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What are common complaints associated the cardiovascular system?
  • Chest pain: tightness, squeezing, crushing, or stabbing
  • Palpitations: an unpleasant awareness of the heart beat
  • SOB/DOE: shortness of breath and dyspnea on exertion
  • Edema: excessive fluid in the interstital tissue, swelling
Subjective assessment of CV system (chest pain/dyspnea)
  • Chest pain (PQRSTU) When did it start? Describe the character (quality), Was it brought on by activity? Any associated symptoms (SOB, N/V, sweating)? Anything relieve the pain? NTG? How many tabs?
  • Dyspnea: any SOB/DOE? suddenly? does positioning help? Does it awaken you at night? How many pillows do you use when sleeping? PND?
  • stress can trigger MI
  • diabetics may experience symptoms differently or just not feel like
  • Levine sign
Subjective assessment of CV system cont.
  • Cough? Is it wet, congested, or dry? How long have you had it? Productive or not?
  • Fatigue: do you tire easily? Are you able to do the activities you used to do?
  • Have you ever noticed your face or lips turning blue?(circumoral cyanosis is worse than peripheral)
  • Edema: do you have any swelling in your hands or feet? 1-2+ edema is about 10 lbs of extra fluid
Subjective CV assessment cont.
  • What is your past cardiac history?
  • What medications are you taking?
  • What is your family history?
  • Cardiac Risk factors: Lifestyle (stress), Diet (increased sodium, increased fat intake, smoking/alcohol: decrease o2 in blood, etoh strips GI mucosal lining, how much do you exercise? Do you check your BP? How often?
What are some lifestyle modifications than can help control HTN?
  • weight reduction (apple vs pear shape)
  • sodium restriction
  • dietary fat modifcation
  • aerobic exercise vs weight training
  • alcohol restriction
  • caffeine restriction
  • relaxation techniques (biofeedback)
  • Potassium supplements (also Ca and Vit D)
Objective CV assessment data
  • pulse and BP
  • extremeties
  • neck vessels
  • precordium
  • general appearance (pale, cyanosis, cap refill, clubbing)
  • start from head and work in an organized manor
  • systolic < 90 affects perfusion in coronary arteries
What needs to be done to take a proper BP?
Pt should be seated with the arm supported and positioned at the heart level, Pt should not have ingested caffeine or smoke within the last 30 minutes, measure after 5 minutes of rest.
CV assessment of the neck
  • palpate the carotid pulse (one side at a time,)
  • carotid pulse: systolic at least 70
  • radial pulse: systolic at least 80
  • listen with bell side to the carotid areas to assess for a bruit (swooshing sound, sign of atherosclerosis in middle aged people)
  • inspect jugular venous pulse
  • position the pt supine 30-45 degree angle and look for pulsation
Jugular venous pressure
  • estimate JVD
  • position pt properly
  • If neck veins are distended think of heart failure/ fluid overload
Assessment of the anterior chest
  • inspect the chest looking for pulsations
  • palpate across the chest using the plantar aspect of the fingers feeling for PMI (point of maximal impulse)
  • percuss the chest for cardiac borders
Cardiac valve auscultation
  • Aortic: 2nd right intercostal space
  • pulmonic: second left intercostal space
  • tricuspid: left lower sternal border
  • mitral valve: left mid cavivular line at 5th intercostal space
What are you listening for when aucultating the heart?
  • Rate and regularity
  • ID S1 (lub) AV valves closing
  • ID S2 (dub) closure of the SL valves (AP)
  • listen for murmurs, rubs, clicks,
  • Listen for S3/S4
Grading heart murmurs
  • I: murmur so faint that it can only be heard with great effort
  • II: a faint murmur, but one that can be easily detected,
  • III: a moderately loud murmur
  • IV: a very loud murmur that is associated with a thrill (palpable purring/vibration)
  • V: an exceptionally loud murmur that can be heard while the stethoscope is lifted off the skin
  • children may have an innocent murmur (grade II) that disappears
S3 heart sound
ventricular gallop occurs during diastole during rapid refilling, the sound is heard after S2, It indicates stiff noncompliant ventricles and is auscultated in the left lower sternal border, S3 precedes the crackles hear from fluid overload
S4 heart sound
atrial gallop occurs when atria contract and happens when there is decreased compliance in the ventricle or long standing HTN, It is best auscultated at the apex in the left lateral position
Peripheral vascular assessment: subjective data
  • Leg pain or cramps (pqrstu)
  • does it wake you up at night?
  • Changes with exercise?
  • How far can you walk without stopping?
  • Any changes on the arms or legs? Changes in redness, blueness, brown discolorations, or ulcerations?
  • Swelling in the arms or legs?
  • What medications are you taking?
  • Skin changes could include lack of hair, shiny skin, blue/brown skin
Periperal vascular assessment: objective data
  • inspect and palpate the arms inspecting for color and pulses (1:thready, 2-3:normal, 4:bounding)
  • assess both sides for symmetry in pulse
  • Allen test for brachial/radial artery patency
  • assess lower extremities for color and tenderness
  • never do homan's sign:can turn a clot into an embolus
Peripheral vascular disease
  • more common in pts that are older or have DM
  • can be arterial or venous
  • Risk factors: DM, obesity, genetic, smoking, dyslipdemia, HTN, age can all lead to atherosclerosis which in turn can lead to coronary, cerebrovascular, or peripheral vascular events
Peripheral artery disorders
  • primarily caused by atherosclerosis which slowly occludes blood
  • risk factors: DM, smoking, elevated lipids, phlebitis, surgery, autoimmune disorder
  • lower limbs are more susceptible
Peripheral Artery Disease
  • emphasis on CAD, MI, CVD, CVA
  • leg pain: muscle strain, arthritis, sciatica
  • pts with critical limb ischemia shocked to learn that the disease is limb threatening
Arterial occlusion
  • Acute: pain, pulselessness, low ABI (ankle brachial pressure index), pallor, paralysis, paresthesia (pins and needles), poiklothermia (coldness)
  • Chronic: shiny skin, hairlessness, dystrophied toenails, sin pallor when leg elevated, slow wound healing
Chronic critical limb ischemia
  • ischemic rest pain: ache, pain, numbness, of arch of foot/toes with leg elevation (most uncomfortable at night while resting in bed, interferes with sleep). Relief with dependent positioning of limb
  • ischemic ulceration: found distally at the ends of toes, over bony prominences on feet (dry devitalized, black, intense pain)
  • gangrene
Chronic venous disorders
  • varicose veins: permanently distended veins that develop from the loss of vascular competence, S/S: aching heaviness, itching, swelling, unsightly appearance
  • Venous stasis ulcers: it is the end of chronic venous insufficiency, ulceration is due to the stasis of blood, usually found on the lower leg and appears irregular with a beefy red base, lower extremity discoloration (venous tatooing)
Lymphatic disorders
  • lymphedema: swelling in the interstital tissue most often in the arms or legs
  • Primary: classified according to age at onset
  • secondary: occurs because of some damage or obstruction to the lymph system
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