Health assessment on Cardiovascular System- History, physical Examination with normal & Possible Abnormal Findings

1. CARDIOVASCULAR
SYSTEM
ASSESSMENT
Mr. Nikhil Ingawale
F.Y.M.Sc. Nursing
BVDU CON, Pune
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2. •AIMS :
At the end of the seminar group will able to understand Cardiovascular
System Assessment and able to apply in Clinical setting.
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3. 3
•OBJECTIVES :
At the end of the seminar group will able to :
1. Define Health Assessment
1. Define Assessment of the Cardio vascular system.
2. Revise the Anatomy and Physiology of Cardiovascular System
3. Explain the Cardiovascular System Assessment
4. Differentiate Normal & Possible Abnormal Findings
5. Explain the nursing Role in Cardiovascular System Assessment

4. Definition of Health Assessment
Assessment is the deliberate and systematic collection of data to
determine a client’s current and past health status, functional status and
to determine the client’s present and coping patterns.
Definition of Cardiovascular system Assessment
An evaluation of the condition, function, and abnormalities of the
heart and circulatory system.
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5. 5
Part I: Assessment of cardiovascular function
• Health history
• Physical assessment
Inspection
Palpation
Percussion
Auscultation
• Laboratory test

6. Anatomy & Physiology
Functions of the heart & CV system
• Pumps blood to tissues to supply O2
& nutrients
• Remove CO2 & metabolic wastes
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7. Circulation in the Heart
1. Oxygen-poor blood (shown in
blue) flows from the body into the
right atrium.
2..Blood flows through the right
atrium into the right ventricle.
3. The right ventricle pumps the
blood to the lungs, where the blood
releases waste gases and picks up
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8. 4. The newly oxygen-rich blood (shown in red) returns to the heart and
enters the left atrium.
5. Blood flows through the left atrium into the left ventricle.
6. The left ventricle pumps the oxygen-rich blood to all parts of the
body.
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9. Coronary Circulation
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10. Coronary Blood Flow
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11. Valves of the Heart
Tricuspid – Directs the flow of blood from the right atrium to the left
ventricle.
Mitral Valve – Directs the flow of blood from the left atrium to the left
ventricle.
Pulmonic (semilunar) – Lies between the right ventricle and the
pulmonary artery.
Aortic Valve (semilunar) – Lies between the left ventricle and the
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12. BLOOD
There are four main components of blood
I.Red blood cells
II.White blood cells
III.Platelets
IV.Plasma
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13. Functions of Blood
Blood is a vital fluid in our bodies and performs many important functions.
Some of these functions include:
 Supplying oxygen to tissues (carried by RBCs)
 Supplying nutrients from food to cells around the body
 Removal of waste, including carbon dioxide
 Defense against diseases and detection of foreign material (by WBCs)
 Clotting and prevention of blood loss (platelets and clotting proteins)
 Messenger functions by transporting hormones to various systems,
allowing them to interact
(e.g. insulin is created by the digestive system and circulated through the
blood, allowing cells to
absorb sugars from food we eat)
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14. Blood Vessels
The blood vessels are the part of the CVS that carry blood throughout
the different parts of the body. These vessels carry blood into all of our
organs and tissues, supplying the oxygen and nutrients necessary for
our bodies to function properly.
There are 3 major types of blood vessels:
I. Arteries – carry blood (rich in oxygen) away from the heart to the
body
II.Capillaries – very small blood vessels that allow for exchange of
gases (oxygen and carbon
dioxide), water, nutrients, and waste products to and from the blood
III.Veins – carry blood (poor in oxygen) back to the heart14

15. Cardiovascular System Assessment
1.Health History
A) Chief complaint-
•chest pain
•Irregular heartbeats or palpitations
•Shortness of breath on exertion, lying down, or at night
•Cough
•Cyanosis or pallor
•Weakness
•Fatigue
•Unexplained weight change
•Swelling of the extremities
•Dizziness
•Headache
•High or low blood pressure
•Peripheral skin changes, such as decreased hair distribution, skin colour changes,
or a thin shiny appearance to the skin
•Pain in the extremities, such as leg pain or cramps
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16. B) Current health history-Ask patient for -
•shortness of breath
•Feeling dizzy or fatigued
•Feeling of tightness in shoes
•Ankle swelling
•Any changes in colour or sensation in leg
•If sores or ulcers present how quickly they heel
•Ask patient nature of work - standing or sitting for long
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17. C) Past health history- Ask for -
•Cardiac related disorder such as hypertension, rheumatic fever etc.
