Nursing Assessment of the CVS

1. Care of Clients with Problems in
Oxygenation, Fluids and Electrolytes,
Inflammation and Immunologic
Responses, Cellular Aberration, Acute
and Chronic
NCM 112

2. Lesson
Module 13:
Unit 2
Assessment of the
Cardiovascular System

3. Learning Objectives:
1. Describe focus assessment criteria
when caring for a client with
cardiovascular problems.
2. List common diagnostic test used to
evaluate client with suspected heart
conditions.
3. Discuss the nursing care management
of client undergoing cardiovascular
diagnostic test.

4. Lesson
Content:
• Assessment of the Cardiovascular System
• Physical Examination
• Diagnostic Tests

5. Introduction
• The function of the cardiovascular system is to supply
oxygen-rich blood to all body cells and tissues and
eliminate carbon dioxide and cellular waste. Damaged to
and disease within the cardiovascular system greatly
jeopardizes a person’s health. Heart disease is a leading
cause of deaths for adults. It is always in the top 10 of the
morbidity and mortality statistics.
• Many advanced treatments have been and are being
created to reduce deaths from heart diseases. Human
heart transplantation and the temporary use of total
artificial heart as a bridge to transplant are already a
reality. Nevertheless, the primary focus remains on
preserving the natural heart by preventing heart disease.

6. • Learning Objectives
1. Review the normal anatomy and physiology of
the cardiovascular system.
2. Identify and describe focus assessment criteria
when caring for a client with cardiovascular
problems.
3. List common diagnostic tests used to evaluate
the client with suspected heart disease.
4. Discuss nursing care management of a client
undergoing cardiovascular diagnostic tests.

7. Assessment of
the
Cardiovascular
System
History
• Clients or family description of the symptoms the client
experienced before and during admission.
• Past medical history and family medical history.
• Identify prescription and nonprescription drugs that
the client is taking.
• Use of illicit drugs such as cocaine and
methamphetamine.
• Drug and food allergies.
General Appearance
• Appraise the client’s general appearance including
nonverbal behavior, body position that may indicate
that the client is anxious, depressed, in pain, or
uncomfortable.

8. • Pain
• Poor circulation is a common problem in clients with
cardiovascular disorders because of ischemia.
• Pain is a classic sign of ischemia.
• Chest pain is ischemia to the heart muscle.
• Leg pain, especially with activity, indicate inadequate oxygenation
to leg muscles.
• Vital signs
• Fever can accompany inflammatory response when myocardial
cells are damaged or if there is an infection such as rheumatic
fever and endocarditis.
• Pulse when taken, nurse should take note of the rate, rhythm, and
quality.
• Pulse volume is described as full, weak, or thready.
• Respiratory rate should be counted for sixty seconds.
• Observe the character of respiration whether breathing is
labored, deep, shallow, noisy, or quiet.
• Use of accessory muscle must be noted.

9. • Blood Pressure
• If patient is not acutely ill, take orthostatic blood pressure.
• Nurse questions the client about dizziness or light headedness when changing
positions.
• Cardiac Rhythm
• Electrical activity that produces the heart rhythm can be observed
continuously with bedside cardiac monitor.
• Electrodes are attached to the chest and connected to a machine that displays
the cardiac rhythm on an oscilloscope.
• Heart Sounds
• Auscultation of the heart requires familiarization with normal and abnormal
heart sounds.

11. • Skin
• A good light is necessary when assessing skin color.
(Cyanosis, Pallor)
• Cyanosis can be detected on the lips, earlobes, skin,
and nail beds, and mucous membrane of the mouth.
• Nurse inspects the arms and legs for variations in
skin color and temperature and compare this with
other areas of the body.
• Sparse hair growth on the legs and thick toenails can
indicated poor circulation.
• Check for presence of varicosities.
• Weight
• Weight gain can indicate edema.
• Weight loss reflects the loss of excess fluid from the
tissues and is used to evaluate the effectiveness of
diuretics.
• Weight is recorded daily.
• Weigh the client at the same time in the same
amount of clothing, using the same scale each day.
• Record it properly in the flow sheet.

