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Cardiac AssessmentSubjective data-Chest pain-PQRST- angina described as “clenched fist”Dyspnea- PQRST- paroxysmal, constant, recumbentSleeping- Nocturnal dyspnea(CHF) lying down causes increased intrathoracic blood- weak heart cannot compensate person awakens after 2 hours needs air Nocturia-(CHF) laying recumbent causes fluid re-absorption and excretion in ambulatory personsOrthopnea- needs to sit upright to breathe (how many pillows)Cough- Duration, frequency, type, productive, hemoptysis is usually pulmonary can occur in mitral stenosisFatigue- cardiac related worse in eveningColour- cyanosis, pallor- colour changes due to tissue perfusionEdema- dependent with heart failure better in amRisk factorsfor coronary artery disease (CAD) - lipidemia, HTN, diabetic, obesity, smoking, sedentary lifestyle, post menopausal women –hormone useObjective data-Cardiac assessment includes- Vitals (Pulse, BP), extremities, Neck vessels, precordiumVitals- take vitals- Pulse- rate, rhythm, force, elasticityBlood Pressure- both arms- can be a difference of 5-10 mm Hg between the two arms____________________________________________________________Extremities- Inspect and palpate both armsnoting colour of skin and nail beds, temperature, texture, and turgor note any lesions, edema or clubbing (profile sign-proximal edge of elevated >180° ) check cap refill (1-2 sec) feel pulses size and pulses(2+) should be symmetric. Check Allen test for collateral circulationInspect and palpate bothlegs noting colour, hair distribution, venous pattern, size, lesionsor ulcers. Check temperature Asymmetry of calves of 2cm or more abnormal. Assess Homans – dorsiflex foot or flex person’s knee press calf forward against tibia (tibial vein)Palpate pulses femoral, popliteal, dorsalis pedis and posterior tibial. Asses pretibial edema normally no pitting can be seen in persons standing all day or during pregnancy. Note visible dilated or tortuous veins with standing check competent valve in varicose veins (hand at knee and ankle press down at knee should not feel wave at ankle wave= incompetent valves) arterial disease pain, pallor, puslessness, parasthetia, paralysis, dependent rubra (lift legs then dependent)Neck vessels- Carotid- (sitting up) palpateone carotid at a time avoid excessive pressure (carotid sinus hypersensitivity pressure leads to decreased HR, BP, cerebral ischemia and syncope) note contour (smooth) and amplitude (2+) Findings should be the same bilaterally. 1
Auscultate- neck in neutral position 3 levels- 1. jaw angle 2.midcervical 3. base of neck. Have person take a breath, exhale, and hold briefly while you listen. Asses for bruit (blowing swishing sound indicating turbulent blood flow) should not have bruit. Bruit indicates vascular cause narrowing by one half to two thirdsJugular Vein- (supine with head and chest slightly elevated 30-45°angle wherever you can see pulsation no pillow) - assess central venous pressure (CVP) which assess the hearts efficiency as a pump. The right internal jugular vein is attached more directly to the superior vena cava so better for assessment. You cannot see the vein but you can see the pulsation. The higher the venous position the higher the angle (usually at 45°the