Week 2: Cardiovascular and Peripheralvascular Assessment Flashcards
Path of Blood through the heart
Superior vena cava -> Right atrium -> Tricuspid valve -> Right ventricle -> Pulmonary valve -> Pulmonary artery -> Lungs -> Left atrium -> Mitral valve -> Left ventricle -> Aortic valve -> Aorta -> rest of the body
Risk factors of Cardiovascular (Heart) Disease
-Family history
-Increased age
-Elevated cholesterol
-HBP
-High sugar levels
-Ethnicity
-Obesity
-Cigarette smoking
-Diet
-For Women: menopause as risk for Coronary Artery Disease
Signs and Symptoms of CV problem
-pain (breathing muscles)
-shortness of breath
-dyspnea, orthopnea
-paroxysmal nocturnal dyspnea
-cough
-lightheadedness
-nausea and vomiting
-edema
Assessment of Cardiovascular System: History
- Demographic/SDoH
- OLDCARTSS
- Current/recent symptoms
- Associated symptoms
- Inquire about respiratory concerns
- Ask about risk factors
- Discuss family history
- Ask about past medical history, meds, allergies
- Inquire about social history
- Functional ability (ADL, IADL)
Physical Assessment: Inspection
Start with Vital Signs
Inspection:
-general survey
-skin color
-respirations
-speech pattern
-diaphoresis
-size and shape of thorax
-finger ~ nailbeds, clubbing
-landmarks
-abnormal pulsations
Physical Assessment: Palpation of Pulses
Take note of:
-rate
-rhythm
-strength/volume
-absent, weak, thready, normal, full/bounding, symmetry
OBJECTIVE DATA: Carotid Pulse Assessment
-assess volume/character
Auscultation: Unexpected Heart Sounds
-Murmurs: turbulence causes “swooshing” or “blowing” sounds
-result of cardiac abnormalities: increased blood velocity, structural valve defects, valve malfunction, abnormal chamber openings
Bruits: turbulent blood flow - usually by partial obstruction sites: carotids, abdominal aortic, renal, iliac, femoral
Palpation of the PMI (point of maximal impulse)
-Aortic area
-Pulmonic area
-Tricuspid area
-Apical area
-Epigastric area
Landmarking
Aortic area:
right second intercostal space
Pulmonary area:
left second intercostal space
Tricuspid area:
inferior left sternal margin
Mitral area
5th intercostal space (apex)
Heart Sounds (s1 + s2)
S1 is the closing of AV valve (beginning of systole)
S2 is the closing of SL valve (beginning of diastole)
Effects of Aging on the Heart
-collagen in the heart increases and elastin decreases
-decreased contractility and HR
-cardiac valves become thicker and stiffer from lipid accumulation, valve incompetence or stenosis = murmur
-# of pacemaker cells in SA node decreases = bradycardia, heart block
-decreased sympathetic nervous system control of cardiovascular system
-arterial blood vessels thicken and become less elastic = increased BP
When to perform a neurovascular assessment
-trauma/injury to limb
-presence of cast or other protective device
-surgery to a limb
-presence of a wound on a limb, varicose veins
-conditions which may cause poor circulation
Venous Insufficiency
occurs when your leg veins don’t allow blood to flow back to your heart
Varicose veins
are swollen, twisted vein that lie under the skin and usually occur in the leg
Arterial Insufficiency
Any condition that slows or stops the flow of blood through your arteries
Atherosclerosis
the buildup of fats, cholesterol and other substances in and on the artery walls
Clubbing
changes in areas under and around the toenails and fingernails that occur with some disorders
(may result from chronic low blood-oxygen levels)
Arterial vs Venous Insufficiency
Arterial: Pain with exertion - intermittent claudication
-relieved by short rest
-pale when leg elevated, rubor with dependency
Venous: Pain described as aching, dull, heaviness
-swelling as day progresses
-pain and edema relieved when legs elevated
-varicose veins
Peripheral Vascular Assessment (More Than Six Bananas Can Elevate Potassium)
-Circulation and nerve conduction ~ only on a limb
Movement
Temperature
Sensation
Blanching
Colour
Edema
Pulse
Rating Scale: Extent of pitting Edema
0+ No pitting edema
1+ Mild pitting edema, 2mm depression that disappears rapidly
2+ Moderate pitting edema, 4mm depression that disappears in 10-15 secs
3+ Moderately severe pitting edema, 6mm depression that may last more than 1 min
4+ Severe pitting edema, 8mm depression that can last more than 2 min
Palpating neuro component of assessment
Peroneal Nerve
Sensation: the web space between the big and second toe
Motion: dorsiflex ankle and extend toes at the metatarsal phalangeal joints
Tibial Nerve
Sensation: the medial and lateral surfaces of the sole of the foot
Motion: planter flex ankle and toes
Radial Nerve
Sensation: web space between the thumb and index finger
Motion: hyperextend thumb then wrist and hyperextend the 4 fingers at the knuckles
Ulnar Nerve
Sensation: distal fat pad of the small finger
Motion: abduct all fingers
Median Nerve
Sensation: distal surface of the index finger
Motion: oppose thumb and small finger (note if patient can flex wrist)
Reynaud’s
-triggered by cold, stress
-vasospasm
-restricts blood supply to fingers/toes
-turns white, feels numb
-sometimes turns blue, then red before returning to normal
Measuring Arterial Insufficiency: Ankle-Brachial Index
Normal ABI: ankle/brachial = 120/120 = 1.0
the lower ankle pressure, the greater the severity of occlusive disease and the higher the risk of cardiovascular events
ACUTE Neurovascular Assessment
Acute situations of serious vascular compromise:
1. Arterial occlusion
2. Deep Venous Thrombosis (DVT)
3. Compartment syndrome
COMPARTMENT SYNDROME = EMERGENCY
All accompanied by EXCRUTIATING pain
Circulation Assessment: 5 Ps
Pain
Pulse
Pallor - scale of paleness
Paresthesia - can you feel this?
Paralysis - can you move this
