cardiacassessmentppt-130317013327-phpapp01.pptxcardiacassessmentppt-130317013327-phpapp01.pptx cardiacassessmentppt-130317013327-phpapp01.pptx

cardiacassessmentppt-130317013327-phpapp01.pptx

1. CARDIO VASCULAR ASSESSMENT DR. Mona Nadr

2. INTRODUCTION Cardiovascular disease is the every State’s leading killer for both men and women among all racial and ethnic groups. A thorough cardiovascular assessment will help to identify significant factors that can influence cardiovascular health such as high blood cholesterol, cigarette use, diabetes, or hypertension.

3. ANATOMY AND PHYSIOLOGY OF HEART

4. History The purpose of the cardiovascular health history is to provide information about your patient’s cardiovascular symptoms and how they developed. A complete cardiovascular history will give you indications to potential or underlying cardiovascular illnesses or disease states.

5. History Present History (Signs & Symptoms). Past Medical History. Family history. Allergies for drugs, food. Life style habits.

6. Past Health History The past health history should elicit information about the following issues: hypertension, elevated blood cholesterol or triglycerides, heart murmurs, congenital heart disease, rheumatic fever or unexplained joint pains

7. Personal and Social History tobacco , alcohol, and substance use • Environment • Diet: restrictions, supplements, caffeine intake Sleep patterns: number of pillows used Exercise

8. • Past diagnostic tests and interventions: electrocardiogram , echocardiogram, stress test , electrophysiology studies, myocardial imaging studies , thrombolytic therapy, cardiac catheterization, percutaneous transluminal cardiac angioplasty, stent placement, atherectomy , pacemaker or implantable cardioverter defibrillator implantation, valvuloplasty

9. Risk factors: age, heredity, gender, race, tobacco use, elevated cholesterol, hypertension, physical inactivity, obesity , diabetes mellitus • Past surgeries: coronary artery bypass grafting ( CABG), valvular surgery , peripheral vascular surgeries

10. Medications, including prescription drugs, drugs , vitamins, herbs, and supplements: angiotensin-converting enzyme (ACE) inhibitors, anticoagulants, antihypertensives , antiplatelets , antiarrhythmics , angiotensin II receptor blockers (ARBs), β-blockers, calcium channel blockers, antihyperlipidemics,diuretics , electrolyte replacements, nitrates, inotropes, hormone replacement therapies, oral contraceptives ,

11. Allergies and reactions to medications, foods, contrast dye, latex or other materials • Transfusions , including type and date

12. Family History • Health status or cause of death of parents and siblings: CAD, hypertension, diabetes mellitus, sudden cardiac death, stroke, peripheral vascular disease, lipid disorders

13. Current Lifestyle and Psychosocial Status Nutrition Smoking Alcohol Exercise Drugs Family History

14. INSPECTION:

15. • General appearance and presentation. patient’s general appearance and presentation are key elements of the initial inspection. The nurse notes first impressions of the patient’s age, nutritional status , self-care ability, alertness, overall physical health, and ability to move and speak with or without distress. The patient’s posture, gait, and musculoskeletal coordination are also considered. •

16. • General appearance and presentation. • Jugular venous distention. Evaluation of jugular venous distention provides insight into hemodynamics and cardiac function. The height of the level of blood in the right internal jugular vein is an indication of right atrial pressure (RAP) Jugular venous distention is assessed by measuring the highest point of visible pulsation as the vertical distance above the sternal angle

17. Chest. The nurse also notes abnormally strong precordial pulsations (thrusts ), asymmetry , any depression or bulging of the precordium , and any signs of trauma or injury. • Extremities. The nurse examines the extremities for lesions, ulcerations, unhealed sores , varicose veins, and hair distribution. A lack of normal hair distribution on the extremities may indicate diminished arterial blood flow to the area.

18. Skin. The nurse evaluates the skin for moistness or dryness , color, elasticity, edema, thickness, lesions , ulcerations , and vascular changes. Cyanosis and clubbing of the nail beds may indicate chronic cardiac or pulmonary abnormalities.