12. • Jugular Vein
• If the right side of the heart fails to pump effectively,
blood becomes congested in the neck veins.
• Distention of neck veins indicate increased fluid
volume and pressure eon the right side of the heart.
• Lung Sounds
• The nurse auscultates the lungs for abnormal and
normal breath sounds.
• With left-sided heart failure, auscultation reveals
crackling sound, wheezes, or gargles.
• Left-sided heart failure us followed by right-sided
heart failure because the circulatory system is a
continuous loop.
• Sputum
• Patient may have productive or nonproductive cough.
• Note the frequency and the amount and appearance
of the sputum.
• Mental Status
• Clients with cardiac disorders may be alert, confused,
or disoriented.
• Confusion or disorientation result from a decrease in
oxygen supply to the brain.
• Chest pain and impaired breathing can create anxiety.

13. Diagnostic Testing for
Cardiovascular System
• Laboratory Tests
• Various general laboratory tests are used in
the diagnosis of heart disease and in
monitoring the client’s progress.
• Blood chemistries, such as fasting blood
glucose and serum electrolyte, cholesterol
and triglyceride levels may be used as part
of diagnostic process.
• Serum cholesterol and lipid tests and
isoenzyme analyses may also be ordered.
When tissues and cells break down, are
damaged, or die, large quantities of certain
enzymes are released into the bloodstream.
• Enzymes therefore may be elevated in
response to cardiac or other organ damage.

14. • Radiography and Radionuclide Studies
• Chest radiography and fluoroscopy determine the size and position of the
heart and condition of the lungs.
• Computed tomography (CT) scanning and magnetic resonance imaging are
used to determine heart size and detect lung involvement.
• Radionuclides are radioactive chemical elements that are injected into and
travel through the bloodstream. Their use sometimes is referred to as
nuclear cardiology. Radionuclide technetium-99m is used to detect areas
of myocardial damage.

15. • Magnetic Resonance Imaging (MRI)
• The principle underlying MRI is that many elements within
the human body, such as hydrogen, are magnetic. The MRI
machine’s magnetic field excites the hydrogen atoms,
creating radio signal.
• The radio signal is converted to an image on a computer
monitor. Because magnetism is used, clients undergoing
MRI are not exposed to radiation as would occur with tests
involving x-rays.
• An MRI is prohibited on clients with various metal devices
within their body; external metal objects must be
removed.
• Preparation for cardiac MRI includes attaching ECG leads,
starting intravenous infusions in one or two sites for the
purpose of instilling fluids; medication, such as adenosine
(Adenocard), to accelerate the heart rate; and contrast
medium, a radiopaque substance that fills hallow
structures, to help the physician observe the heart in “real
time”

16. Metal Devices That Prohibit a Magnetic
Resonance Imaging (MRI)
Within the body On the body (Must be removed)
Wound staples
Implanted pacemaker
Implanted cardiac defibrillator
Artificial heart valve or stents
Metallic pins, screws, plates
Implanted drug delivery devices
Aneurysm clips
Implanted brain / nerve stimulator
Tattooed eyeliner
Watch
Jewelry
Hearing aid
Hair clips or pins
Pocket knife
Keys
Credit card or bank cards
Body piercing
Removable dental work

17. • Echocardiography
• Uses ultrasound waves to determine the functioning of
the left ventricle and to detect cardiac tumors, congenital
defects, and changes in the tissue layers of the heart.
• Electrocardiography (ECG)
• Is the graphic recording of the electrical currents
generated by the heart muscle. During ECG, color-coded
electrodes matched to corresponding lead wires connect
the client to the recording machine.
• Electrodes are coated with conductive gel and applied to
the skin surface of the wrist, ankles and chest.
• A computerized ECG machine immediately interprets the
tracings, or rhythm strips, which serves as a screening
device. A physician later interprets the rhythm strips to
aid in diagnosing heart disease.

