ASSESSMENT OF THE CARDIOVASCULAR SYSTEM Flashcards
Changes lead to a loss of cardiac reserve and are present when there are increased demands on body - more noticeable when increased metabolic needs (exercise/stress)
Cardiac valves
Conduction system
Left ventricle changes
Aorta and other large arteries
Baroreceptors (sensors located in the blood vessels - tell body what going on)
CV changes associated with aging
Calcification (harden) and degeneration (can break down primarily -mitral and aortic valves)
Monitor for murmurs - cannot func as well
Cardiac valves - CV changes associated with aging
Pacemaker cells decrease in number
Fibrous tissue and fat in the sinoatrial node increase - decrease number in muscle fibers
Few muscle fibers in the atrial myocardium and bundle
Conduction time increases - more time for conduction go through muscle
Increased risk for atrial dysrhythmias - due to increased time
Conduction system - CV changes associated with aging
Increases in size, becomes stiff, and less distensible (less able dilated and stretch out - more fibrotic - cannot recoil) - harder fill ventricle
Fibrotic changes decrease speed of early diastolic filling by 50%
Decrease stroke volume (amount blood ejected from LV with each contraction), ejection fraction, and cardiac output - not able oxyengate as well - see symp with increased metabolic needs
Less able to meet oxygen demands
Left ventricle changes - CV changes associated with aging
Thicken, stiffer and less distensible - not stretch as well
Systolic BP increases
Systemic vascular resistance increases - can lead to HTN
Left ventricle pumps against greater resistance - pumping against higher resistance so it can get larger and less effective
Left ventricular hypertrophy
Monitor for hypertension - more at risk for HTN because changes in arteries
Aorta and other large arteries - CV changes associated with aging
Become less sensitive
Monitor for orthostatic hypotension - more likely have this
Baroreceptors (sensors located in the blood vessels - tell body what going on) - CV changes associated with aging
Patient History
Nutrition History - part pat history; very imp; lot things can do effected to health can change
Family and Genetic History - cannot change these and these often affect heart
Current Health Concerns - symp: SOB?
Functional History - know CV probs (HF) - scoring sys dependent on how functional (how do ADLs) - good assessment; severity of CVD
Physical Assessment: imp
Assessment methods
Focus on diff risk factors and symptoms have
Assess nonmodifiable risk factors
Assess modifiable risk factors
Assess for chronic diseases
Patient History
Age, gender, ethnicity, family history
Ex. men and post menopausal women at higher risk for coronary artery disease (CAD); certain things cannot do things amount to affect
Assess nonmodifiable risk factors
Nurses focus on these
Decrease cholesterol
Obesity, smoking (now/in past), inactivity (want moving little bit), psychological stress (how feel when have wait for appt - high stress/anger - contributes to hit)
Assess modifiable risk factors
Ex. Diabetic patients at higher risk for CVD; pulm issues lead to CVD; lots contribute
Assess for chronic diseases
Ex. High sodium, fat and cholesterol can increase risk and big risk factor for CV disease
Eat healthy diet lower risk
Nutrition History
Screen first degree relative (siblings, mothers, fathers) for history of CAD, hypertension, sudden cardiac death
Can have huge impact
Family and Genetic History
Chest pain or discomfort - know at rest/exertion
Dyspnea - SOB; orthopnea
Fatigue - HUGE
Palpitations
Edema - esp peripherally and dependent - heart func not up where need be
Syncope
Extremity pain - vascular probs: PAD and PVD
Ask about these
Current Health Concerns/Symptoms - symp pats having; find out what having
Functional classifications once know have CVD to see how severe it is
Functional History
Look at this: General appearance - distress, holding chest, alert, how communicating, able finish sentence, dyspnea concern
Skin
Extremities
Blood pressure (BP) - huge; way assess CV sys
Venous and arterial pulses
Precordium (area over heart)
Physical Assessment
Assess color and temperature - HUGE; know if decreased circ
Assess nail beds, mucous membranes, and conjunctival mucosa: see changes no matter pigment skin
Decreased perfusion can be manifested as cool, pale, cyanotic, gray and/or moist skin
Skin
Assess for dehydration – skin turgor; huge impact on CV func; not enough fluid volume through not as effective as CO
Assess for edema - big things assess for for CV - know where is: indic what going on
Vascular changes
Extremities
Location and extent (1+, 2+, 3+, 4+): measure, see if pitting: stay/rebound
Assess for edema - big things assess for for CV - know where is: indic what going on
Paresthesia, muscle fatigue, pain, nubmness, coolness, loss of hair, palor
Occlusion in periphery area imp assess extremities
Vascular changes
Hypertension - diagnose with:
BP < 90/60 may not be adequate for providing enough oxygen and sufficient nutrition to body cells - worried about enough O2 and blood supply to rest body; monitor MAP invasively or vaguely calc; want not between 60-70 to adequately perfuse organs; want greater than 70
Postural (orthostatic) hypotension
Pulse pressure
Blood pressure (BP) - huge; way assess CV sys
Systolic blood pressure (SBP) >140 mm Hg
Diastolic blood pressure (DBP) > 90 mm Hg
Taking drugs to control BP
Any things diagnosed with it
Hypertension - diagnose with:
Decrease of more than 20 mm Hg of the SBP or more than 10 mm Hg of the DBP and 10-20% increase in HR with changes in position
More common in older because baroreceptors not working as well
Postural (orthostatic) hypotension