19. Eyes The presence of yellowish plaques on the eyelids (xanthelasma) could indicate hyperlipoproteinemia, a risk factor for hypertension as well as arteriolosclerosis.

20. Chest Observe the chest for overall torso contour. Do you see pectus excavatum (caved-in chest)? Do you see pectus carinatum (pigeon chest)?

21. Skin Clubbing The presence of clubbing (broadening of the extremities of the digits, accompanied by nails which are abnormally curved and shiny) indicates chronic poor oxygen perfusion to the distal tissues of the hand and feet.

22. Cyanosis The presence of cyanosis (bluish colour) also denotes chronic poor oxygen delivery to the peripheral tissues of the hands and feet.

23. Xanthomas The presence of yellowish plaques under the skin (non-eruptive) excoriated through the skin (eruptive) could indicate hyperlipoproteinemia, a risk factor for hypertension as well as arteriolosclerosis.

24. Edema The presence of edema (tissue swelling) can be caused by several factors, although most commonly is associated with decreased cardiac function leading to decreased capillary flow. 

25. Palpation Use the palm of your hand to feel the chest wall for the "Point of Maximal Impulse" (PMI), which is usually found at the apex of the heart. This apical pulse is generally located in the 5th intercostal space, about 7-9 cm (the width of your palm) to the left of the midline.

26. Palpate the peripheral arteries. These include the brachial, radial, femoral, popliteal , dorsalis pedis , and posterior tibial . Note the contour and amplitude of each pulsation. These should feel similar bilaterally.

27. Chest percussion: Normally only the left border of heart can be detected by percussion. It extends from the sternum to mid clavicular line in the third to fifth inter costal space. The right border lies under the right margin of the sternum and is not detectable. Enlargement of the heart too either the left or right usually can be noted.

28. Auscultation:

29. Areas of auscultation Areas of auscultation.

30. Auscultation The precordium is auscultated systematically In each area auscultated, the nurse identifies the first (S1) and second (S2) heart sound noting the intensity of the sound, respiratory variation , and splitting.

31. Heart sound S1, the “ lub ” of the “ lub -dub,” is produced by the closure of tricuspid and mitral valves. S2 is produced by the closure of the semilunar ( aortic and pulmonic) valves and is heard best over the aortic area.

32. Heart sounds S3 is also known as a ventricular gallop (“ lub -DUB- ta ”). S3 is heard in early diastole. It is heard best at the apex in the left lateral decubitus position S4 is also known as an atrial gallop (“ta- lub -DUB”). It is typically heard in late diastole before S1.

33. left lateral decubitus position

34. Murmurs Murmurs are sounds produced either by the forward flow of blood through a stenotic valve or by the backward flow of blood through an incompetent valve or septal defect. The sound may indicate that blood is flowing through a damaged or overworked heart valve, that there may be a hole in one of the heart's walls, or that there is a narrowing in one of the heart's vessels

35. Summation Gallop With rapid heart rates that shorten ventricular diastole , if an S 3 and S 4 are both present, they may fuse together and become audible as a single diastolic sound. This is called a summation gallop. This sound is loudest at the apex and is heard best with the stethoscope bell while the patient lies turned slightly to the left side.

36. Friction rub A high-pitched, rasping, scratchy sound that varies with the cardiac cycle is called a pericardial friction rub. A pericardial friction rub is produced when inflamed pericardial layers rub together.

37. Blood Pressure

38. Blood Pressure Classification in Adults Category Systolic Diastolic Normal <130 <85 High Normal 130-139 85-89 Mild Hypertension 140-159 90-99 Moderate Hypertension 160-179 100-109 Severe Hypertension 180-209 110-119 Crisis Hypertension >210 >120

39. Percussion Although radiologic methods give more precise data about heart size, a gross estimation of heart size can be made by percussing for the dullness that reflects the cardiac borders .