18. • Ambulatory Electrocardiography
• Or Holter monitoring, is the recording of an ambulatory client’s cardiac rate
and rhythm over 24 to 48 hours as the client performs daily activities.
• The Holter monitor, which is worn on a belt or carried on a shoulder strap,
consists of a tape recorder connected to ECG leads attached to the client’s
chest.
• During the test period, the client keeps a diary of activities and associated
symptoms. At the end of the recording period, the monitor is returned to the
hospital or physician and the tape is analyzed. Ambulatory ECG helps to detect
dysrhythmias (rhythm abnormalities) and myocardial ischemia that occur
sporadically during activity or rest.
• Exercise Electrocardiography
• Also known as a stress test, the electrical activity of the heart is assessed with
an ECG monitor while the client walks on a treadmill, pedals a stationary
bicycle, or climbs up and down stairs.
• The client’s heart and rhythm are monitored continuously, and waveforms are
recorded periodically. The client is instructed to report the onset of chest pain,
dizziness, leg cramps or weakness. The stress test is aborted if the client
develops chest pain, severe dyspnea, elevated BP, confusion or dysrhythmias.

19. • Cardiac Catheterization
• Cardiac catheterization is a diagnostic test performed in an operative setting.
• A long, flexible catheter is inserted from a peripheral blood vessel in the
groin, arm, or neck into one of the great vessels (inferior or superior vena
cava) and then into the heart.
• Cardiac catheterization may be carried out on the left side of the heart by the
way of an artery or on the right side by the way of a vein.
• Before the procedure:
• The client needs to consult the physician about which
prescribed medications to take or omit the day of the
catheterization.
• Allergies must be identified .
• IV fluids are administered before the test to maintain
hydration and to administer any necessary medications.
• A sedative is administered before the test.

20. • After the test:
• Catheter is removed and the site is covered with a
pressure dressing to control bleeding.
• The nurse monitors BP and pulse frequently to detect
complications.
• Checks the dressing over the insertion site frequently
for signs of bleeding.
• The nurse palpates the pulse in various locations and
checks the color and temperature in the extremity to
confirm that blood is circulating well.
• Instructions include the following:
• Keep the extremity straight for several hours and
avoid movement
• Report any warm, wet feeling that may indicate
oozing blood, numbness, tingling, or sharp pain in
the extremity
• Drink large volume of fluid to relieve thirst and
promote the excretion of the dye

21. • ARTERIOGRAPHY
• Coronary Arteriography
• An arteriography is a diagnostic procedure that
involves instilling contrast medium into an
artery.
• In this case, it is instilled into the catheter and
deposited into each coronary artery. Occlusive
heart disease is indicated if one or more
coronary arteries appear narrow or do not fill.
• After removal of the catheter, the nurse
inspects the insertion site for bleeding,
tenderness, hematoma formation, and
inflammation.
• The client remains on bed rest for the rest of
the day. He or she must avoid flexion, or
bending of the arm or leg used for catheter
insertion. Vascular assessments distal to the
insertion site continue at frequent intervals.
• Absent distal peripheral pulses, cool toes, and
pale or cyanotic arms and legs indicate arterial
occlusion, usually from a blood clot.
• Nurse must report immediately to the physician

22. • Angiocardiography
• A radiopaque contrast medium is injected into a
vein, and its course through the heart is
recorded by a series of radiographic pictures
taken in rapid succession.
• The picture reveal the size and shape of the
heart chambers and great vessels and the
sequence and time of their filling with dye.
• Angiocardiography of the heart is used
particularly to diagnose congenital
abnormalities of the heart and great vessels.
• The client fasts for at least 3 hours before the
test. A sedative and an antihistaminic
medication usually are administered

23. • Aortography
• Aortography detects aortic abnormalities such as
aneurysms and arterial occlusions.
• Contrast medium is injected and radiographic films are
taken of the abdominal aorta and major arteries in the
legs.
• Peripheral Arteriography
• Used to diagnose occlusive arterial disease in smaller
arteries. Contrast medium is injected into an artery, and
radiographic films are taken.
• After the procedure, the chance for bleeding is greater
than after a venipuncture; therefore, a pressure dressing is
applied and client activity is restricted for about 12 hours.
• The nurse observes the client for bleeding and cardiac
dysrhythmias and assesses the adequacy of peripheral
circulation by frequently checking the peripheral pulses.

24. Next: Lesson
Module 14
Infectious and Inflammatory Disorders of the Heart
and Blood Vessels