Chapter 10 Assessment of Cardiovascular System

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Chapter 10Assessment of Cardiovascular System

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• Subjective data
• 1. Assessment of chief complaints
• - Chest pain location, quality, duration
  associated symptoms.
• - Irregular heart beat pound, too fast, jump..
  Etc.
• 2. Assessment of risk factors
• - Ask about history of hypertension, diabetes,
  rheumatic fever?
• - Ask about family history of heart attack,
  hypertension, stroke, and diabetes?

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• - Describe your nutritional intake have you
  ever been told you have high cholesterol,
  triglyceride level.
• -Do you smoke? How much? And for how long?
• - How do you view yourself? What do you do to
  relax?
• - How many hours a day do you work? How do you
  cope with stress.
• - Exercise what do you do for exercise? How
  often?
• - Pain in calves, feet, buttocks or legs? What
  aggravates the pain (walking, sitting long
  periods, standing long periods, sleep)? What
  relieves the pain elevating legs, rest, lying
  down?
• - Is there fitting shoes? Does client wear
  constricting garments or hosiery?

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• -In what type of chair does client usually sit?
• - Does he/she cross legs frequently?
• - Assessment of the client must be in supine or
  sitting positing according to his/her health.
• Inspection palpation
• By inspection and palpation you may detect
  ventricular hypertrophy (thickening of the
  ventricular walls in the heart).
• Use source of light to inspect subtle movement
  in chest e.g. pulsation, retraction, etc.

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• Apical pulse in left fifth intercostal space, if
  deviation in site observed may indicate cardiac
  enlargement 6th intercostal space.
• Retractions (when some of the tissue is pulled
  into the chest on the precordium) may be seen
  around site of apical pulse. Marked retraction
  may indicate pericardial disease.
• Heaves or lifts (precordial movements when right
  ventricle work increases). Heaves are best felt
  with the heel of the hand at the sternal border).

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• Apical pulse

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• Apical pulse

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• Palpation (sitting position).

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• Palpation (supine position).

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• Palpate from apex, moving to external border to
  base.
• Detect abnormalities in site of palpation and
  abnormal sounds especially for thrill abnormal
  flow of blood
• Thrill a fine vibration, felt by an examiner's
  hand on a patient's body over the site of an
  aneurysm or on the precordium, resulting from
  turmoil (disturbance) in the flow of blood and
  indicating the presence of an organic murmur of
  grade 4 or greater intensity.

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• It is important to describe pulsations in
  relation to their timing in the cardiac cycle.
• Describe in terms locations of pulsation in
  relation to mid-sternal, midclavicular or
  axillary lines.

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• Midclavicular and axillary lines

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• Strength of palpation of apical pulse differs
  from thin person to obese.
• Conditions such as stress, anxiety, anemia,
  fever, and hyperthyroidism may increase the
  amplitude and duration of apical pulse (you feel
  lifting sensation under your fingers).
• Palpation of pulse at base of the heart
  (putting your hand at second left and right
  intercostal spaces at sternal borders).
• Percussion is not used in cardiac assessment

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• Auscultation
• -All heart sounds are generally low pitched and
  difficult for the human ear to hear.
• -You may start auscultation from base to apex or
  from apex to the base.
• Assess
• Rate and rhythm of the beat.
• Concentrate initially on sound "1", noting its
  intensity and variations, possible duplication
  and effects of respiration.
• Then listen to sound "2" for same
  characteristics.
• Finally listen for extra sounds and for murmurs.

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• Sound "1" caused by the closing of the tricuspid
  and mitral valves. Systole begins with Sound "1"
  extends to Sound "2.
• Sound "2" results from closing of the aortic
  pulmonary valves.
• Diastole begins with Sound "2" and extends to
  next Sound "1"
• Sound "2" louder than Sound "1" at the base of
  heart, and is quieter than Sound "1" at the apex.
  

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• Sound "3" During diastole, rapid distention of
  ventricles occurs causes vibrations of
  ventricular walls, and this known as sound "3".
• Sound "3" best heard at the apex with bell of
  stethoscope.
• Sound "4" occurs after sound "3" (late diastolic
  filling), occurs from vibrations of ventricular
  wall or vibrations of the valves.
• Summation gallop three cardiac sounds heard
  S1, S2 and summation of S3 and S4.

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Neck vessels - Jugular veins assessed for
venous pulse waves and pressure. - Assess for
distention, may result from right-sided heart
failure. - The client must be in supine position
or in fowler position "45" degree. - Assess
jugular pulse venous" which is wave of blood
retrograde after ejecting blood into the right
ventricle
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• Assess carotid arteries inspection, then palpate
  below and just medial to the angle of the jaw,
  then auscultate by the bell of the stethoscope.
• Assess carotid arteries for pulsation noting is
  it strong or weak, rise or collapse, rapid or
  slow, double or single.
• Listen for heart murmurs ( abnormal sounds
  produced by vibrations within the heart or in the
  walls of large vessels during systole or
  diastole.
• Murmurs occurrence result from valve defects,
  changes in the blood vessels or by defects in the
  myocardium.

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• Special maneuvers for vascular assessment
• Check for deep phlebitis by quickly squeezing
  calf muscles against tibia (normally no pain).
• Check Homan's sign by extending leg and
  dorsi-flexing foot (normally no pain).
• Check for competency of valves (Trendelenburg
  test) if client has varicose veins feel dilated
  veins with one hand while using the other hand to
  compress veins firmly above level of the first
  hand, then palpate for impulse of blood flow
  which is normally no pulsation palpated.

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• Trendelenburg test (Tourniquet test)
•  With the patient in a supine position, the lower
  limb is elevated to empty the superficial venous
  system. The tourniquet is applied just below
  level of sapheno-femoral junction (SFJ).
• The patient is then asked to stand. Rapid filling
  of the varicosities with the tourniquet still on
  suggests incompetent perforators below the level
  of the SFJ. If no filling is seen at this point,
  the tourniquet is released.

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Arterial and venous insufficiency of lower
extremities
Item Arterial insufficiency Venous insufficiency
Pulses Decreased or absent Present
Color Pale on elevation and cold Pink to cyanotic, brown pigment at ankles
Temperature Cool, cold Warm
Edema Non Present
Skin Shiny skin, thick nails, absent of hair, ulcers on toes, gangrene may develop Ulcers on ankles discolored, scaly
Sensation Leg pain aggravated by standing relieved with rest. Pressure on buttocks or calves or cramps during walking, parasthesia Leg pain aggravated by standing or sitting relieved by elevation of legs, lying down, or walking. Also relieved with use of support hose.
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The end

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