•Sever fatigue not caused by exertion
•Prescription
•Any allergy- drug, food, any other product
•In female patient ask for use of hormonal contraceptive or oestrogen,
menopause, any complication during pregnancy
D) Family history- Ask patient-
•Cardiac problem in blood relation
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18. E) Psychosocial history- ask patient-
•Occupation
•Educational background
•Family relationships
•Any stress
•Current health habit- smoking, alcohol, exercise, diet
•Daily activity
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19. 2. Physical assessment
Before assessing the cardiovascular system, assess the factors that
reflect cardio vascular function that includes
a)Vital signs
•Temp.
•Blood pressure
•Pulse
•Radial pulse
•Respiration evaluation
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20. b)General appearance and related body structures
•Physical appearance
•Height
•Weight
•Skin colour
•Skin temp.
•Skin texture
•Tongue exam
•Conjunctiva
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21. Extremity assessment
•Arms and leg hair growth- even? Thicker?
•Arms and leg size compared with trunk
Fingernail assessment
•Appearance
•Capillary refill time-if delayed suggests a sign of low cardiac output
•Clubbing finger
•Any deformities
•Spoon nail- a sign of iron deficiency anaemia or raynaud’s disease
Eye assessment
•Inner canthus- hyper lipidemia
•Colour of sclera
Head movement assessment
•Assess for head movement at rest
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22. 3. Heart assessment
Neck
•Inspection-
- Inspecting carotid artery and jugular Venous system
- To visualise external venous pulsation look for pulsations in
supraclavicular area
- To visualise internal venous pulsations look for pulsations at supra
sternal notch
- Normal JVP is less than 3 cm. A central venous pressure can be
estimated by adding 5 cm to the JVP.
- Measuring Jugular venous pressure - patient with head 30 to 45
degree angle place a ruler vertically, perpendicular to the chest at the
sternal angle (angle of louis)
- (Finding) Elevated JVP - Rt sided CHF, constrictive pericarditis,
tricuspid stenosis and superior vena cava obstruction.
Low JVP - hypovolemia
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23. •Palpation- start from sterno clavicular area to epigastric area
-a) Palpating the carotid
-Lightly palpate each carotid seperately and note rate, rhythm,
amplitude, contour, symmetry, elasticity and thrills.
-b) Palpating the Jugulars
-Occluding under the jaw, the jugular should flatten but the wave form
become more prominent.
-Occluding above the clavicle, the jugular normally distends.
-C) Palpating the precordium
- Identify and palpate each cardiac site for pulsations, and thrills:
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24. •Apex (left ventricular area), or mitral area fifth intercostals space,
midclavicular line.
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25. • Base right (aortic area), second intercostals space right sternal
border.
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26. •(tricuspid area), fourth to fifth intercostal space at left sternal
border.
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27. •-Base left (pulmonic area), second intercostal space left sternal
border.
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28. •Listen at each site with both the bell and the diaphragm.
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29. •chest, thorax, shape (barrel chest- chronic obstructive pulmonary
disease), scoliosis, kyphosis
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30. Findings-
- Thrills (vibrations palpated secondary to a murmur—turbulent blood
flow through a heart valve) - Bony part of hand, ball of hand
- Thrills are palpable vibrations created by turbulent blood flow.
