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Cardiac assessment

this explain about the cardiac assessment in medical and surgical nursing-a practical aspect

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Cardiac assessment

  1. 1. Cardiac assessment
  2. 2. Introduction •Assessment of the cardiovascular system is one of the most important areas of the nurse’s daily patient assessment. This video is designed to be used with the guidelines already in effect at your institution.
  3. 3. Important aspects ● Power of observation. ● Be as objective as possible.Assess with every tool possible; inspection, palpation, etc. ● Report your findings as clearly as possible. ● Clear Charting
  4. 4. Articles Needed A Clean tray containing Wrist watch and pen Stethoscope Sphygmomanometer Ruler and inch tape Pen and paper
  5. 5. Anatomy of the heart
  6. 6. Physiology of the heart Cardiac cycle: Systole and diastole Cardiac output- Amount of blood pumped by the left ventricle per minute Stroke volume- Amount of blood pumped by the ventricle per beat Preload - Volume of blood left in the ventricle at the end of DIastole Afterload- SVR,Amount of resistance of the ventricles to open the aortic valve
  7. 7. Cardiovascular assessment
  8. 8. Steps Biographical data/Demographic data History: ★ Current health history ★ Past medical history ★ Family history ★ Personal history ★ Risk factor analysis
  9. 9. General appearance Look at the client and observe for ● Does the client lie quietly or restless ● Can the client lie flat or in upright position ● Do facial expression reflects pain or distress ● Are their signs of pallor or cyanosis
  10. 10. Basic information Along with general appearance some baseline informations like Body built Consciousness Orientation: To time/Place and Person Body posture Height/Weight and /BMI Should be collected
  11. 11. Vital signs Blood pressure: Both hands/Standing/Sitting/Lying Pulse pressure: Systolic- diastolic (Normal 30-40mmhg) Pp increases with Anxiety, Exercise,Bradycardia, Hypertension, Fever,CAD etc Decreases with Shock,Heart failure, Hypovolemia,Mitral Regurgitation etc… Mean arterial pressure: (MAP) ( 2xDiastolic BP) + systolic BP 3
  12. 12. Pulse points Pulse should be checked for its Rate,Rhythm and Quality. ● Carotid ● Radial ● Brachial ● Femoral ● Popliteal ● Posterior tibial ● Dorsalis pedis
  13. 13. Common signs and symptoms of cardiovascular disease ● Chest pain/ Discomfort ● Palpitations ● Syncope ● Fatigue ● Dyspnea ● Cough ● Weight gain ● Edema
  14. 14. Skin /Nail ● Color ● Texture ● Warmth ● Turgor ● Clubbing of finger ● Cyanosis ● Splinter hemorrhage
  15. 15. Capillary refill ● Capillary refill - greater than 3 seconds in case of Dehydration,PVD,Hy pothermia and Shock
  16. 16. Clubbing of finger
  17. 17. Eyes ● Sclera/Conjunctiva - Signs of anemia ● Xanthelasma : Yellowish plaques around eye lids ● Arcus Senilis: Grey ring around iris
  18. 18. Neck ● Thyroid: For enlargement ● Carotid artery: Bruit ● Carotid pulse: Rate /Min Pulse deficit:Difference between Apical pulse and Carotid pulse
  19. 19. JVP(Jugular Venous Pulsation)
  20. 20. Chest Inspection: lesion/Scar/Mass/ Pacemaker Palpation: Precordial heaves: Visible or palpable pulsations/ Thrills PMI (Point of maximum impulse) Apical pulse 5th intercostal
  21. 21. Chest - Auscultation
  22. 22. Normal and abnormal sounds S1 - Closure of mitral and tricuspid valve- Best heard in Mitral area S2 - Closure of pulonic and aortic valve- Best heard in Erb’s or Pulmonic area MURMURS:Heard when there is turbulent blood flow within heart. GALLOPS: Pericardial Friction Rub : Caused by inflammation of pericardial sac
  23. 23. Abdomen Abdominal aortic pulsation: present in case of aneurysm Bruits: Hepatojugular reflux: Positive indicates the inability of the right heart to handle increased venous return
  24. 24. Extremities Peripheral pulse and Peripheral edema
  25. 25. Allen’s test Assessment of arterial blood flow in Radial and Ulnar artery
  26. 26. Homan’s sign
  27. 27. Summary ● Baseline data / History ● General appearance ● Vital signs ● Skin and Nail ● Eyes ● Neck/Carotid ● Chest ● JVP/HUX ● Abdomen ● Extremities ● Allen’s test ● Homan’s sign