,
lies toward the back
 Apex, lower portion,
points anteriorly
 Point of maximal
impulse (PMI)
Heart Sounds
 S1 – occurs when the
atrioventricular valves
close, “lub”
 S2 – occurs when the
semilunar vlaves close, S1 S2
“dub”
 Systole – is the period in
which the ventricles
contract
 Diastole – is the period
in which ventricles relax
Anatomy of the Heart
 Anatomic sites of
precordium
• Aortic area
• Pulmonic area
• Tricuspid area
• Mitral or apical area
• Epigastric area
 Central Vessels
 Carotid arteries
• Common
carotid artery
• External and
internal carotid
artery
 Jugular veins
• Internal jugular
vein
• External jugular
vein
Assessing the Heart and Central Vessels
 Inquire if the client has any history of the
following:
• Family history of incidence and age of heart
disease
• High cholesterol levels
• High blood pressure
• Stroke
• Obesity
• Congenital heart disease
• Hypertension
Assessing the Heart and Central Vessels

 Simultaneously inspect and palpate the

precordium for the presence of abnormal
pulsations, lifts or heaves. Locate the valve
areas of the heart
 Assessing the Heart and Central Vessels

 Auscultate the heart in all four

anatomic sites: aortic, pulmonic,
tricuspid and apical (mitral)
• Eliminate room noise
• Client in supine position with head
elevated 30 to 45 degrees
• Use both the diaphragm and the bell
to listen to all areas
• Distinguish both s1 and s2 sounds
• Concentrate on one particular sound
at a time in each area
• Reexamine the heart while in the
upright position
Carotid Arteries
 Palpate the carotid artery,
using extreme caution
 Auscultate the carotid artery
• Turn the client’s head
slightly away from the side
being examined
• Auscultate the carotid artery
on one side and then the
other
• Listen for the presence of
bruit
Jugular Veins
 Inspect the jugular veins for distention, client
is placed in a semi-Fowler’s position with
head supported on a small pillow
 If jugular distention is present, assess the
jugular venous pressure
Lifespan Considerations
 Infants:
• S2 may be heard when the child takes a deep
breath
• Murmurs may be heard in newborns
 Children
• Heart sounds may be louder
• S3 is present in about 1/3 of all children
• PMI is higher and more medial in children
under 8 years old
Lifespan Considerations
 Elders
• Cardiac output and strength of contraction
decrease
• S4 heart sound is considered normal in older
adults
• Sudden emotional and physical stresses may
result in cardiac arrhythmias and heart failure
Assessing the Peripheral Vascular
System
 Inquire if the client has any history of the
following:
• Past history of heart disorders
• Varicosities
• Arterial disease
• Hypertension
• Lifestyle
• Activity patterns
• Smoking
• Use of alcohol
Assessing the Peripheral Vascular
System
 Palpate the peripheral
pulses on both sides of
the client’s body to
determine symmetry of
pulse volume
Assessing the Peripheral Vascular
System
 Inspect the peripheral veins in the arms and
legs for the presence and/or appearance of
superficial veins
 Assess the peripheral leg veins for signs of
phlebitis
• Homan’s test
Assessing the Peripheral Vascular
System
 Inspect the skin of the hands and feet for
color, temperature, edema, and skin changes
 Assess adequacy of arterial flow
• Buerger’s Test
• Capillary refill test
• Allen Test
Lifespan Considerations
 Infants:
• Compare strength of the femoral pulses with
the radial and apical pulse
 Elders
• Overall effectiveness of blood vessels
decreases
• Assessment should always include upper and
lower extremities’ temperature, color, pulses,
edema, skin integrity and sensation
The best and the most beautiful
things in the world cannot be seen
nor even touched. They must be
felt by the heart…..

Be a nurse with a pure heart.