CH 25 Assessment of cardiovascular function Flashcards
The impulses of the heart are initiated by….
-If one of these has trouble firing the next one will send an impulse, HR decreases as it moves down the pathway
In this order SA node> AV node> Bundle of his> Right bundle branch> left bundle branch> purkinje fibers
- Location of chest pain?
- Severity or duration of chest pain(1-10)?
- What other symptoms?
- Is it radiating to other areas?
- When did it start?
- what relieves it?
assessment of chest pain
a symptom of worsening HF.
-A nighttime symptom of a sudden wakening with SOB. it is caused by the reabsorption of fluid from dependent areas of the body back into the circulatory system within hours of lying in bed.
paroxysmal nocturanal dsypnea
the nurse evaluates the cardiovascular system for any deviations from normal with regard to the following
- The heart as a pump
- atrial and ventricular filling volumes and pressures(JVD, peripheral edema, ascites, crackles, postural changes in BP)
- CO ( reduced pulse pressure, hypotension, tachycardia, reduced urine output, lethargy, disorientation
- compensatory mechanisms( peripheral vasoconstriction, tachycardia)
physical assessment
Looking for deviations in patients appearance
- LOC
- Mental status (oriented?)
- signs of distress (pain, SOB, anxiety?)
- size( normal, overweight, catchetic?)
- Skin
assessment of general appearance
skin examination includes
- color
- temperature
- texture
- problems with circulation( hematomas, edema, prolonged cap refill, clubbing, hair loss, dry brittle nails)
assessment of skin
- normal pulse pressure 30-40mm Hg
- indicates how well the patient maintains CO
- A pulse pressure less than 30 indicates a serious reduction in CO
Pulse pressure
Most often caused due to a significant reduction in preload, which compromises CO.
orthostatic hypotension
-Caused by right sided HF, due to hypervolemia, pulmonary hypertension, and pulmonary stenosis.
JVD
- Aortic area
- Pulmonic area
- Erb’s point
- Tricuspid area
- Mitral(apical) area
6 Epigastric area
heart inspection and palpitation
second intercostal space to the left of the sternum
pulmonic area
third intercostal left of the sternum
Erb’s point
fourth and fifth intercostal spaces to the left of the sternum
tricuspid area
left fifth intercostal at the midclavicular line
mitral(apical) area
below the xiphoid process
epigastric area
The sound made when the tricuspid and mitral valve close. The “lub”
S1
The sound made when the closure of the pulmonic and aortic valves close. the “dub”
S2
This heart sound can be a normal finding in children and adults up to 35 or 40 years old. In older adults it is a significant finding.
S3
It is a sound generated during atrial contraction as blood forcefully enters a noncompliant ventricle. It is caused by HTN, CAD, cardiomyopathies and others.
S4
These findings are frequently present in patients with cardiac disorders
- Hemoptysis( frothy pink sputum)
- Cough( dry hackneying)
- Crackles
- Wheezes
Lung assessment
These findings are important to assess for in patients with cardiovascular disorders
- Abdominal distension
- Hepatojugular reflex
- bladder distension
abdominal assessment
- HTN is common in this population
- S4 heart sounds, murmurs, split S2
- Orthostatic Hypotension
Older adult cardiovascular assessment
normal level is less than 100, primary goal for lipid management is less than 70
Carries cholesterol and triglycerides TO the cell.
LDL
normal range is 35-70men 35-85 women. The goal is to be above 40.
Transports cholesterol AWAY from the cell.
HDL’s
composed of free fatty acids and glycerol, it is stored in the adipose tissue and is a source of energy. Increases after meals and is affected by stress, alcohol, and obesity.
Normal range 150
Triglycerides
Helps regulate BP and fluid volume.
Levels higher than 100 suggests HF.
BNP
A protein produced by the liver in response to systemic inflammation. Used to predict CVD levels greater than 3 may indicate great risk for CVD. Moderate (1-3) low less than 1.
C- reactive protein
an amino acid linked to the development of atherosclerosis. Elevated levels is thought to indicate high risk for CAD, CVA, and PVD. high risk greater than 15
Homocysteine
determines size, contour and position of the heart.
-It reveals cardiac and pericardial calcifications and demonstrates physiologic alterations in the pulmonary circulation.
Doesn’t help diagnose MI, but can help to diagnose HF.
Chest X-ray and Fluroscopy
Non invasive utlrasound test that is used to measure EF and examine the size, shape and motion of cardiac structures.
Particularly useful in diagnosing pericardial effusions; determining chamber sized the etiology of heart murmurs.
echocardiography
A technique which involves threading a small transducer through the mouth into the esophagus. The patient will be given a topical anesthetic agent and moderate sedation.
TEE
