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cvs assessment

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L1  cvs assessment L1 cvs assessment Presentation Transcript

  • CARDIOLOGY NURSINGAssessment of the CVS PUAN ROSDIANA RAMLI 1
  • Learning Outcomes:At the end of the session, student will able to;• review the anatomy and physiology of cardiovascular system.• Taking health history for cardiac assessment.• Perform the physical examination• Outline the diagnostic test. 2
  • THE CARDIOVASCULAR SYSTEMHEART’S NORMAL ANATOMY• The heart is located in the LEFT side of the mediastinum• Consists of Three layers - epicardium, myocardium and endocardium 3
  • THE CARDIOVASCULAR SYSTEM• The layer that covers the heart is the PERICARDIUM• There are two parts - parietal and visceral pericardium• The space between the two pericardial layers is the pericardial space 4
  • THE CARDIOVASCULAR SYSTEM• The heart also has four chambers - two atria and two ventricles• The Left atrium and the right atrium• The left ventricle and the right ventricle 5
  • The Cardiovascular SystemThe heart chambers are guarded by valves• The atrio-ventricular valves - tricuspid and bicuspid• The semi-lunar valves - pulmonic and aortic valves 6
  • The Cardiovascular SystemThe Blood supply of the heart comes from the Coronary arteries1. Right coronary artery supplies the RIGHT atrium and RIGHT ventricle, inferior portion of the LEFT ventricle, the POSTERIOR septal wall and the two nodes - AV (90%) and SA node (55%) 7
  • The Cardiovascular System2. Left coronary artery- branches into the LAD and the circumflex branch• The LAD supplies blood to the anterior wall of the LEFT ventricle, the anterior septum and the Apex of the left ventricle• The CIRCUMFLEX branch supplies the left atrium and the posterior LEFT ventricle 8
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  • The Cardiovascular SystemThe CONDUCTING SYSTEM OF THE HEARTConsists of the1. SA node- the pacemaker2. AV node- slowest conduction3. Bundle of His – branches into the Right and the Left bundle branch4. Purkinje fibers- fastest conduction 10
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  • The Cardiovascular SystemThe Heart sounds1. S1- due to closure of the AV valves2. S2- due to the closure of the semi-lunar valves3. S3- due to increased ventricular filling4. S4- due to forceful atrial contraction 12
  • The Cardiovascular SystemHeart rate• Normal range is 60-100 beats per minute• Tachycardia is greater than 100 bpm• Bradycardia is less than 60 bpm• Sympathetic system INCREASES HR• Parasympathetic system (Vagus) DECREASES HR 13
  • CVS Assessments• History taking• Physical assessment• Psychosocial assessment• Laboratory assessment• Radiographic assessment• ECG• Hemodynamic monitoring 14 14
  • ASSESSING CARDIAC FUNCTION• HEALTH • DIAGNOSTIC TESTS ASSESSMENT: – LABORATORY Health History – INVASIVE TEST• PHYSICAL • CARDIAC CATHETERIZATION EXAMINATION – Coronary angiography – Coronary arteriography. – NONINVASIVE TESTS • CXR • STRESS/EXERCISE TEST • ECG 15
  • CARDIAC ASSESSMENT1. Health History• Obtain description of present illness and the chief complaint• Chest pain, SOB, Edema, palpitations, etc.• Assess risk factors• Personal habits and nutritional history.• Activity-exercise• Sleep-rest. 16
  • History Taking• Personal particulars• Medical and surgical history• Family history and genetic risks• Diet history• Socioeconomic status• Risk factors – smoking, physical inactivity, obesity, psychological factors• Present history of illness, sign & symptoms – Chronic disease, pain, discomfort, dyspnea, fatigue, palpitations, weight gain, syncope, and extremity pain 17
  • CARDIAC ASSESSMENT2. Physical examination• General appearance.• Vital signs- BP, PP, MAP• Inspection of the skin• Inspection of the thorax• Palpation of the point of maximal impulse(PMI), pulses• Auscultation of the heart sounds 18
  • Physical Assessment• General appearance• Skin & mucous membranes (colour, temperature)• Extremities (clubbing, oedema, bruits, b/p, pulse pressure)• Precordium (inspection, palpitation, percussion & auscultation – heart sounds (paradoxical splitting, gallops & murmurs, pericardial friction rub). 19 19
