Week 2: Cardiovascular and Peripheral vascular Assessment Flashcards
what are the risk factors for cardiovascular disease?
FIEHHEOCSDF
- Family history
- Increased age
- Elevated cholesterol
- High Blood Pressure (↑BP)
- High blood sugar levels or known Diabetes Mellitus (DM; IDDM; NIDDM)
- Ethnicity
- Obesity
- Cigarette smoking
- Sedentary lifestyle
- Diet, sodium
- For ♀: menopause as risk for Coronary Artery Disease (CAD) increases thereafter
Signs and symptoms of potential CV problem
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- Pain (chest, jaw, neck, left shoulder, left arm, subscapular, stomach pain)
- Shortness of breath
- Dyspnea, orthopnea
- Paroxysmal nocturnal dyspnea
- Cough
- Diaphoresis (sweating)
- Lightheadedness
- Leg pain, ulcers to lower extremities
- Nausea and vomiting
- Edema
- Pressure like an “elephant sitting on my chest.”
- Nocturia
- Racing heart
- Indigestion/heart burn
- Palpitations/dysrhythmia
- Fatigue
- Pre-syncope/syncope (fainting)
What are the 10 steps of assessing CV history?
DOCAIADAIF
- 1.Demographic/SDoH
- 2.OLDCARTSS
- 3.Current/recent symptoms
- 4.Associated symptoms – such as?
- 5.Inquire about respiratory concerns (S & S)- why?
- 6.Ask about risk factors
- 7.Discuss family history
- 8.Ask about past medical history, meds, allergies
- 9.Inquire about social history such as relationships stress
- 10.FUNCTIONAL ABILITY (ADL, IADL)
physical assessment: vital signs
- Start with vital signs
- Think about the results, compare the results
- Interpret the results in the patient’s own context
- How are the vital signs related – which ones are influencing others?
- Do the findings require urgent action or monitoring?
physical assessment: inspection
GSRSDSFLA
- General survey
- Skin Colour
- Respirations
- Speech pattern
- Diaphoresis
- Size and shape of thorax
- Fingers – nailbeds, clubbing
- Landmarks
- Abnormal pulsations
physical assessment: palpation of pulses
RRSAWTNFS
- Rate
- Rhythm
- Strength/Volume:
- absent
- weak
- thready
- normal
- full, bounding
- symmetry
- *vital signs uses radial as default
why do we auscultate
- to hear unexpected heart sounds
- like murmurs which are swooshing or blowing sounds
- Most are the result of cardiac abnormalities: ↑ blood velocity, structural valve defects, valve malfunction, abnormal chamber openings e.g. septal defects
BRUITS: Also turbulent blood flow – usually by partial obstruction Sites: carotids, abdominal aortic, renal, iliac, femoral
characteristics of S1 + S2
S1
Loudest at the apex (bottom)
AV valve closure (M & T, between chambers)
Beginning of systole
S2
Loudest at base (top)
SL valve closure (A & P, out to body/ lungs)
Beginning of diastole
APTM 2245
Aortic Area
- right second intercostal space just lateral to sternum
Pulmonary Area
- S2 is best heard here
- Left second intercostal space just lateral the sternum
Tricuspid Area
- Inferior left sternum margin
4th intercostal space
Mitral Area
- S1 is best heard here
- 5th intercostal space mid clavicular line
what are the effects of aging on the heart?
- Amount of collagen in the heart (up) and elastin (down)
- Decreased contractility and HR.
- Cardiac valves become thicker & stiffer from lipid accumulation, valve incompetence or stenosis = murmur.
- # of pacemaker cells in SA node (down) = bradycardia, heart block.
- (down) sympathetic nervous system control of cardiovascular system.
- Arterial blood vessels thicken & become less elastic = (up) BP
when should you perform a neurovascular assessment
- Trauma/injury to limb – ie soft tissue injury or fracture or both
- Presence of cast or other protective device (mostly the ones that are rigid, like a plaster or fiberglass cast)
- Surgery to a limb (you can consider this trauma, it’s just controlled trauma)
- Presence of a wound on a limb, varicose veins
- Conditions which may cause poor circulation – heart failure, diabetic peripheral neuropathy
- Client complaining of discomfort or pain in a limb
- ◦Smoking restricts circulation
- ◦Arterial/venous insufficiency
- ◦Extreme edema ie. lymphedema, compartment syndrome
- Hypothermia
arterial vs venous insufficiency
- Arterial: Pain with exertion – intermittent claudication
- Relieved by short rest
- Pale when leg elevated, rubor with dependency
- Venous: Pain described as aching, dull, heaviness
- Swelling as day progresses
- Pain and edema relieved when legs elevated
- Varicose veins
New terms
- Venous insufficiency: occurs when your leg veins don’t allow blood to flow back up to your heart.
- Varicose veins: twisted, enlarged veins
- Arterial insufficiency: any condition that slows or stops the flow of blood through your arteries.
- Atherosclerosis: the buildup of fats, cholesterol and other substances in and on the artery walls
- Clubbing: changes in the areas under and around the toenails and fingernails that occur with some disorders. The nails also show changes. Clubbing may result from chronic low blood-oxygen levels.
Peripheral Vascular Assessment:
More Than Six Bananas Can Elevate Potassium
- M = movement
- T = temperature
- S = sensation
- B = blanching
- C = colour
- E = edema
- P = pulse
What are the characteristics of Reynauld (one finger in hand is white)
- Triggered by cold, stress
- Vasospasm
- Restricts blood supply to fingers/toes
- Turns white, feels numb
- Sometimes turns blue, then red before returning to normal
