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

2. Elsevier items and derived items © 2006 by Elsevier Inc. 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

3. Elsevier items and derived items © 2006 by Elsevier Inc. Blood Pressure Blood pressure is the force of blood exerted against the vessel walls.

4. Elsevier items and derived items © 2006 by Elsevier Inc. 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

5. Elsevier items and derived items © 2006 by Elsevier Inc. 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

6. Elsevier items and derived items © 2006 by Elsevier Inc. 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

7. Elsevier items and derived items © 2006 by Elsevier Inc. Modifiable Risk Factors Cigarette smoking Physical inactivity Obesity Psychological factors Chronic disease Cigarette smoking Physical inactivity Obesity Psychological factors Chronic disease

8. Elsevier items and derived items © 2006 by Elsevier Inc. 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)

9. Elsevier items and derived items © 2006 by Elsevier Inc. 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.

10. Elsevier items and derived items © 2006 by Elsevier Inc. Pain Assessment Onset Manner of onset Duration Frequency Precipitating factors Location Radiation (Continued) Onset Manner of onset Duration Frequency Precipitating factors Location Radiation (Continued)

11. Elsevier items and derived items © 2006 by Elsevier Inc. 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

12. Elsevier items and derived items © 2006 by Elsevier Inc. 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

13. Elsevier items and derived items © 2006 by Elsevier Inc. Other Manifestations Fatigue Palpitations Weight gain Syncope Extremity pain Fatigue Palpitations Weight gain Syncope Extremity pain

14. Elsevier items and derived items © 2006 by Elsevier Inc. 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

15. Elsevier items and derived items © 2006 by Elsevier Inc. 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

16. Elsevier items and derived items © 2006 by Elsevier Inc. 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

17. Elsevier items and derived items © 2006 by Elsevier Inc. 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

18. Elsevier items and derived items © 2006 by Elsevier Inc. 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

19. Elsevier items and derived items © 2006 by Elsevier Inc. 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