Assessment of Client with Cardiovascular Disease

 

The Health Assessment Interview

It is used to determine problems with cardiac function as a part of a health screening, or it may focus on a chief complaint. If the client has a problem with cardiac function, analyze its onset, characteristics, course, severity, precipitating and relieving factors, and any associated symptoms, noting the timing and circumstances.

Physical Assessment Assess the heart through inspection,

palpation, and auscultation over the precordium

The equipment needed includes a stethoscope with a diaphragm and a bell, a good light source, and a ruler

The client may sit or lie in the supine position. Movements over the precordium may be more easily seen with tangenital lighting (in which light is directed at a right angle to the area being observed, producing shadows

Apical impulse is a normal visible pulsation (thrust) in the PMI

Retraction is a pulling in of the tissue of the precordium; a slight retraction just medial to the PMI is normal

Lift is a more sustained thrust than normal

Heave is an excessive thrust

Apical Impulse Assessment with Abnormal Findings

Using the finger pads palpate the precordium for symmetry of movement and the apical impulse for location, size, amplitude, and duration

An enlarged or displaced heart is associated with an apical impulse lateral to the MCL or below the 5th ICS

Decreased amplitude is associated with a dilated heart in cardiomyopathy

A thrill (palpable vibration over the precordium or an artery) may accompany severe valve stenosis

Cardiac Rate and Rhythm Assessment with Abnormal Findings

A heart rate exceeding 100 BPM is tachycardia. A heart rate less than 60 BPM is bradycardia

Palpate the radial pulse while listening to the apical pulse

If the radial pulse falls behind the apical rate, the client has a pulse deficit, indicating weak, ineffective contractions of the left ventricle

Auscultate heart rhythm Dysrhythmias may be regular or

irregular in rhythm; their rates may be slow or fast. A pattern of gradual increase and decrease in heart rate that is within normal heart rate and that correlates with inspiration and expiration is called sinus arrhythmia

Heart Sounds Assessment with Abnormal Findings

Identify S1 and note its intensity An accentuated S1 occurs in

tachycardia, fever, mitral stenosis, and exercise

A diminished S1 occurs with mitral regurgitation, CHF and pulmonary or systemic HTN

Identify S2 and note its intensity An accentuated S2 may be heard

with HTN, mitral stenosis, CHF, and cor pulmonale

A diminished S2 occurs with aortic stenosis and pulmonary stenosis

Identify extra sounds in systole Ejection sounds or clicks result from the

opening of deformed semilunar valves A midsystolic click is heard with mitral

valve prolapse Identify the presence of extra heart

sounds in diastole An opening snap results from the

opening sound of a stenotic mitral valve A pathologic S3 or ventricular gallop

results from myocardial failure and ventricular volume overload

A S4 or atrial gallop results from increased resistance to ventricular filling after atrial contraction

A less common right-sided S4 occurs with pulmonary HTN and pulmonary stenosis

A combined S3 and S4 is called a summation gallop and occurs with severe CHF

A pericardial friction rub results from the inflammation of the pericardial sac

Murmur Assessment with Abnormal Findings

Identify any murmurs. Note location, timing, presence during systole or diastole, and intensity

Midsystolic murmurs are heard with semilunar valve disease and hypertrophic cardiomyopathy

A late systolic murmur is heard with MVP Middiastolic and presystolic murmurs

such as with mitral stenosis, occur with turbulent blood flow across the AV valves

Continuous murmurs throughout systole and all or part of diastole occur with patent ductus arteriosus

Central Vessels

A bruit (a blowing or swooshing sound) is created by turbulence of blood flow due either to a narrowed arterial lumen or to a condition such as anemia or hyperthyroidism, which elevates cardiac output.

A thrill, which frequently accompanies a bruit, is a vibrating sensation. It indicates turbulent blood flow due to arterial obstruction

Palpate the Carotid artery using extreme caution

Decreased pulsations may indicate impaired left cardiac output. Thickening, hard, rigid, inelastic walls indicate arteriosclerosis

Inspect the jugular veins for distention while the client is placed in a semi-Fowler’s position (30° to 45° angle), with the head supported on a small pillow

Veins visibly distended indicate advanced cardiopulmonary disease

Peripheral Vascular System

Palpate the peripheral pulses on both sides of the client’s body.

Increased pulse volume may indicate HTN, high cardiac output, or circulatory overload

Inspect the calves for redness and swelling over the veins. Palpate the calves for firmness or tension of the muscles, the presence of edema over the dorsum of the foot and areas of localized warmth

Firmly dorsiflex the client’s foot while supporting the entire leg in extension (Homan’s test)

Inspect the skin of the hands and feet for color, temperature

Capillary Refill Test

Squeeze the client’s fingernail or toenail between your fingers sufficiently to cause blanching ( about 5 seconds)

Release the pressure and observe how quick normal color returns. Color normally returns immediately in less than 2 seconds