Assessing Cardiovascular System: Nursing Assessment for History,

NP125.05.01.02 Nursing AssessmentAssessment of the Cardiovascular SystemHistoryThe initial assessment includes the client’s (or family member’s) descriptionof the symptoms the client experienced before and during admission. Thehistory also includes the client’s past medical history and family medicalhistory. The family medical history is important because many cardiacdisorders have a familial or genetic predisposition. If close blood relatives areno longer living, it is important to ask about the cause of death, age atdeath, and relationship to the client.The nurse asks the client to identify prescription and nonprescription drugsand herbal substances and herbal substances that he or she is taking.Adverse effects or drug interactions can contribute to cardiac symptoms. Useof illicit drugs, such as cocaine and methamphetamine, is also significant tothe cardiac history. Drug and food allergies are noted because futurediagnostic procedures may involve the administration of drugs orsubstances, such as radiopaque dyes.Pharmacologic ConsiderationsWhen assessing the medication history, be sure to ask specifically aboutnonprescription medications and herbal or nutritional supplements. Clientsmay not think of these items as medications, yet they can also impact bloodpressure, pulse, or cardiac function.Physical ExaminationGeneral AppearanceAn appraisal of the client’s general appearance may suggest problems thatrequire further exploration. The client’s nonverbal behavior and bodyposition may indicate that he or she is anxious, depressed, in pain, oruncomfortable.PainPoor circulation, a common problem in clients with cardiovascular disorders,causes ischemia (reduced blood supply) to body organs. A classical sign ofischemia is pain, which results from a lack of oxygen in the tissue. Chest pain

is a manifestation of ischemia to the heart muscle. Leg pain, especially withactivity, can indicate inadequate oxygenation to leg muscles.When pain is present, the nurse evaluates it carefully. Obtaining as muchinformation as possible is essential. Prompt management of pain isextremely important.Vital SignsTemperatureFever is characteristic in some types of heart disease. It can accompany theinflammatory response when myocardial cells are damaged after an acutemyocardial infarction (MI; heart attack) or infections such as rheumatic feverand bacterial endocarditis.PulseWhen taking a client’s pulse, the nurse notes its rate, rhythm, and quality.Pulse rhythm is the pattern of the pulsations and the pauses between them.A normal pulse is felt regularly with a similar length of pause. The pulsequality refers to its palpated volume. Pulse volume is described as feelingfull, weak, or thready, meaning barely palpable. The nurse also determinesany pulse deficit by counting the heart rate through auscultation at the apexwhile a second nurse simultaneously palpates and counts the radial pulse fora full minute. The difference, if any, is the pulse deficit.