Page 262 - Cardiac Nursing

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238 P A R T III / Assessment of Heart Disease
The Valsalva maneuver (forced expiration against a closed glot- turn to baseline or may be elevated briefly. The return to baseline
tis) has variable effects associated with each of its four phases. In of left ventricular hemodynamics is delayed for six to eight beats
I
I
phase I, the initial phase, intrathoracic pressure increases, causing and also may be elevated briefly. 6,33 During phase II, all murmurs
I
a transient elevation in left ventricular output. In phase II, the diminish except those of hypertrophic cardiomyopathy and mitral
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straining phase, venous return is decreased; first right, then left valve prolapse. The Valsalva maneuver should not be held for
ventricular filling is reduced; stroke volume, mean arterial pres- more than 10 seconds because it reduces cardiac output.
sure, and pulse pressure are reduced; and heart rate is increased. In Postural change from sitting or standing to lying down increases
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phase III, the release phase, venous return is increased, with subse- venous return first to the right and then to the left ventricle. Re-
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quent increases in right, then left, ventricular filling. In phase IV,V cumbence and passive leg raising cause most auscultatory cardiac
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the overshoot phase, right ventricular filling and stroke volume re- events to increase except the murmurs of idiopathic hypertrophic
A Appex
Apex
ex
of of lunungng
of lu g
LUL
L
RU
RUL
RUL
Horizontaal S
Spinous
fissure LUL
process
p
of T3
o
RML L LLL
RLL
Oblique
fissure
RLL
RL L LLL
RLL
LLL
Inspiratory
descent t Inspiratory
descent
Anterior view Posterior view
RULL LUL
LLL
RMML
LL
RLL
Ri g ht lateral vie w Left lateral view
Right lateral view
■ Figure 10-29 Respiratory assessment: Lobar localization. RUL, right upper lobe; RML, right middle lobe; RLL, right lower lobe; LUL, left
upper lobe; LLL, left lower lobe.