00:01
Now, let's talk about
when we talk about cardiac,
It is more than just your
heart rate, your heart rhythm.
00:07
We've got to think about that heart
perfuses all the rest of our body.
00:11
And this is going to be
an assessment details
that are important to include.
00:16
Now, this is going to include
your pulses,
your jugular vein distension.
00:20
And we'll get into that
a little bit more.
00:23
Capillary refill,
and also checking the edema.
00:25
So again,
your vascular system tells us a lot
about the cardiovascular and
circulatory status of your patient.
00:33
So we're talking about pulses.
00:35
so palpating pulses,
if you remember
palpating the feeling
that are central and distal.
00:41
Now, it's important here that
you're going to compare sides.
00:45
We want to check the rate,
we want to check the rhythm,
and how regular it is
just like that lub-dub.
00:51
We want to check the tension.
00:53
So if we talk about
compressing an artery
if you push on it,
you should feel some like
rebound, some flexibility.
01:00
And there should be a
certain amount of resistance.
01:03
And also when we talk about
strength or volume,
we're looking here: Is it strong?
Is it bounding? Is it weak?
Can we barely feel it?
These are all important
things to note
when we're talking about pulses.
01:16
So if you take a look at
this image here on our guy,
you see there's pulses
all over the place.
01:21
We've got lots of pulse points
starting in the neck with carotids,
your brachial artery
for blood pressure,
your radial which is in the wrist,
and your radial artery
is very easy to find.
01:33
So many times you're gonna gain a
pulse rate from the radial artery.
01:37
Your femoral artery,
the popliteal behind the knee,
and of course, those in the feet.
01:42
All of these are really important,
circulatory points.
01:47
Now, when we're talking
about palpating pulses,
here's something to keep in mind,
like, especially if you're
teaching or learning
how to assess a radial pulse.
01:56
Many times when you see in
new students assessing a pulse,
you will see that
they're pushing down,
it's really best that
you use your fingers
and really try to
lay them more flat
and provide light compression.
02:09
So if I'm finding my radial,
for example,
if I go down my thumb side,
use my thumbs.
02:15
And you notice I'm not here
pushing down,
I'm more flat,
I can easily find my radial pulse.
02:21
Now, one key note,
don't use your thumb,
your thumb has
a pulsating in itself
and this can give you an
inaccurate reading and assessment.
02:31
So next, let's talk about
something we call JVD
or Jugular Vein Distension.
02:37
So this is a sign of
increased venous pressure
inside of our body.
02:41
Now this can be a sign
of a lot of issues.
02:45
So this is really showing
when we're talking about
central venous pressure.
02:49
It just tells us how much blood
is flowing back into the heart,
how well that heart
can move into your body
or through your
body into your lungs
and back into
the rest of your body.
02:59
But if you see this JVD,
if you take a look at this image,
you see we're here in the jugular,
meaning the neck,
you see this vein is all engorge
and it's here to the surface,
that indeed is
jugular vein distension.
03:14
That means we've got too much fluid
in our circulatory system on board.
03:19
And this can cause lots of issues.
03:21
So if we assess that,
we need to examine the client with
the head of bed about 45 degrees.
03:28
And so when we're looking
at that vein in the neck,
is it distended, engorge,
and popping out
like you see in this image,
or is that pulsating?
This is all something
you want to report
to the health care provider.
03:40
Now another really easy and
important vascular system assessment
is capillary refill.
03:47
So this is really helpful
on diabetics
and specially on feet and toes
of a diabetic patient.
03:53
Capillary refill is really simple
and it's effective.
03:57
Here we're just checking
peripheral perfusion
or blood flow
to our extremities.
04:02
So all we do here
like you see in the image
is take a finger, push down
on the patient's fingernail.
04:09
Now we should see normal color
come back within three seconds.
04:13
If it's any longer
than three seconds,
this is abnormal.
04:17
This is a really easy test or
practice you can do at home.
04:20
And clearly if the patient
has fingernail polish,
you may have to remove this.
04:25
Now, in next thing to talk about
when you're talking about
the vascular system,
if you see any signs
of what we call cyanosis,
cyanosis is a bad thing.
04:36
So if you see this bluish color,
like you see in the image here,
if you see it in the hands,
the feet, the lips or the face,
any of this have signs of
cyanosis or this bluish color,
we have low oxygenation.
04:53
We are not perfusing,
meaning we're not getting
good blood flow to tissues
and this is an emergency.
04:59
You can lose tissues
and this is a problem.
05:02
And this is emergency
we've got to report.
05:06
Now next off, let's talk
about something called edema.
05:09
Now, edema can sometimes
be a less serious issue.
05:13
But again, this is going to
vary depending on the reason
why the edema is there.
05:17
So if we take a look at this image,
you see this patient's leg.
05:21
So on the forside of the image,
you see pretty normal
sided L size leg,
and then you see the other one
that's large, and engorge.
05:30
You can even see the skin
maybe coming around the ankle,
that is a edema.
05:34
So just by assessing the patient
on both sides,
you can tell if one leg
is larger than the other.
05:41
Same thing here on
the image of the feet.
05:43
Notice one foot looks
relatively normal.
05:46
The other one, you see the little
wrinkling almost around the ankle
and the size of the foot?
This is also noting edema.
05:54
So we talk about edema,
a lot of reasons.
05:57
So fluid volume excess, and you
could because there's a blood clot,
it could be a lot of reasons
or an infection
that the patient's got edema.
06:05
Now, we classify this
in two different ways.
06:08
One is called pitting edema,
meaning when we push on it,
it almost develops a little pit.
06:14
And non-pitting, which is like,
let's say you cut your finger
and it gets red hot swollen
and really tight.
06:22
That's what we call
non-pitting edema.
06:24
So just to discuss
how we rate edema,
or discuss non-pitting edema,
if you take a look at this image,
you see how the nurse simply just
takes their finger and pushes down
into the edematous area.
06:37
Now, this is kind of subjective,
but we really just kind of count
one, 1002, 1003, 1004, 1000.
06:46
And let's say it takes up to
one, 1002, 1000.
06:51
to get back to normal,
then we'll call it
+2 pitting edema.
06:56
So again, remember we
only grade pitting edema,
because you can push on it,
make that pit
like you see in the image.
07:05
We're gonna count,
and then see what we grade that
and that is only on pitting edema.
07:10
Now, other edema
can be caused again
from like DVTs,
where it's red, hot, and swollen.
07:15
This is called non-pitting,
and you can't push down
on that type of edema.