Elsevier items and derived items © 2006 by Elsevier Inc. Chapter 36 Assessment of the...

Elsevier items and derived items © 2006 by Elsevier Inc.

Chapter 36

Assessment of the Cardiovascular System


The Cardiovascular System

• Anatomy and physiology

• Heart—its structure and function

– Valves, arteries

• Cardiac output, cardiac index, heart rate

• Stroke volume

• Preload

• Afterload

• Vascular system

• Contractility

• Anatomy and physiology

• Heart—its structure and function

– Valves, arteries

• Cardiac output, cardiac index, heart rate

• Stroke volume

• Preload

• Afterload

• Vascular system

• Contractility


Blood Pressure

• Blood pressure is the force of blood exerted against the vessel walls.

• Blood pressure is the force of blood exerted against the vessel walls.


Blood Pressure Regulation

• Autonomic nervous system

– Baroreceptors

– Chemoreceptors

• Renal system

• Endocrine system

• External factors also affect BP

• Autonomic nervous system

– Baroreceptors

– Chemoreceptors

• Renal system

• Endocrine system

• External factors also affect BP


Venous System

• Structure: a series of veins located adjacent to the arterial system

• Function: completes the circulation of blood by returning blood from the capillaries to the right side of the heart

• Cardiovascular changes in the older adult: only evident when the person is active or under stress

• Structure: a series of veins located adjacent to the arterial system

• Function: completes the circulation of blood by returning blood from the capillaries to the right side of the heart

• Cardiovascular changes in the older adult: only evident when the person is active or under stress


Assessment Techniques

• History

• Demographic data

• Family history and genetic risk

• Personal history

• Diet history

• Socioeconomic status

• History

• Demographic data

• Family history and genetic risk

• Personal history

• Diet history

• Socioeconomic status


Modifiable Risk Factors

• Cigarette smoking

• Physical inactivity

• Obesity

• Psychological factors

• Chronic disease

• Cigarette smoking

• Physical inactivity

• Obesity

• Psychological factors

• Chronic disease


Pain or Discomfort

• Pain or discomfort can result from ischemic heart disease, pericarditis, and aortic dissection.

• Chest pain can also result from noncardiac conditions such as pleurisy, pulmonary embolus, hiatal hernia, and anxiety.

(Continued)

• Pain or discomfort can result from ischemic heart disease, pericarditis, and aortic dissection.

• Chest pain can also result from noncardiac conditions such as pleurisy, pulmonary embolus, hiatal hernia, and anxiety.

(Continued)


Pain or Discomfort (Continued)

• Terms such as discomfort, heaviness, pressure, indigestion, aching, choking, strangling, tingling, squeezing, constricting, or vise-like are all used to describe pain.

• Women often do not experience pain in the chest but rather feelings of discomfort or indigestion.

• Terms such as discomfort, heaviness, pressure, indigestion, aching, choking, strangling, tingling, squeezing, constricting, or vise-like are all used to describe pain.

• Women often do not experience pain in the chest but rather feelings of discomfort or indigestion.


Pain Assessment

• Onset

• Manner of onset

• Duration

• Frequency

• Precipitating factors

• Location

• Radiation (Continued)

• Onset

• Manner of onset

• Duration

• Frequency

• Precipitating factors

• Location

• Radiation (Continued)


Pain Assessment (Continued)

• Quality

• Intensity, which can be graded from 0 to 10, associated symptoms, aggravating factors, and relieving factors

• Quality

• Intensity, which can be graded from 0 to 10, associated symptoms, aggravating factors, and relieving factors


Dyspnea

• Can occur as a result of both cardiac and pulmonary disease

• Difficult or labored breathing experienced as uncomfortable breathing or shortness of breath

• Dyspnea on exertion (DOE)

• Orthopnea: dyspnea when lying flat

• Paroxysmal nocturnal dyspnea after lying down for several hours

• Can occur as a result of both cardiac and pulmonary disease

• Difficult or labored breathing experienced as uncomfortable breathing or shortness of breath

• Dyspnea on exertion (DOE)

• Orthopnea: dyspnea when lying flat

• Paroxysmal nocturnal dyspnea after lying down for several hours


Other Manifestations

• Fatigue

• Palpitations

• Weight gain

• Syncope

• Extremity pain

• Fatigue

• Palpitations

• Weight gain

• Syncope

• Extremity pain


Physical Assessment

• General appearance

• Integumentary system

• Skin color

• Skin temperature

• Extremities

• Blood pressure

• Venous and arterial pulses: central and jugular venous pressures, and jugular venous distention

• General appearance

• Integumentary system

• Skin color

• Skin temperature

• Extremities

• Blood pressure

• Venous and arterial pulses: central and jugular venous pressures, and jugular venous distention


Precordium

• Assessment of the precordium (area over the heart) involves:

– Inspection

– Palpation

– Percussion

– Auscultation

• Normal heart sounds

• Paradoxical splitting

• Gallops and murmurs

• Pericardial friction rub

• Assessment of the precordium (area over the heart) involves:

– Inspection

– Palpation

– Percussion

– Auscultation

• Normal heart sounds

• Paradoxical splitting

• Gallops and murmurs

• Pericardial friction rub


Serum Markers of Myocardial Damage

• Troponin

• Creatine kinase

• Myoglobin

• Serum lipids

• Homocysteine

• C-reactive protein

• Blood coagulation tests

• Troponin

• Creatine kinase

• Myoglobin

• Serum lipids

• Homocysteine

• C-reactive protein

• Blood coagulation tests


Cardiac Catheterization

• Client preparation

• Possible complications: myocardial infarction, stroke, thromboembolism, arterial bleeding, lethal dysrhythmias, and death

• Follow-up care:

– Restricted bedrest, insertion site extremity kept straight

– Monitor vital signs

– Assess for complications

• Client preparation

• Possible complications: myocardial infarction, stroke, thromboembolism, arterial bleeding, lethal dysrhythmias, and death

• Follow-up care:

– Restricted bedrest, insertion site extremity kept straight

– Monitor vital signs

– Assess for complications


Other Diagnostic Tests

• Electrocardiography

• Electrophysiologic study

• Exercise electrocardiography

• Echocardiography

– Pharmacologic stress echocardiogram

– Transesophageal echocardiogram

• Imaging

• Electrocardiography

• Electrophysiologic study

• Exercise electrocardiography

• Echocardiography

– Pharmacologic stress echocardiogram

– Transesophageal echocardiogram

• Imaging


Hemodynamic Monitoring

• Invasive system used in critical care areas to provide quantitative information about vascular capacity, blood volume, pump effectiveness, and tissue perfusion

• Pulmonary artery catheter

• Systemic intra-arterial monitoring

• Impedance cardiography

• Invasive system used in critical care areas to provide quantitative information about vascular capacity, blood volume, pump effectiveness, and tissue perfusion

• Pulmonary artery catheter

• Systemic intra-arterial monitoring

• Impedance cardiography

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