STUDY - Technical - New Dacian's Medicine
jugular
vein distention (Classical / Allopathic Medicine)
Jugular vein
distention (JVD) is the abnormal fullness and height of the
pulse waves in the internal or external jugular veins. When a
patient in a supine position has his head elevated 45 degrees,
a pulse wave height greater than 1½″ (4 cm) above the angle of
Louis indicates distention. Engorged, distended veins reflect
increased venous pressure in the right side of the heart. This
sign characteristically occurs in heart failure and other
cardiovascular disorders. (See Evaluating jugular vein
distention.)
ALERT:
If you detect JVD and the patient is in respiratory distress:
- take his vital signs
- assess his skin for paleness, coolness, and clamminess
- auscultate lung sounds
- provide supplemental oxygen and monitor cardiac status.
If the patient isn't in respiratory distress, perform a focused assessment.
If you detect JVD and the patient is in respiratory distress:
- take his vital signs
- assess his skin for paleness, coolness, and clamminess
- auscultate lung sounds
- provide supplemental oxygen and monitor cardiac status.
If the patient isn't in respiratory distress, perform a focused assessment.
HISTORY:
Ask the patient if he has gained weight recently. Does he have difficulty putting on shoes? Are his ankles swollen?
Ask the patient if he has experienced chest pain, shortness of breath, paroxysmal nocturnal dyspnea, anorexia, nausea, and vomiting.
Review the patient's medical history for cancer and heart, pulmonary, or renal disease.
Ask the patient if he has experienced a decrease in urine output.
Ask the patient if he has gained weight recently. Does he have difficulty putting on shoes? Are his ankles swollen?
Ask the patient if he has experienced chest pain, shortness of breath, paroxysmal nocturnal dyspnea, anorexia, nausea, and vomiting.
Review the patient's medical history for cancer and heart, pulmonary, or renal disease.
Ask the patient if he has experienced a decrease in urine output.
Evaluating jugular
vein distention
To evaluate jugular vein distention (JVD), first place the patient in the supine position so that you can visualize pulsations reflected from the right atrium. Then elevate the head of the bed 45 to 90 degrees. (Normally, veins distend only when a patient lies flat.) Next, locate the angle of Louis (sternal notch) - the reference point for measuring venous pressure. To do so, palpate the clavicles where they join the sternum (the suprasternal notch). Place your first two fingers on the suprasternal notch. Then, without lifting them from the skin, slide them down the sternum until you feel a bony protuberance - this is the angle of Louis.
Find the internal jugular vein (which indicates venous pressure more reliably than the external jugular vein). Shine a flashlight across the patient's neck to create shadows that highlight his venous pulse. Be sure to distinguish jugular venous pulsations from carotid arterial pulsations. One way to do this is to palpate the vessel: Arterial pulsations continue, whereas venous pulsations disappear with light finger pressure. Also, venous pulsations increase or decrease with changes in body position, but arterial pulsations remain constant.
Next, locate the highest point along the vein where you can see pulsations. Using a centimeter ruler, measure the distance between that high point and the sternal notch. Record this finding as well as the angle at which the patient was lying. A finding greater than 4 cm above the sternal notch, with the head of the bed at a 45-degree angle, indicates JVD.
PHYSICAL EXAMINATION:
Take the patient's vital signs, and then weigh him, if possible.
Inspect and palpate the extremities and face for edema.
Auscultate the lungs for crackles and the heart for gallops and a pericardial friction rub.
Inspect the abdomen for distention, and palpate and percuss for an enlarged liver.
To evaluate jugular vein distention (JVD), first place the patient in the supine position so that you can visualize pulsations reflected from the right atrium. Then elevate the head of the bed 45 to 90 degrees. (Normally, veins distend only when a patient lies flat.) Next, locate the angle of Louis (sternal notch) - the reference point for measuring venous pressure. To do so, palpate the clavicles where they join the sternum (the suprasternal notch). Place your first two fingers on the suprasternal notch. Then, without lifting them from the skin, slide them down the sternum until you feel a bony protuberance - this is the angle of Louis.
Find the internal jugular vein (which indicates venous pressure more reliably than the external jugular vein). Shine a flashlight across the patient's neck to create shadows that highlight his venous pulse. Be sure to distinguish jugular venous pulsations from carotid arterial pulsations. One way to do this is to palpate the vessel: Arterial pulsations continue, whereas venous pulsations disappear with light finger pressure. Also, venous pulsations increase or decrease with changes in body position, but arterial pulsations remain constant.
Next, locate the highest point along the vein where you can see pulsations. Using a centimeter ruler, measure the distance between that high point and the sternal notch. Record this finding as well as the angle at which the patient was lying. A finding greater than 4 cm above the sternal notch, with the head of the bed at a 45-degree angle, indicates JVD.
PHYSICAL EXAMINATION:
Take the patient's vital signs, and then weigh him, if possible.
Inspect and palpate the extremities and face for edema.
Auscultate the lungs for crackles and the heart for gallops and a pericardial friction rub.
Inspect the abdomen for distention, and palpate and percuss for an enlarged liver.
SPECIAL
CONSIDERATIONS:
If the patient has cardiac tamponade, prepare him for pericardiocentesis. If he doesn't have cardiac tamponade, restrict fluids and monitor his intake and output.
If the patient has cardiac tamponade, prepare him for pericardiocentesis. If he doesn't have cardiac tamponade, restrict fluids and monitor his intake and output.
PEDIATRIC
POINTERS:
Jugular vein distention is difficult (sometimes impossible) to evaluate in most infants and toddlers because of their short, thick necks. Even in school-age children, measurement of jugular vein distention can be unreliable because the sternal angle may not be the same distance (5 to 7 cm) above the right atrium, as it is in adults.
Jugular vein distention is difficult (sometimes impossible) to evaluate in most infants and toddlers because of their short, thick necks. Even in school-age children, measurement of jugular vein distention can be unreliable because the sternal angle may not be the same distance (5 to 7 cm) above the right atrium, as it is in adults.
PATIENT
COUNSELING:
Teach the patient with chronic heart failure about appropriate treatments, including dietary restrictions such as a low-sodium diet. Also, instruct him to report edema of the lower extremities and weight gain of 2 lb (0.9 kg) in one day or 5 lb (2.3 kg) in one week.
Teach the patient with chronic heart failure about appropriate treatments, including dietary restrictions such as a low-sodium diet. Also, instruct him to report edema of the lower extremities and weight gain of 2 lb (0.9 kg) in one day or 5 lb (2.3 kg) in one week.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)