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Heart is hollow four chamber, muscular pump organ Pericardium outer layer Pericardial sac in between parietal and visceral layer ,containing 5-20cc of fluid, protects myocardium Myocardium makes up the walls of the heart chambers – left ventricle is 5-10 times thicker than right side Inner endocardium are the cardiac valves and blood vessels. The intraventricular and intraatrial septa separates the right and left chambers Atrioventricular valves- tricuspid and mitral valves Semilunar valves- pulmonic and aortic valves VASCULATURE Right coronary artery, left coronary artery, great cardiac veins, anterior cardiac veins, besian veins Automaticity ( pace maker ability) Conductivity (Each cell has the ability to conduct impulses to tnext cell) Contractility (ability to contract) Irritability (each cell has the ability to contrct on its own) BP is determined by the cardiac output, the velocity, the resistance of the blood vessels. Systolic- initial force of contraction of heart Diastolic-pressure of blood vessels after initial force Pulse pressure- difference between systolic and diastolic BP Control of HR, CO, blood vessels and the amount of blood volume Sympathetic secretes norepinephrine and innervate cardiac plexus and increase rate of SA node Parasympathetic secretes acetylcholine and innervates cardiac plexus leads to decrease of SA node rate Both regulates normal heart rate and blood pressure Prior history collection the nurse should know the data of the patient Read old charts or summary : previous admission, current and past drugs, reason of admission, social support, allergies, discharge information, chronic medical problems Ask symptoms of present illness Maintain a soothing conversation Don’t rush the patient to answer Ask the patient to describe illness finally Record response and can ask more details if necessary Ask for specific cardiac conditions Find out any cardiac drugs patient is taking Assess for any use of alcohol or nicotin Assess the social factors Record the findings INSPECTION Explain the procedure to the patient Provide privacy and undress the patient Sit upright to inspect thorax Inspect posture and symmetry, color of skin, deformities of bone, the neck, face and eyes Breathing pattern to be noted Aware of cyanosis Central cyanosis -lips mouth and conjunctiva indicates heart disease and poor oxygenation Peripheral cyanosis- lips, ear lobes, nail buds PMI (point of maximum intensity): ask to lay on left side and assess skin color of thorax EYES: Arcus senilis- light gray ring surrounding iris common in older patient. If in younger patient indicate lipid metabolism disorder. Xanthelasma- yellowish plaques on skin surrounding the eyes ,also in elbow indicate hypercholesterolemia PALPATION SKIN: frank edema ,puffiness, pitting edema +1,+2,+3,+4.(feet, ankle, face , sacrum, trunk, abdomen) BREATHING: lay hands on chest at different location , feel -respiration pattern , rib elevation, precordial pulses ARTERIES: apical Read less