This document provides guidance on performing a cardiovascular assessment. It describes indications for assessment, necessary equipment, areas of inquiry for patient history, positioning the patient, taking vital signs, inspecting the chest, auscultating heart sounds at multiple sites, assessing perfusion, examining extremities, and assessing the abdomen. The goal is to evaluate a patient's cardiovascular status, identify abnormalities, and ensure individual patient needs are met.

2. Cardiovascular Assessment
Indications
 During routine admission physical assessments,
 when monitoring patient status following trauma,
treatment
 a disease process in order that each patient’s
individual needs are responded to appropriately.
Evidence of therapeutic interaction
Explaining the procedure generally increases patient
compliance with the procedure and reduces anxiety.

3. Equipment:-
 Sphygmomanometer
Stethoscope
 Bath blanket

4. Cardiac history
 information about chest pain, palpitations,
 family history of cardiac problems,
 exercise tolerance, claudication,
 chronic medical conditions, smoking,
 weight, cholesterol levels (if known),
 current medications,
 diet and sleep difficulties (e.g., awakening at night
with shortness of breath or need to pass urine) and
fatigue.
 Determine if the patient has a fever, or has ingested
alcohol, caffeine or nicotine recently.

5. Position the patient
 The supine position is well suited for assessing the
anterior chest.
 Raising the head of the bed as high as 45 degrees is
acceptable if the patient has difficulty breathing.
 If the patient is obese it may be necessary to sit
them upright or slightly forward. The patient can
also be positioned on their left side. These positions
bring the cardiac structures close to the chest wall
and render their sounds easier to hear

6. Take blood pressure
 Obtain a blood pressure reading to measure the
pressure exerted on arterial walls with each cardiac
contraction
Inspect the anterior thorax
 Identify landmarks such as the Angle of Louis and
midclavicular line.
 Look for an apical impulse (pulsations at the apex of
the heart), indicating the position of the left
ventricle – normally at the 5th intercostal space,
medial to the left midclavicular line.

8.  Palpate the anterior chest Use the finger pads to
palpate the heart from base to apex for pulsations.
Use the palmar surface of the hand to palpate for
thrills (vibrations) or heaves (lifts) of the cardiac
area.

9.  Palpatethe apical pulse
 Use either the fingertips or the palm of the hand to
locate the apical pulse. Then pinpoint the pulse with
one finger pad. This should disclose a light tap at the
point of maximal impulse (5th intercostal space, medial
to the left midclavicular line). An unusually forceful or
displaced apical pulse is not normal and must be
reported.

10. Auscultate the apical pulse
 Assessing for one minute allows the examiner to assess
the rate and rhythm of the pulse. If the heart rhythm is
irregular, determine if there is a pattern to the
irregularity. Use the diaphragm of the stethoscope.
Tachycardia, bradycardia and dysrhythmias must be
reported for further assessment.

11. Four Cardiac Auscultation Sites
 Listen to each auscultation site in sequence for several
cycles. The opening and closing of the cardiac valves
cause the sounds known as heart sounds.

12. S1 and S2 sounds to become familiar with their
rhythm.
 Normal heart sounds last a fraction of a second
and are followed by a longer period of silence. The
guidelines outlined to identify auscultating heart
sounds are to first note the rate and rhythm; next
identify S1 and S2, and then assess S1 and S2
separately (use the diaphragm of the stethoscope);
following this, listen (using the bell of the
stethoscope) for extra heart sounds; and finally
listen for murmurs. Once familiar with normal
heart sounds, you will recognize abnormal sounds.

13. These cardiac auscultation sites are:
1. aortic area – right 2nd intercostal space to apex of the heart
2. pulmonic area – 2nd and 3rd left intercostal space, close to
sternum, but may be higher
or lower
3. left atrial area – 2nd to 4th intercostal space, left sternal
border
4. right atrial area – 3rd to 5th intercostal space at the right
sternal border
5. left ventricular area – 2nd to 5th intercostal space, from
left sternal border to left midclavicular line
6. right ventricular area – 2nd to 5th intercostal spaces
centred over the sternum.

16. Assess perfusion quality
Using bilateral simultaneous palpation of the pulses,
assess volume, rate, rhythm and symmetry of peripheral
pulses –
If the carotid is palpated, palpate one side at a time. Use
of a common scale (such as 3 = bounding; 2 = normal; 1 =
weak, thready, diminished; and 0 = absent) makes
documentation of information consistent.

17. Assess patient’s extermities

18. Clubbing nails

19. Pitting edema

22. THE ABDOMEN
The nurse locates and describes abdominal findings using
two common methods of subdividing the abdomen:
quadrants and regions. To divide the abdomen into
quadrants, the nurse imagines two lines: a vertical line
from the xiphoid process to the pubic symphysis, and a
horizontal line across the umbilicus

23. Abdominal landmark

24. Assessment of the abdomen:
 When assessing the abdomen, the nurse performs
inspection first, followed by auscultation, percussion,
and/or palpation. Auscultation is done before palpation
and percussion because palpation and percussion cause
movement or stimulation of the bowel, which can
increase bowel motility and thus heighten bowel
sounds, creating false results.