- Lifts or heaves are diffuse, lifting impulses. A thrust is a rocking
movement
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31. •Percussion- helpful in locating
cardiac borders
Auscultation- heart sound
Normal heart sound Abnormal heart sound
S2- base of the heart at the end of ventricular systole S3- also known as ventricular gallop
-at the apex of the heart
S1- the apex of the heart S4- also known as atrial gallop
- during atrial contraction
Summation gallop- S3 & S4 occur so close together that they appear to
be sound
Clicks
Snaps
Rubs
Murmur- it is longer than heart sound
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32. Position of Auscultation-
•Forward leaning position- best suited for hearing high pitched sound
(aortic & pulmonic)
•Left lateral recumbent position- low pitched sound (mitral valve &
extra sound)
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33. Abnormal finding
-Irregular rhythm: Arrhythmia.
-Accentuated S1: High-output states, mitral or tricuspid stenosis.
-Diminished S1: First-degree heart block, CHF, CAD
-Variable S1: Atrial fibrillation.
-S3, low-pitched, early diastolic sound: CHF.
-S4, low-pitched late-diastolic sound: CAD, HTN, MI.
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34. 4) Vascular Assessment
-Examination of arms and leg can reveal arterial or Venus disorders
• Inspection- assess for
- Arms equal in size?
- Legs symmetrical?
- Skin colour - Cyanosis, pallor, cool or cold skin- cardiac output poor
- Warm skin- increase cardiac output
-Distribution of hair all over the body
-Swelling or oedema- heart failure or venous insufficiency
-Ascites and generalised oedema- chronic right sided heart failure
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35. •Palpation-
to assess skin temp., texture
Capillary refill time
Oedema (pitting or non-pitting)
Palpate for peripheral and arterial pulse (
check for temporal, carotid pulse,
brachial pulse, radial pulse, ulnar,
femoral pulse, popliteal pulse, posterior
tibial pulse, dorsalis pedis pulse)
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36. 5) Abnormal findings
•Blood pressure decrease or increase
•Bruits- abnormal sounds
•Capillary refill time increase
•Chest pain
•Atrial gallop
•Ventricular gallop
•Intermittent claudication- cramping limb pain
•Jugular vein distention
•Palpitations- usually felt over throat or neck
•Peripheral oedema
•Pulse absent or weak
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37. Laboratory tests
•Creatine kinase (CK) and its isoenzyme CK-MB
•Lactic dehydrogenase
•Troponin I
•as low-density lipoproteins (LDL) and
high-density lipoproteins (HDL).
•Cholesterol (normal level, less than 200 mg/dL)
•LDL (normal level, less than 130 mg/dL)
•HDL (normal range in men, 35 to 65 mg/dL; in women, 35to 85 mg/dL) have a
protective action
•Triglycerides (normal range, 40 to 150 mg/dL), composed of free fatty acids and
glycerol, are stored in the adipose tissue and are a source of energy
•Coagulation Studies
•Partial thromboplastin time (PTT)
• Prothrombin time (PT)
•Chest x-ray and fluoroscopy
•Electrocardiography
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38. Diagnostic Procedures
1.EKG 12 Lead
continuous cardiac monitoring holter monitor
2. Chest x-ray – detects
enlargement of heart & pulmonary congestion
3.Echocardiography – ultrasound that reveals size, shape and motion of cardiac
structures
Evaluates heart wall thickness, valve structure, differentiates murmurs
4.TEE–transesophageal
echocardiography provides a clearer image because less tissue for sound waves to
pass through
5. Angiography / cardiac catherization determines coronary lesion size,
location, evaluate (L) ventricular function, measures heart pressures
6. Exercise tolerance test
7. Radionuclide Imaging
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39. Nurses role in cardiovascular System Assessment
Pre CVS Assessment
•Prepare the Assessment room
•Prepare the assessment tray or trolly
•Prepare the patient for assessment
•Explain the procedure to the patient
During CVS Assessment
•Assess the CVS assessment
•Maintain IPR with patient
Post CVS Assessment
•Make a assessment record file
•Rearrange the assessment room
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40. THANK YOU
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