Study Guide –
Heart, Neck, Vessels, and Peripheral Vascular Systems
1. Review the direction of blood flow in the body by following the movement of a blood
clot in the right leg that has dislodged.
If there was a blood clot that had been dislodged in the right led it would carry on to
travel to the right atrium through inferior vena cava.
- From the right atrium it would then pass on through the tricuspid valve to th
pulmonary artery.
- After going through the pulmonary artery the blood clot would travel through to the
lungs to become oxygenated.
- The oxygenated blood will then pass back through left ventricle to the aorta.
- The aorta then delivers blood to body.
2. During your assessment of a peer you will be ausculating his/her heart sounds. Which
heart sound is heard louder at the apex? Which sound is louder at the base? What is
happening within the heart to create these sounds?
The loudest sound heard at the apex (5 intercostal space) is S1. S1 (lub) stands for the
first heart sound, which occurs with closure of the AV valves thus signals the
beginning of systole. There is also the mitral component to the first sound which
slightly precedes the tricuspid component, but these 2 sounds are usually heard
together as one sound.
The loudest sound heard at the base is S2. S2 (dub) is the second heart sound, which
occurs with closure of the semilunar valves and signals the end of systole. There is
also the aortic component of the second sound which slightly precedes the pulmonic
component.
During inspiration, intrathoracic pressure decreased. This pushes more blood into the
vena cava, increasing venous return to the right side of the heart. This increases right
ventricular stroke volume.
On the left side, a greater amount of blood is sequestered in the lungs during
inspiration. This briefly decreases the amount returned to the left side of the heart,
decreasing left ventricular stroke volume.
3. You will ausculate your peer’s neck for carotid bruit. What instructions will you give
her? What part of the stethoscope is best for detecting bruits? What other vessels
would you assess in the neck?
When ausculating for bruits I would ask my peer to keep her head in the neutral
position. As I am ausculating I will ask the person to take a breath, exhale, and hold it
briefly while I listen. For ausculating bruits in the neck I will use the bell of the
stethoscope and ausculate on the angle of the jaw, the midcervical area, and the base
of the neck.
Other vessels that you would asses would be the carotid artery and the jugular veins
(left and right external and internal jugular veins). These vessels reflect the efficiency
of cardiac function.
4.
Discuss the health promotional focus relevant to Southern Alberta, incorporating
information relevant to cultural groups in this area.
Since were in the middle of Canadian Non-smoking week in Canada, this is a health
promotional idea, since it raises awareness of the effects of tobacco use. Smoking can
cause decreased oxygen to the heart, increase BP and HR, increased blood clotting
and damage to cells that line coronary arteries and other blood vessels.
Many institutions raise awareness regarding diabetes since many of the first nations
are at high risk for diabetes. People with diabetes are more likely to get heart disease
because your blood sugar level is much higher then average. This can lead to
damaging of many parts of the body including blood vessels. They can get ulcers
because of poor circulation and opothy
5.
You are assessing circulation, sensation, and movement (CSM) on your peer’s legs.
Describe the assessment included in CSM.
potter and perry, as well as on sheets in the work sheets
c- hair growth on both sides of the body- distribution
asses pulse on both sides
manual compression test (check valves)
temperature
color
edema
cap refill, under 3 seconds
lesions
s- can you feel touch?
Cotton swap and ask where they are touching you.
Any unusual sensations, and can you feel me touching you with your eyes closed. Is it
equal on both sides.
m- ROM
move big toe
equal strength bilaterally
“toes to nose”
6.
Which lymph nodes could be assessed in this system?
The nodes which are accessible to inspection and palpation in this system are the:
Cervical nodes: which drain the head and neck.
Axillary nodes: drain the breast and upper arm.
Epitrochlear nodes: is in the antecubital fossa and drains the hand and lower arm.
The inguinal nodes: in the groin and drain most of the lymph of the lower extremity,
the external genitalia, and the anterior abdominal wall.
7.
Bring a research article about taking blood pressure especially in the elderly and
discuss application of the information.
8.
Discuss the difference between ulcers caused by arterial insufficiency or venous
insufficiency.
When inspecting the leg, you may come upon skin discoloration, skin ulcers, or
gangrene.
Venous ulcers occur usually at medial malleolus because of bacterial invasion of
poorly drained tissues. On the other hand with arterial deficit, ulcers occur on tips of
toes, metatarsal heads, and lateral malleoli.
Venous
- Faulty valves- pools
- Skin change- brown pigments- iron
- Cyanotic- red or normal
- Normal temp
Arterial- artherscolosis- deposits, decrease blood to area.
Skin change- shiny skin
Pale, pallor
Cool temp
*Chart in potter and perry
Also Jarvis pg 552
9.
Identify the principles related to applying an elastic bandage (tensor) and
thromboembolic device (TED) hose. Discuss when these might be used.
When trying to prevent thrombus formation the most cost-effective way to address
the deep vein thrombisis formation is through prevention. The thromboembolic
device (TED) aids in maintaining external pressure on the muscles of the lower
extremities and thus may promote venous return. When considering applying TED
stockings the nurse first assesses the client’s suitability for wearing them. The
stockings should not be applied if there is any local condition affecting the leg
because applying may compromise circulation. The nurse should assess circulation at
the toes to ensure that the hose are not too tight.
10. How does your level of nursing knowledge and experience influence your ability to
think critically in the clinical setting?
When approaching a clinical setting, the nurse will collaborate with the client and
choose nurse interventions to meet the needs of the client. The nurse will use his/her
knowledge base to be able to assess a patients situation and be able to come out with
the best nursing care plan possible. The knowledge will allow the nurse to assess the
patient accurately being able to identify what is an expected finding versus and a
finding that needs to be further assessed.
Nurses experience will work in partnership with their knowledge they have already
gained. They will have gained experience throughout their years as students and as a
nurse, giving them familiarity with some situations. The nurse will then be able to
begin to understand clinical situation, recognize cues of clients health problems and
interpret cues as relevant or irrelevant. The nurse will no longer assess just by their
knowledge base instead use intuition because of experience.
11. Definitions
Pulses in the body
Temporal- head and neck
Carotid- CVS
Brachial-PBS
Radial- PBS
Inguinal- not OSCE
Femoral- not OSCE
Popliteal- not OSCE
Dorsalis pedis- PBS for feet (top of feet)
Posterior tibialis- PBS for feet (by ankle)