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Cardiovascular
System
Infants:
Transition from fetal circulation to postnatal
circulation. By 9 months anatomical closure
of foramen ovale occurs.
S1 and S2 sounds similarly on auscultation.
Pulse rate 120/min.
Horizontal position of the heart (till 7-years-
old).
Developmental Considerations
Infants:
Apex impulse is
located at the 4th
intercostal space 1 to
2 cm outward from
left midclavicular line.
Developmental Considerations
The pregnant female:
By the end of pregnancy blood volume
increases by 30 to 40 %.
Stroke volume and cardiac output are
increased.
BP decreases due to vasodilation.
Pulse rate increases of 10 to 15 beats/min.
Developmental Considerations
Developmental Considerations
An aging adult:
Objectives:
Subjective data.
Health history data.
Preparation.
Inspection: general appearance, precordium.
Palpation: peripheral pulses, apical impulse.
Percussion.
Auscultation: heart sounds, murmurs.
Summary checklist.
Subjective data
Angina an important
Subjective data
pulmonary problem,
but also occurs with
mitral stenosis
Edema:
Swelling of legs or dependent body part due
to increased interstitial fluid.
Onset, recent change, relation to time of day,
relieving factors, associated symptoms.
Nocturia:
Occurs with heart failure in the person who
is ambulatory during the day.
History taking.
Bring to lab:
Watch with second hand,
Stethoscope,
Marking pen and small centimeter ruler,
Alcohol swab (to clean endpiece).
Wear:
loose T-shirt or some other garment
that allows for practice of physical
assessment
Inspection
A Z-pattern is recommended.
Before beginning alert the person for long
duration of procedure.
Begin with diaphragm endpiece and use
the following routing:
Note the rate
the rhythm
Identify S1 and S2
Listen for extra heart sounds
Listen for murmurs
Auscultation (cont.)
Rhythm:
Regular
Irregular:
Synus arrythmia common variation. Rate
on inspiration and on expiration.
Regularly irregular
Irregularly irregular no pattern to the sounds,
beats come rapidly and at random intervals.
Pulse deficit occurs with atrial fibrillation,
heart failure, detects weak heart contractions.
Auscultation (cont.)
Identify S1 and S2
Location and amplitude,
Correlation with peripheral pulses, PMI
Correlation with ECG waves
Lub or dup
Give description of origin.
Listen to sounds separately:
accentuation, split (fixed, paradoxical).
Auscultation (cont.)