Nursing Cardiovascular Nursing Cardiovascular Physical Examination Made Physical Examination Made Ridiculously SimpleRidiculously SimpleRUBEN M. ASIS, JR., RN

Mariano Marcos State UniversityCollege of Health SciencesDepartment of Nursing

WARNINGWARNING

This short REVIEW is designed to give the audience a brief overview of the important details in performing a cardiovascular assessment.

IT IS NOT meant to supplant the comprehensive discussion provided by the standard textbook.

OBJECTIVES

•To review the anatomy and physiology of the cardiovascular system (CVS)

•To highlight the essential aspects of the CVS physical exam (PE)

•To provide useful clinical hints from the PE

ESSENTIAL ANATOMY

ESSENTIAL ANATOMY

ESSENTIAL ANATOMY HINTS•Know the location of the heart and the major blood vessels

•Knowing where your organs are located facilitates the PE

•An abnormal finding at a specific site helps determine the problem

ESSENTIAL PHYSIOLOGY• Heart – pumps blood• Lungs – perform gas

exchange• Arteries – carry

blood away from heart to tissues

• Capillaries –distribute blood in the tissues

• Veins – carry blood back to the heart

ESSENTIAL PHYSIOLOGY HINTS•CVS is a“circuit”; if one section breaks

down, the system becomes problematic

•Problems in the CVS will cause changes in the VITAL SIGNS (VS) – blood pressure, heart rate, respiratory rate

•The effects of a CVS problem will manifest in the PE findings

CVS PE HIGHLIGHTS

•Vital Signs•Cardiac•Vascular

…look, listen and feel (LLF)…

CVS PE HIGHLIGHTS•VITAL SIGNS (BP, HR, RR)

▫Know the normal range▫BP (90-130/60-80 mmHg)

Hypotension – heart failure, anemia Hypertension – heart disease, kidney disease

▫HR (60-100 beats/min) Bradycardia – heart block, CNS problem Tachycardia – heart failure, anemia

▫RR (16-20 breaths/min) Bradypnea – CNS problem Tachypnea – congestive heart failure

CVS PE HIGHLIGHTS• CARDIAC

▫Look for the APEX BEAT or the APICAL IMPULSE

▫5th intercostal space, left midclavicular line

▫If displaced laterally or inferiorly, could signify cardiomegaly

CVS PE HIGHLIGHTS• CARDIAC

▫ Auscultate for the heart sounds (usually 2 – S1 and S2) “LUB-DUB”

▫ Are the sounds clear or distant? Weak sounds could

signify pericardial effusion or thickening

▫ Listen for ADDITIONAL SOUNDS Rumbling or clicking

sounds could be murmurs from valvular disease

An extra heart sound could be a “gallop” of heart failure

CVS PE HIGHLIGHTS• CARDIAC

▫Is the rhythm regular? Irregular rhythms

signify heart disease

▫Feel for the apical pulse This is to verify

your visual observation

CVS PE HIGHLIGHTS• VASCULAR

▫ Observe for skin changes, wounds, swelling, masses Cyanosis means poor

blood flow, brownish discoloration could be due to venous insufficiency, erythema could be infection or ischemia; ulcers are associated with vascular occlusion; masses could be tumors or aneurysms

▫ Listen for BRUITS A bruit arises from

disturbed blood flow

CVS PE HIGHLIGHTS• VASCULAR

▫ Palpate the arterial pulses; know their locations and significance The carotid pulse is

always the reference point in terms of “grading” – 0 to 2

A weak or absent pulse means arterial occlusion proximally

▫ Feel for thrills This is a palpable BRUIT

▫ Check the temperature of the skin Warmth could mean

infection, coldness ischemia

CVS PE HIGHLIGHTS

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