Chapter 35 Assessment of the Cardiovascular System Mrs. Marion Kreisel MSN, RN NU230 Adult Health 2 Fall 2011

Surface Anatomy of the Heart

Blood Flow Through the Heart

Sequence of Events During the Cardiac Cycle

Cardiovascular System Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Chambers of the Heart Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Heart Valves and Sounds Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Mechanical Properties of the Heart Cardiac output Heart rate Stroke volume Preload Impedance Myocardial contractility

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

Physiology of Blood Pressure Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Blood Pressure Regulation Autonomic nervous system: Baroreceptors Chemoreceptors—hypercapnia Renal system Endocrine system External factors also affect BP

Venous System—Blood Vessels

Venous System—Systemic Circulation

Cardiovascular System: Assessment Patient history Nutritional history Family history and genetic risk Current health problems: Pain or discomfort Dyspnea, DOE, orthopnea, Fatigue Palpitations Edema Syncope Extremity pain

Cardiovascular System: Physical Assessment General appearance Skin Extremities Blood pressure Jugular Vein Distention: Check for this with patient lying supine HOB elevated degrees

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

Serum Markers of Myocardial Damage Troponin—Troponin T and troponin I Creatine kinase (CK) Myoglobin Serum lipids Homocysteine Highly sensitive C-reactive protein

Laboratory Tests Microalbuminuria Blood coagulation studies ABG F&E Erythrocyte count H&H Leukocyte count

Cardiac Catheterization

Other Diagnostic Tests Electrocardiography (ECG) Electrophysiologic study (EPS) Exercise electrocardiography (stress test) Watch the EKG for changes meaning trouble. Echocardiography: Pharmacologic stress echocardiogram Transesophageal echocardiogram (TEE) Myocardial nuclear perfusion imaging High Density Lipoproteins (HDL) Good Cholesterol. The more of this cholesterol the less likely to develop CHD and Low Density Lipoproteins (LDL) Bad cholesterol

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 Invasive arterial catheter Impedance cardiography

Hemodynamic Monitoring (Cont’d)

NCLEX TIME

Question 1 A person who smokes more than 20 cigarettes per day increases his or her risk for cardiovascular disease by: A.One time B.Two times C.Three times D.Four times

Question 2 The patient is complaining of substernal pain that spreads to the left side and back and is usually relieved with sitting upright. The nurse suspects the patient is most likely experiencing: A.Angina B.Myocardial infarction C.Anxiety attack D.Pericarditis

Question 3 A woman who is experiencing a myocardial infarction may experience which set of symptoms instead of intense pain or pressure in the chest? A.Indigestion, feelings of chronic fatigue, and a choking sensation B.A moderate ache in the chest, worse on inspiration C.Sudden, intermittent, stabbing pain D.Pain that spreads across the chest and the back and/or down the arm

Question 4 To maintain perfusion of major body organs, such as the kidneys or the brain, the mean arterial pressure (MAP) needs to be: A.At least 40 mm Hg B.At least 50 mm Hg C.Between 60 and 70 mm Hg D.Between 70 and 80 mm Hg

Question 5 The best indicator of fluid retention is: A.Tachycardia B.Crackles in the lungs C.Weight gain D.Increased blood pressure