Week 8 Nursing Flashcards
Cardiovascular Assessment includes
▪ Secondary survey
– Health history
– Head to toe
– Physical examination
▪ Focussed assessment
– Respiratory assessment
– Neck vessels
– Precordium
– Extremities
– Skin, hair and nails
Heart Sounds
▪ Produced by the closure of the valves between the chambers in the heart.
▪ Normal heart sounds are known as S1 & S2.
▪ Normally heard as a ‘lub dub’ then a pause.
▪ Extra heart Sounds - S3 & S4 and murmurs.
▪ S1
– Beginning of systole
– Closure of atrioventricular valves (tricuspid and mitral)
– Auscultate left of midclavicular line at 5th intercostal space
▪ S2
– Beginning of diastole
– Closure of semilunar valves (aortic and pulmonic)
– Auscultate on left & right sternal border at 2nd intercostal space
Abnormal Heart Sounds
Auscultate for abnormal heart sounds:
▪ Murmurs are swooshing or blowing sounds due to turbulent blood flow.
▪ Classified as innocent, functional, or pathological
▪ Possible causes include
– Increased blood velocity
– Structural valve defects
– Valve malfunction
– Abnormal chamber openings or septal defects
▪ Can use the stethoscope diaphragm over aortic, pulmonic, mitral, and tricuspid areas.
▪ Can use the stethoscope bell over mitral and tricuspid areas.
Why do we focus on chest pain/pain?
- Chest pain is a common complaint. Pain could indicate heart death we need to stop that as soon as possible.
- Chest pain can have cardiac or non-cardiac causes:
– Cardiac - Ischaemic (Angina, acute myocardial infarction, empty vena cava).
- Non-Ischaemic (Pericarditis, aortic dissection, mitral valve prolapse, myocarditis).
– Non-Cardiac - Gastro-oesophageal (reflux, oesophageal spasm or perforation, gastritis, oesophageal varices).
- Musculoskeletal (costochondritis, rib fracture).
- Pulmonary (pneumothorax, pulmonary embolus, tumour, infection).
- Other (e.g. Herpes Zoster).
- An accurate history is vital to help differentiate between the two causes.
Mnemonic PQRST for chest pain
P= Preciptating the chest pain
▪ What the patient was doing when the pain started can often provide data as to the aetiology of the pain.
▪ Where were you when the pain started?
▪ Enquire about how the patient looked at the time (i.e. pale, sweaty, conscious state etc.). Ask family or witnesses.
▪ Sudden or gradual onset?
Q= Quality
▪ Ask about the quality or character of the pain.
▪ What kind of pain is/was it?
R=RADIATION
▪ Neck and Jaw
▪ Shoulders
▪ Arms
▪ Interscapular
▪ Epigastrium
S=Severity
T=TIMING/ treatment
▪ When did the pain start?
▪ When did the pain resolve?
▪ Was the pain worse at any time? A spike in severity may indicate time of infarct.
▪ Have you had this pain before? What have you done about it?
▪ Is the pain like your usual angina pain?
▪ How often do you get the pain? Can inform whether stable or unstable angina
Common Cardiovascular terms
▪ Hypertension =high blood pressure
▪ Angina is chest pain
– Stable
▪ caused by coronary atherosclerosis
▪ Often occurs with exertion
▪ Usually resolved in 5 minutes or less
▪ Is relieved by rest or medication (e.g. glyceryl trinitrate)
– Unstable
▪ caused by coronary atherosclerosis
▪ Often occurs at rest or with minimal exertion
▪ Pain does not resolve quickly
▪ Pain persists and may increase over time
▪ Can progress to Acute Myocardial Infarction (AMI)
▪ Myocardial Infarction
– cell death of the myocardium due, complete blockage of blood
▪ Heart failure= inadequate pumping or filling of the heart = inadequate oxygen supply to the body
Cardiovascular Investigations
Angiogram:
– Coronary arteries are X-rayed after radio opaque dye is injected
Stress test:
– Measures cardiac conduction while stressing the heart with exercise
Cardiovascular Blood Investigations
CK-MB
– Enzyme released by muscle and more specific to cardiac cells
Troponin
– Proteins released by damaged cardiac muscle but also found in skeletal muscle
▪ TnC, TnI & TnT
▪ Electrolytes , X match, full blood count, cholesterol