40. Assessment of Pain Degree of pain on scale 1 to 10. Duration of pain. Site of pain. Radiation of pain to any other areas. Associated symptoms with pain as: nausea, sweating, shortness of breathing Recurrence of pain. Aggravating factors of pain such as activity. Onset of pain sudden or gradual. Characteristics of pain burning, squeezing, aching, or heaviness. Vital Signs, Temperature, Pulse, Respiratory Rate, Blood Pressure. Heart Sounds. Peripheral Pulses. Lung Sound. Skin. Peripheral Edema. External Jugular Vein.

41. Assessment of Pain Onset of pain sudden or gradual. Characteristics of pain burning, squeezing, aching, or heaviness.

42. Diagnosed Tests Laboratory Tests Electrolytes (Na, K, Ca ). Serum Cardiac Enzymes (CPK. MB. LDH, Troponin I). Coagulation Profile (PTT, INR). Lipids (Cholesterol, LDL, HDL) HB,HCT,platelet count

43. Diagnostic studies Standard 12-lead electocardiogram (ECG) Used to assess dysrhythmias and myocardial ischemia or infarction. Electrodes applied to the patient’s chest and limbs record electrical impulses as they travel through heart , producing 12 different views of the heart’s electrical activity

44. Diagnostic studies Standard 12-lead electocardiogram (ECG) Used to assess dysrhythmias and myocardial ischemia or infarction. Electrodes applied to the patient’s chest and limbs record electrical impulses as they travel through heart , producing 12 different views of the heart’s electrical activity

45. Diagnostic studies Standard 12-lead electocardiogram (ECG) Used to assess dysrhythmias and myocardial ischemia or infarction. Electrodes applied to the patient’s chest and limbs record electrical impulses as they travel through heart , producing 12 different views of the heart’s electrical activity

46. Diagnostic studies Transthoracic echocardiography Used to assess ejection fraction, wall motion and thickness, valve function and disease, and blood fl ow through the chambers and valves of the heart

47. Transesophageal echocardiography (TEE) Used to obtain high-quality images of cardiac structures A 2D transducer on the end of a flexible endoscope is passed through the esophagus

48. Stress testing Used to assess prognosis and determine functional capacity in patients with ischemic heart Disease Physiologic parameters ( eg , heart rate and ECG) are monitored while the heart is in a resting state and then again when the heart is stressed either by exercise or by a pharmacological agent that simulates exercise

49. Cardiac Catheterization Pre-procedure Care Explain procedure the patient. Patient should be fasting 6-8 hrs before procedure. Identify the patient’s allergies. Administer pre medications as prescribed. Instruct the patient to follow instructions during procedure. Inform the patient that will feel warm while njection dyes. Inform the patient that might report chest discomfort or nausea. Assess dorsal ped's pulse before procedure .

50. Cardiac Catheterization During - Procedure Care Close monitor for ECG. Instruct patient to cough when asked him/ her

51. Cardiac Catheterization After -procedure Care Apply firm pressure after removal of catheter at the site of insertion. Instruct the patient to keep the affected extremity straight for 12 hrs after procedure. Monitor vital signs /15 min. Monitor urine output. Increase oral fluid. Assess dorsal ped's pulse. Instruct the patient to report any warm, wet feeling or sharp pain in extremity. (2) Non- Invasive Procedures

52. Holter Monitor Preparation of the Patient Explain procedure to the patient. Place 2 to 3 electrodes on the patient's chest. Encourage the patient to go to usual activities.

53. Stress Test (1) Exercise induced Stress Testing Pre-Procedure Care A resting ECG is taken as a a base line. Monitor HR, BP during the test. Administer medication as prescribed. Patient might be fasting 2-3 hrs before test. Instruct female patient to wear bra. Wear comfortable and supportive shoes .

54. Stress Test (1) Exercise induced Stress Testing During -procedure Care Monitor vital signs every 15 minute. Instruct patient to report if there is chest pain. Monitor ECG. Post-procedure Care Keep patient in complete bed rest. Avoid hot shower to prevent hypotension. Report if any manifestations happened.

55. Coronary angiography Used during cardiac catheterization to obtain information regarding the lumen and wall structure of the coronary arteries