assessment of body and its related organs

1. Mahesh Chand
Nursing Tutor
Cardiac AssessmentCardiac Assessment

2. Risk Factors
1.Age
2.Sex
3.Menopausal Status
4.History of Cardiovascular Diseases
5.Positive Family history of CHD
6.Previous history of Stroke
7.Peripheral Vascular disease

3. Risk Factors
8.Smoking
9.Hypertension
10. Psychological Risk Factors: Stress, Lack
of Social Support, depression.
11.Low socio-economic status
12. Diabetes Mellitus
13. Increased Body Mass Index

4.  Chest pain
 Shortness of breath or dyspnea
 Edema and weight gain
 Weakness and fatigue
 Palpitation
 Dizziness and syncope or loss of conscious
Manifestation of heart disease

5. Cardiac assessment includes
 History (patient’s story)
 Assessment of perfusion
 Mental status
 Blood pressure
 Pulses
 Inspection of the patient
 Evaluation for dependent edema
 Auscultation of the heart
 Chemistries(cardiac enzyme)

6. Health History
 The nurse should obtain the history by using
the specific question about the onset &
severity of the chest discomfort, associated
symptoms, current medication& allergy.
 History include the following history
1.History of present illness
2.Past illness
3.Allergic history
4.Medication history
5.Family history
6.Personal history

7. Physical Assessment
 General appearance
 Cognition
 Inspection of the skin
 Vital sign
 Arterial pulse
 Jugular venous pulsation
 Heart inspection, palpation ,
percussion and auscultation
 Inspection of extremities
 Respiratory
assessment
Physical assessment of the cardiac patient
include :

8. History (patient’s story)
 Patient’s presenting sign
or symptoms
 Pain:
 Where is it?
 Does it move or stay
in one place?
 What is it like?
 How severe is it?
 How frequent?
 What are you doing
when it occurs?
 What can you do to
make it go away?
 Other symptoms

9. Evaluation of Pain
 The reddened area is the most common area
of discomfort in ACS
 The pain is usually not a sharp, jabbing pain,
but a sensation of pressure, fullness,
squeezing or aching

10. Evaluation of Pain
 Distress may extend from
the chest into one or both
arms or may appear in the
arms alone
 It may be mistaken for
arthritis, bursitis, or
muscle strain
 To tell the difference ask
the patient to lift arms
above head, heart pain
will not be aggravated by
this while the other
causes will

11. Evaluation of Pain
 Discomfort may radiate into
the neck and jaws or one or
both sides and in front or
back
 It may be mistaken for a
tooth ache, arthritis or stiff
neck
 To test: turn your head or
bend your neck, heart pain
will not be aggravated,
whereas most pain originating
in the neck will be
 Differentiation of toothache
from heart attack may be
more difficult

12. Evaluation of Pain
 Pain – usually pressure,
fullness, squeezing or
aching may appear in the
upper abdomen where it
is often mistaken for
indigestion
 Nausea or vomiting may
occur with this pain

13. Evaluation of Pain
 Back pain may be the only
sign of heart attack
 Usually this is located
between the shoulder
blades and is similar to the
tired hurt experienced
after tedious work
involving protracted use of
the arms and hands and
stooping of the shoulders

14. Evaluation of Pain
 Heart pain often occurs in a combination of
patterns in all these areas
 Not infrequently pain the neck, jaws, abdomen,
arms, and back may be even more severe than
that in the chest
 Nausea or vomiting, sweating, also should be
considered a sign

15. Evaluation of Pain
 Pain in the left chest wall centering on the
left nipple is almost never a sign of heart
attack
 This pain may be a jabbing sensation
lasting a second or two, a dull soreness
lasting for minutes or hours, or a
combination of the two

16. Pain Assessment
R/O Pain Symptoms
Esophageal
Reflex
Sub sternal chest pain
Chest tightness
Indigestion
Pleural Pain Sharp
Positional
Increased with deep breath
Pericardial
Pain
Left chest radiating into clavicle area
or back
Sharp and positional
Increased with deep breath
Fever

17. Pain Assessment
R/O Pain Symptoms
Gallbladder
Pain
Chest pain – abdominal pain
Indigestion
Muscular /
Skeletal
Positional
Tender to palpation
Pleural Pain Sharp
Positional
Increased with deep breath
Catching respirations
Pancreatitis Severe sharp pain
Positional ( pt. Tends to want to sit and
lean forward

18. Inspection of the patient
 Assessment of Perfusion
Mental status
Blood pressure
Skin
Pulses

19. Skin & Nails
 Color
 Moisture/
texture
 Temperature
 Turger
 Capillary refill
normal <3 seconds
 Clubbing
-associated with
cyanotic heart disease
as well as lung disorders

20. Palpation for Pulses
Pulse intensity
O=absent
1 = markedly
impaired,
thready
2 = palpable, soft
3 = Normal
4 = Bounding

22. Assess for edema
1+ = Trace
 2mm (1/4 inch)
2+ = Mild
 4mm (1/4-1/2 inch)
3+ = Moderate
 6mm (1/2 - 1 inch)
4+ = Severe
 8mm > 1 inch
For edema to be visible,
the patient usually has
retained 5L (10lb) of
fluid

23. Blood Pressure Assessments
 Left and right BP should always be compared to
detect any differences
 Normally the BP varies 5-10 mm Hg
 A difference of 20 mm Hg or more suggests arterial
compression or obstruction.
 A difference between arm pressures and/or leg BP
could mean a dissecting aortic aneurysm
 BP should always be taken at heart level
 Falsely elevated readings are obtained if the arm is
lower than the heart
 Falsely lower readings are obtained if the arm is
higher than the heart
 Cuffs size: cover the upper arm by 40%
 Too small can give falsely high readings
 Too large can give falsely low readings

