Cardiovascular Flashcards
cardiovascular assessment
Taking a history
> Begin by asking open questions. Allow the patient to describe their symptoms and prevent unnecessary
– Chest pain. Use the OPQRST acronym to explore this symptom further.
– Dyspnoea. Are they usually short of breath? How far can they walk before stopping for a rest and has this changed?
– Orthopnoea. Is their breathing worse at night or when they are lying down? How many pillows do they sleep on at night?
– Dizziness/light-headedness. When do they feel dizzy? Does anything make it better or worse? Do they often feel light-headed when they stand up from a sitting/lying position? Does the dizziness correlate with any chest pain and/or shortness of breath?
– Syncope. Have they had fainting episodes previously? Has this been investigated by their GP or in hospital? What did they experience leading up to the syncope? Did it correlate with chest pain or palpitations?
– Palpitations. Have they experienced palpitations before? Does it correlate with dizziness or chest pain?
– Fatigue. Do they tire easily? When did the fatigue start? Was it sudden or gradual? Has there been any recent change in energy level?
– Nausea and/or vomiting. When did it start? Is it constant? Does anything make it better or worse?
> Ask questions that explore the patient’s medical history:
– What medical conditions do they have?
– What medications do they take? Are they compliant with these medications? Are the medications in-date?
– Ask if any hospital discharge letters are available, and view if possible. These will provide an excellent overview of the patient’s history
– When was the last time they were assessed by a doctor? (GP or in hospital)
– Does the patient have any family history of cardiovascular problems?
> Document all the important aspects
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Physical assessment
> Look for any signs of bleeding, external and internal
> Feel for a radial pulse and note rate, strength and regularity
> Note the patient’s overall appearance. Are they diaphoretic, pale, clammy, or cyanotic? Are they warm, hot or cool to touch?
> Obtain a full set of vital signs, including a 12 lead ECG, and blood pressure in lying and standing positions (postural hypotension)
> If the patient has chest pain, palpate the chest and feel for any abnormalities and/or a change in pain level
> Auscultate the patient’s lungs. Listen for any abnormal lung sounds or abnormal air entry
> Look for any jugular vein distension
> Look for any peripheral oedema
> Look for any scars, bruising or swelling that may indicate trauma or previous surgery
> Look for any palpable masses that may indicate an abdominal aortic aneurysm.
Describe when it is appropriate to conduct a cardiovascular assessment.
A cardiovascular assessment should be conducted on all patients who have a condition that may affect/be affected by the cardiovascular system
Outline how you would take a history as part of a cardiovascular assessment.
> Questions are systematic and appropriate for patient condition
Questioning on recent illnesses and/or complaints.
Demonstrate how you would perform a cardiovascular assessment on a patient.
> Look for any signs of bleeding, external and internal
Feel for a pulse and note rate, regularity and strength
Note the patient’s overall appearance
Obtain a full set of vital signs, including a 12 lead ECG, and blood pressure in lying and standing positions (postural hypotension)
Palpate the chest if the patient has chest pain
Auscultate the patient’s lungs
Look for any jugular vein
distension
Look for any peripheral oedema
Look for any scars, bruising or swelling that may indicate trauma or previous surgery
Look for any palpable abdominal masses.
SVT
Umbrella term to describe a group of narrow complex tachydysrythmias that cannot be identified accurately because they have indiscernible P waves and fall within a common rate range
Characterised by a rate of BP >150 and normal QRS.
The rate is usually so fast you can not see the P wave
Myocardial oxygens demand is rapidly increased
Verticals do no have adequate time to fill the coronary arteries and so no get adequate blood supply to meet the increased myocardial oxygen demand.
Clinical presentation
Feeling lightheaded and dizzy
Palpitations
Cardiac chest pain
Collapse
Sweating
Pounding in chest or head
>150
Electrical pathway of the heart