  • 3. Peripheral vascular system: a. Inspection: . Skin - colour. . Extremities: - edema. - clubbing of fingers. - varicosities. - lesions. . NeckApr 17, 2009 - large veins. 20
  • Diploma in Nursing , School of Nursing 21 Faculty of Health Science
  • PallorClubbing 22
  • b. Palpation: . Upper and lower extremities: - temperature. - pulses. - edema.Apr 17, 2009 23
  • Diploma in Nursing , School of Nursing 24 Faculty of Health Science
  • Percussion Unnecessary in the CVS examination (except lung bases) Percuss and listen to the lung bases  For any signs of pleural effusion (RVF) and pulmonary oedema (LVF) 25
  • Auscultation• Heart sound• 1st heart sound – closure of tricuspid and mitral valve.• 2nd heart sound – closure of aortic and• pulmonary valves.• 3rd and 4th heart sound – extra heart sound.• Murmur – sounds occuring between normal heart sound.• Pericardial friction rub – scratchy sound between S1 and S2. 26
  • PREKORDIUM 27
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  • Laboratory studiesLaboratory Test Rationale1. To assist in diagnosing MI2. To identify abnormalities3. To assess inflammation4. To determine baseline value5. To monitor serum level of medications6. To assess the effects of medications 29
  • Laboratory Assessment • Serum Markers  Troponin  Creatine Kinase (CK)-MB • Serum Lipids • Homocysteine • C-Reactive Protein • Blood Coagulation Tests  Prothombin Time & International Normalised Ratio (INR)  Partial Thromboplastin Time (PTT) • Arterial Blood Gases • Serum Electrolytes • Complete Blood CountJuly 8, 2012 30 30
  • Radiographic Assessment• Chest Radiography  Size of heart, pulmonary congestion, position of heart and catheters  Preparation of patient• Angiography  Invasive diagnostic procedure when suspect arterial obstruction, narrowing or aneurysm. A contrast media is used and fluoroscopy to see the flow of contract  Preparation of patient• Cardiac Catheterization  To study right, left heart and coronary arteries  Preparation of patient July 8, 2012 31
  • Electrocardiogram (ECG)• Resting  12 lead or rythmn continous monitoring• Ambulatory (Holter monitoring)  24 hrs ECG recording to detect dysrythmias• Exercise ECG – stress test  Assess CVS responds to increased workload  Helps to determine functional capacity of the heart and screens for asymptomatic coronary artery disease  Preparation• Echocardiography  Ultrasound waves to assess cardiac structure and mobility especially of valves July 8, 2012 32
  • DIAGNOSTIC TESTSELECTROCARDIOGRAM (ECG)• A non-invasive procedure that evaluates the electrical activity of the heart. 33
  • DIAGNOSTIC TESTSHolter Monitoring• A non-invasive test in which the client wears a Holter monitor and an ECG tracing recorded continuously over a period of 24 hours• Instruct the client to resume normal activities and maintain a diary of activities and any symptoms that may develop. 34
  • DIAGNOSTIC TESTSStress Test• A non-invasive test that studies the heart during activity and detects and evaluates CAD• Exercise test, pharmacologic test and emotional test• Used to determine CAD, Chest pain causes, drug effects and dysrhythmias in exercise 35
  • DIAGNOSTIC TESTSECHOCARDIOGRAM• Non-invasive test that studies the structural and functional changes of the heart with the use of ultrasound• No special preparation is needed 36
  • DIAGNOSTIC TESTSCARDIAC catheterization• Insertion of a catheter into the heart and surrounding vessels• Determines the structure and performance of the heart valves and surrounding vessels.• Used to diagnose CAD, assess coronary atery patency and determine extent of atherosclerosis. 37
  • Hemodynamic monitoring• An invasive monitoring system esp in ICU• Directly measures pressures in the heart and great vessels. Measuring:  Vascular capacity  Blood volume  Pump effectiveness  Tissue perfusion• Right Atrial Pressure• Pulmonary Artery Pressure• Pulmonary Artery Wedge Pressure• Cardiac output – Thermodilution method 38
  • DIAGNOSTIC TESTSCVP• The CVP is the pressure within the Superior Vena Cava• Reflects the pressure under which blood is returned to the SVC and right atrium 39
  • DIAGNOSTIC TESTSCVP• Normal CVP is 0 to 8 mmHg/ 4-10 cm H2O• Elevated CVP indicates increase in blood volume, excessive IVF or heart/renal failure• Low CVP may indicated hypovolemia, hemorrhage and severe vasodilatation 40
  • THANK YOU 41