NUR202 ModuleBChapter_036

8/14/2019 NUR202 ModuleBChapter_036

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Chapter 36

Assessment of the

Cardiovascular System


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The Cardiovascular

System Anatomy and physiology Heartits structure and function


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Anatomy and Physiology of

the Heart


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Anatomy of the Heart


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Coronary Arteries

Coronary artery blood

flow to the myocardium

occurs primarily during

diastole, when coronaryvascular resistance is

minimized.

To maintain adequate

blood flow through thecoronary arteries, mean

arterial pressure (MAP)

must be at least 60 mm

Hg.


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The Cardiovascular

SystemCardiac output stroke volume Normal: 4 to 6 liters per minute


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The CardiovascularSystemCardiac IndexCO divided by BSA Normal Range: 2.7 to 3.2

L/min/m2 of body surface area

heart rate


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The CardiovascularSystem Stroke volume Stroke volume is the

amount of blood

ejected by the left

ventricle during eachsystole.

Heart rate, preload,

afterload, contractility,

stroke volume, andcardiac output.


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The CardiovascularSystem Preload

According to Starlings law of the heart, the

more the heart is filled during diastole the

more forcefully the heart contracts. Excessive filling of the heart results in

excessive left ventricular end-diastolic volume

and pressure.

May result in decreased cardiac output


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The CardiovascularSystem Afterload

The amount of pressure or resistance the

ventricles must overcome to eject blood into

the peripheral blood vessels. A decrease in stroke volume can result from

an increase in afterload without the benefit of

compensatory mechanisms.


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The CardiovascularSystem Contractility

Increased by factors such as Sympathetic stimulation Calcium release

Positive inotropic drugs Decreased by

Hypoxia acidemia


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Blood Pressure

Blood pressure is the force of blood exertedagainst the vessel walls. BP = CO X PVR

Systolic blood pressure

Amount of pressure generated by the left ventricle todistribute blood into the aorta Diastolic blood pressure

The amount of pressure sustained by the arteriesduring the relaxation phase of the heart

Determined primarily by the ability of the heart to restwhile filling with blood.

Increased by increased peripheral vascular resistance


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Blood Pressure Regulation

Autonomic nervous system Baroreceptors

Chemoreceptors

Renal system

External factors also affect BP


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Venous System

Structure: a series of veins located

adjacent to the arterial system

Function: completes the circulation of

blood by returning blood from thecapillaries to the right side of the heart

Cardiovascular changes in the older adult:

only evident when the person is active orunder stress (Table 36-1)


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Assessment Techniques

History

Demographic data

Family history and genetic risk

Personal history

Diet history

Socioeconomic status


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Modifiable Risk Factors

Cigarette smoking

Physical inactivity

Obesity

Psychological factors

Chronic disease (HOW!?)


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Pain or Discomfort

Pain or discomfort can result from

ischemic heart disease, pericarditis, and

aortic dissection.

Chest pain can also result fromnoncardiac conditions such as pleurisy,

pulmonary embolus, hiatal hernia, and

anxiety.

(Continued)


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Pain or Discomfort(Continued)

Terms such as discomfort, heaviness,

pressure, indigestion, aching, choking,

strangling, tingling, squeezing,

constricting, orvise-like are all used todescribe pain.

Women often do not experience pain in

the chest but rather feelings of discomfortor indigestion.


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Pain Assessment

Onset

Manner of onset

Duration

Frequency

Precipitating factors

Location Radiation

(Continued)


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Pain Assessment(Continued)

Quality

Intensity, which can be graded from 0 to

10, associated symptoms, aggravating

factors, and relieving factors


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Dyspnea

Can occur as a result of both cardiac and

pulmonary disease

Difficult or labored breathing experienced

as uncomfortable breathing or shortnessof breath

Dyspnea on exertion (DOE)

Orthopnea: dyspnea when lying flat Paroxysmal nocturnal dyspnea after lying

down for several hours


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Other Manifestations

Fatigue

Palpitations

Weight gain

Syncope

Extremity pain


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Physical Assessment

General appearance Integumentary system

Skin color

Skin temperature Extremities

Clubbing of fingers

edema

Skin integrity Etc.


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Physical Assessment

Blood pressure High Normal

Systolic 130 to 139 mm Hg Diastolic 85 to 89mm Hg

Pre-hypertension Systolic 120 to 139 mm Hg Diastolic 80 to 89 mm Hg

Postural Hypotension Venous and arterial pulses: central and jugular

venous pressures, and jugular venousdistention


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Precordium

Assessment of the precordium (area overthe heart) involves: Inspection

Palpation Percussion


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Precardium

Auscultation Normal heart sounds

Normal splitting may occur with both S1 Closure of the mitral and tricuspid valves

Beginning of ventriclar systole S2-closure aortic and pulmonic valves

High pitched and best heard at the end ofventricular systole


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Auscultation of Heart Sounds


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Precardium

Paradoxical splitting

Abnormal splitting of S2/wider split

Early closure of pulmonic valve

Delayed closure of aortic valve


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Precardium

Gallops S3 and S4

S3

early sign of heart failure over 35 years of age S4

Hypertension

MI

Anemia

advancing age


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Precardium

Murmurs Turbulent blood flow through normal or abnormal

valves


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Precardium

Pericardial friction rub


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Serum Markers ofMyocardial Damage Troponin T and I

Creatine kinase

Myoglobin

Serum lipids

Homocysteine

C-reactive protein (Marker of

inflammation)


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Blood Coagulation Test


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Blood Coagulation Test

PT and INR Measures the activity of prothrombin, fibrinogen,

and factors V, VII, and X.

PTT Measures deficiencies in all coagulation factors

except VII and XIII


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Allen Test


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Cardiac Catheterization

Client preparation

Possible complications: myocardial

infarction, stroke, thromboembolism,

arterial bleeding, lethal dysrhythmias, anddeath

Follow-up care:

bedrest, insertion site extremity kept straight Monitor vital signs

Assess for complications


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Other Diagnostic Tests

Electrocardiography

Electrophysiologic study

Exercise electrocardiography

Echocardiography Pharmacologic stress echocardiogram

Transesophageal echocardiogram

Imaging


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Hemodynamic Monitoring

Invasive system used in critical care areas

to provide quantitative information about

vascular capacity, blood volume, pump

effectiveness, and tissue perfusion Pulmonary artery catheter

Systemic intra-arterial monitoring

Impedance cardiography


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Pulmonary Artery Catheter

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