Unit 2: Cardiovascular Assessment Flashcards
Risk Factors for Cardiovascular Disease (CVD)
- family hx
- diabetes mellitus
- chronic renal disease
- hypertension
- dyslipidemia
Non-Modifiable Risk Factors for Cardiovascular Disease
-demographic data (age, sex, ethnic background)
Modifiable Risk Factors for Cardiovascular Disease (CVD)
-Weight
-Dietary habits
-Alcohol consumption
-Smoking
-Sedentary lifestyle; exercise promotes cardiovascular health
>excess consumption of fats and sodium is a dietary habit that puts a patient at risk for heart disease
Common symptomatic complaints r/t cardiovascular disease
- chest pain
- difficulty breathing (dyspnea)
- cough
- palpitations
- edema
- fatigue
- syncope
Chest Pain
- evaluated for location, intensity, radiation, duration, and quality
- want to find information that provides relief of pain
What do Palpitations indicate?
abnormal heart rhythms; dysrhythmias
What does Syncope Indicate?
decreased cardiac output from problems with either the mechanical or electrical properties of the heart
The General Assessment of Cardiovascular System
-assess, inspection, palpation, and auscultation
>Evaluate overall appearance:
-color, diaphoresis, edema, and demeanor and restlessness, agitation or confusion
>Observe:
-weight & build, SOB, and mobility
-patients w/ late-stage HF will present w/ edema and appear frail and fatigued
>Evaluate HR and BP:
-info on the efficiency and strength of the heart
-Normal HR: 60- 100 bpm
-HR heard? palpating the pulse over an artery close to the skin (radial), or auscultating the apical HR (place stethoscope at the junction of the fifth intercostal space and the midclavicular line, the point of maximal impulse (PMI)
What does a low heart rate (HR) indicate?
(bradycardia)
-can indicate good physical conditioning and thus an efficient heart
-can indicate inadequate cardiac output (CO)
>if low HR is associated w/ dizziness, SOB, or chest pain; further evaluation
What does a high heart rate (HR) indicate?
- occurs naturally w/ exercise and exertion
- abnormal when occurring at rest; d/t a weak heart muscle, pain, fever, or inadequate fluid volume; further evaluation
Pulse Deficit
- if performed at the same time, the radial pulse rate is less than the apical HR
- can indicate arrhythmias such as atrial fibrillation or premature ectopic beats
Blood Pressure
info on the force of the hearts contraction and volume of cardiac output, as well as the resistance offered by the arterial vascular system
High Blood Pressure
(Hypertension)
-increases risk of heart failure, MI, and stroke
Low Blood Pressure
(Hypotension)
- should be assessed for clinical significance
- presence of postural hypotension (decrease of 20 mmHg in BP from lying to sitting, to standing position accompanied by a 10% increase in HR could = inadequate cardiac output or blood volume
Normal Blood Pressure Reading
- SBP: < 120 mmHg
- DBP: < 80 mmHg
Elevated Blood Pressure Reading
- SBP: 120-129 mmHg
- DBP: < 80 mmHg
Hypertension
> Stage 1:
- SBP: 130-139 mmHg
- DBP: 80-89 mmHg
> Stage 2:
- SBP: >140 mmHg
- DBP: >90 mmHg
Visual Inspection of Cardiovascular System
- assess color, capillary refill time, edema, presence or absence of jugular vein distention, and clubbing of the fingers and toes
- adequate perfusion = skin color and nail beds are pink
- poor perfusion = appears pale gray or bluish color (cyanosis)
Central Cyanosis
- blue coloring of mucous membranes, lips, and tongue
- caused by impaired heart or lung function
Peripheral Cyanosis
- blue discoloration of the extremities
- caused by heart or lung failure
- can indicate peripheral vasoconstriction or obstruction
Capillary Refill Time
tested by compressing a finger or toe momentarily to stop the blood flow, producing a whitening effect, then releasing pressure and timing the return to normal pink color
-adequate peripheral circulation = a return to color within 3 seconds
Edema
can be a sign of cardiac or liver issues
- bilateral lower extremity edema
- unilateral extremity edema
- pitting edema
Bilateral lower extremity edema
if not associated w/ local injury, indicates venous insufficiency or heart failure
-leg swelling in both lower legs
Unilateral extremity edema
if not associated w/ local injury, can indicate a venous or lymphatic obstruction
-one extremity
Pitting Edema
indenting of the skin that remains after pressure has been applied then released
Distention of Jugular Veins
- seen in a constrictive disease such as pericarditis or cardiac tamponade
- seen in right ventricular failure, valvular disease, or hypervolemia
- associated w/ poor contractile function of the heart that is present in heart failure
Clubbing of fingers/toes
Long-term perfusion problem produced by a decrease in oxygenated blood flow to the affected extremities
Palpation: Temperature
assessment of skin temperature
- Adequate CO = warm skin temperatures
- Cool or cold temperatures = vasoconstriction, heart failure, or shock
- Variations in temp = vasoconstriction or vascular disease in the affected extremities
Palpation: Pulses
radial and dorsalis pedis pulses
- others: femoral, popliteal, and posterior tibial pulses
- strong, palpable pulses = adequate CO and good flow through the peripheral vessels
Auscultation
assessment of heart and lung sounds
Heart Sounds
“Lub” and “Dub” are produced by the closure of the valves during the cardiac cycle
- Heart sounds: S1, S2, S3, S4, Systolic murmur, click, friction rub
- fever, inflammation, excess fluid, and narrowed or incompetent valves are clinical situations that produce extra sounds such as clicks, rubs, or murmurs
- any condition that creates a noncompliant LV will produce a S4
- any condition that creates an overly compliant LV will produce a S3 heart sound
Heart Sounds: S1
“Lub”
- closure of AV valves
- signifies beginning of ventricular systole
- sounds longer + louder compared to S2