24. Homen’s Sign
 It is present when brisk flexion of
the foot causes pain in the calf of
the leg
 May be assessed when the patient
is examined for edema
 In some patients it may indicate
deep-vein thrombosis

25. Neck
 No jugular vein
distension should be
present at 30 °
elevation position
Procedure for evaluation
 elevate pt. head of bed
to 30°
 locate external jugular
vein ( may briefly
occlude to identify it
 release pressure and
observe for distension

26. Neck - jugular vein distension
 Head supported and relaxed at 30° - 40 °
 Highest point of pulsation observed during
exhalation
 Vertical distance between pulsation and sternal
angles is estimated in cm
 Normal value is 4cm or less

27. Respiratory Inspection & Lung
Auscultation
 Respiratory effort
 O2 saturation
– desired >93%
 Ventilation in all
lobes
 Rales present?

28. Carotid Auscultation
 Using bell of
stethoscope on carotid
artery
 Auscultate for bruits
 blood flow through
tortuous or partially
occluded vessel
 high flow through a
normal vessel

29. First heart sound - S1
 “LUB”
 Caused by rapid deceleration of blood flow
when the AV (mitral and tricuspid) close at
the beginning of systole
 Dull, low-pitched, louder than S2 at the
mitral area
 Best heard and 4th
intercostal space left of
the sternal border and apex

30. Second heart sound – S2
 “DUB”
 Closing of the aortic and pulmonic valves at
the end of systole
 Higher pitched, snappier and shorter in
duration, louder than S1 at the Aortic area
 Heard best at the base of the heart (2nd
intercostal space to the right and left of the
sternum)

31. Third Heart Sound-S3
 Ventricular diastolic gallop
( Ventricular Disorder rhythm)
 “Ken-tuck-y”
 Due to rapid filling of the left ventricle
 Can be normal in young adults and children
 After age 40 S3 is likely to be
associated with heart diseases
(congestive heart failure)
Best heart with the bell
over apex

32. Fourth Heart Sound - S4
 Atrial diastolic gallop ( Artrial Disorder rhythm)
 “Ten-ne-see”
 Occurs during diastole with atrial contraction (atrial kick)
 Note: Cannot be heard with patients in atrial-fib
 Associated with a noncompliant ventricle – AMI,
hypertension, hypertrophy
 Not commonly heard in adults
 Athletes may have a benign S4
Best heart with the bell at
the apex with the pt. lying in
the left lateral position

33. Causes of Murmurs
 Flow through damaged valves
 Increased flow through normal valves and
vessels
 fever, exercise
 Backflow across an incompetent valve
 Blood flow across a partial obstruction or
irregularity
 Shunting of blood from an abnormal passage
from high to low pressure (patent foramen
ovale)
 Decreased strength of myocardial
contraction

34. Assessment always
Includes Family!

35. 1. Complete Blood Count- RBC, WBC,
Platelet Count, Hemoglobin Level, Blood
Glucose Level
2. Coagulation Studies- Prothrombin time ,
Tromboplastin time
3. Blood Chemistry- Lipids profile ,
cholesterol level, serum electrolyte level,
BUN,
4. Cardic Enzymes- CPK,CK, myoglobin,
troponine, LDH
Investigations

36. Blood Lipid Good Borderline high
Total cholestrol 200 or less 200-239 240&Above
LDL (Bad)
Cholestrol
130 OR
Less
130-159 160 & above
Triglyceride
level
150 or less 150-199 200 & above
Cholesterol & Triglyceride level for heart
disease

37. Diagnostic Tests
1. X- ray- to evaluate internal structure.
2. Electrocardiogram- to evaluate the
interpretation of the electrical activity of the
heart.
3. Cardiac stress test- to determine the heart
response with the increased oxygen need.
4. Echocardiogram-it help in record the blood flow
through heart, valvular abnormality, congenital
cardiac defect & cardiac function
5. Holter Monitoring- Monitor ECG rhythm 24-48
& correlating the rhythm changes with symptoms
recorded in the diary

38. Diagnostic Tests
6. Stress echocardiogram-The combination
of exercise test with echocardiogram are
done in the resting image as well as after
exercise.
7. Nuclear Cardiology- it involve the I V
injection of radioisotopes & uptake is
counted over the heart by scintillation
camera to identify myocardial contractility
8. Magnetic resonance angiograph- In the
MRA, with the use of gadolinium as I V
contrast to evaluate the arterial disease

39. 9. PET scan- In this two radionuclide
Nitrogen-13- ammonia is injected I V first
& scan evaluated for myocardial
perfusion.
10. Coronary Angiogram- The injection of
the radiopaque contrast medium directly
into coronary artery same as cardiac
catheterization to evaluate the patency of
coronary artery.
11.Cardiac catheterization- to identify the
oxygen saturation and the pressure
reading as well as heart chamber
Diagnostic Tests

40. 12. Electrophysiology study- the test used to
record intra-cardiac electrical activity using
catheters inserted via the femoral vein into
the right side of the heart. It recorded the
electrical activity of the cardiac structure.
13.Peripheral arteriography & venography
– the injection of the radiopaque medium is
inserted in the artery and vein after that
serial X- rays taken to detect & visualize
the atherosclerotic plaque, occlusion,
aneurysm & traumatic injury
Diagnostic Tests

41. 14. Haemodynamic monitoring- the
haemodynamic monitering of the arterial
blood pressure, pulmonary artery
pressure, pulmonary wedge pressure &
cardiac out put is done to evaluate the
cardiovascular status & response of the
patient towards the treatment.
Diagnostic Tests

42. THANK YOU