Cardiovascular System Assessment PDF

Cardiovascular System Assessment Modified by Dr. Kim Stiles, PhD, RN, CNE, AHN-BC Top 5 Leading Causes of Death 1. Heart disease: 695,547 2. Cancer: 605,213 3. COVID: 416,893 4. Accidents: 224,935 5. Stroke (cerebrovascular diseases): 162,890 2 More interesting data In 2022, CV disease killed more t...

Cardiovascular System Assessment Modified by Dr. Kim Stiles, PhD, RN, CNE, AHN-BC Top 5 Leading Causes of Death 1. Heart disease: 695,547 2. Cancer: 605,213 3. COVID: 416,893 4. Accidents: 224,935 5. Stroke (cerebrovascular diseases): 162,890 2 More interesting data In 2022, CV disease killed more than 650,000 Americans (1 in 5 deaths) ⬤ 2.5 million people will have an MI or a procedure done to open or bypass coronary arteries ⬤ 7 million people live with chest pain daily ⬤ 75% of adults age 60 or higher have some form of CV disease. By age 80, 90% do. ⬤ COVID ↑ MI deaths by 20% in 45-65 year olds 18% in those >65 ⬤ 3 Structures and Functions of Cardiovascular System ⬤ Heart tissue structure Composed of three layers Endocardium Myocardium Epicardium Pericardium Visceral Parietal Pericardial space 4 Blood Flow Through the Heart Chambers ⬤ Right side (unoxygenated): ⬤ SVC and IVC to right atrium to tricuspid valve to right ventricle to pulmonic valve to pulmonary artery to lungs Left side (oxygenated): Pulmonary veins to left atrium to mitral valve to left ventricle to aortic valve to systemic circulation 5 Cardiac Cycle Right side Left side Inferior and Superior Vena Cava drains into RA Diastole: Tricuspid valve opens RV fills RA contraction (kick) Pulmonary Vein drains into LA Lub: S1: Tricuspid valve closes Systole: Pulmonary valve opens RV contracts Lub: S1: Mitral valve closes Systole: Aortic valve opens LV contracts Dub: S2: Pulmonary Valve closes Dub: S2: Aortic valve closes Diastole: MV opens LV fills LA contraction (kick) 6 Heart Valves Mitral ⬤ Tricuspid ⬤ Chordae tendineae ⬤ Papillary muscle ⬤ Pulmonic ⬤ Aortic ⬤ 7 Coronary Circulation 8 Cardiac Muscle Cell Properties ⬤ Automaticity Conductivity Requires adequate electrolytes and acid Base balance! ⬤ Contractility Key electrolytes that impact heart function: Na, Ca, K, Mg ⬤ Irritability ⬤ 9 Conduction System 10 Mechanical System Stroke volume (SV): Amount of blood ejected with each heart beat. Cardiac output (CO): Amount of blood pumped by each ventricle in 1 minute. CO = SV × HR Normal 4 to 8 L/min Cardiac Index (CI): is CO adjusted for body weight. 11 Factors Affecting Cardiac Output CO = SV × HR ⬤ Heart rate—controlled by ANS ⬤ Sustained rapid HR = reduced diastolic filling and coronary artery perfusion ⬤ Stroke volume affected by Preload Contractility Afterload 12 13 Factors Affecting Cardiac Output Preload—volume of blood stretching the ventricles at end of diastole Frank-Starling law increased stretch = increased force of contraction To increase use volume expanders (IVF), to decrease use diruretics or vasodilators (morphine, NTG) Contractility Increased with epinephrine and norepinephrine from SNS Increased contractility increased SV by increased ventricular emptying To increase: inotropic agents, to decrease: beta blockers Afterload—peripheral resistance against which left ventricle must pump Depends on size of ventricle, wall tension, and BP To increase: vasopressors, to decrease: vasodilators 14 Audience Response Question A patient is receiving a drug that decreases afterload. To evaluate the patient’s response to this drug, what is most important for the nurse to assess? a. Heart rate b. Lung sounds c. Blood pressure d. Jugular venous distention 15 Nervous System Impact on HR Sympathetic Nervous System (SNS) Norepinephrine, Epinephrine Parasympathetic Nervous System (PSNS) Acetylcholine, Vagus Nerve 16 Regulation of Cardiovascular System Autonomic nervous system Effect on heart Sympathetic stimulation increases: HR, speed of impulse through AV node, and force of contractions; β-adrenergic receptors  Parasympathetic stimulation slows: HR, impulse conduction from SA to AV node; vagus nerve Safety concern: Beware vasovagal response!  Effect on blood vessels  Sympathetic stimulation of α-adrenergic receptors causes vasoconstriction; decreased stimulation causes vasodilation 17 Regulation of Cardiovascular System ⬤ Baroreceptors Aortic arch and carotid sinus Sensitive to stretch or pressure in arterial system Stimulation sends message to vasomotor center in brainstem to inhibit SNS and enhance PNS to decrease HR and peripheral vasodilation; decreased stretch or pressure does opposite ⬤ Chemoreceptors Aortic and carotid bodies and medulla Increased CO2 results in changes in RR and BP 18 Vascular System 19 Vascular System ⬤ Arteries and Arterioles Arteries—thick walls of elastic tissue to handle pressure; recoil propels blood forward Large arteries, such as the aorta and pulmonary artery, also have smooth muscle Arterioles—more smooth muscle Control arterial BP and blood flow distribution through dilation and constriction Endothelium—inner lining Maintains hemostasis, promotes blood flow, inhibits coagulation Disruption results in coagulation and fibrin clot 20 Vascular System ⬤ Veins and venules Venules—small muscles with minor amount of muscle and connective tissue Collect blood from capillary beds and channel to larger veins Veins—thin wall; large diameter Low pressure; high volume Intermittent valves move blood toward heart Blood volume in venous system affected by: arterial flow, compression of veins by skeletal muscles, changes in thoracic and abdominal pressures, and right atrial pressure (increased right atrial pressure affects SVC—distended neck veins; IVC —liver engorgement) 21 Comparison of Artery, Vein, and Capillary 22 Pulse Pressure and Mean Arterial Pressure ⬤ Pulse pressure Difference between SBP and DBP Normally about 1/3 of the SBP Increased with exercise, atherosclerosis, fever, HTN, aging Decreased with heart failure, hypovolemia, shock ⬤ Mean arterial pressure Average pressure within arterial system MAP = (SBP + 2 DBP) ÷ 3 MAP must be greater than 60 mm Hg to perfuse vital organs or they will become ischemic 23 Audience Question ⬤ a. b. c. d. e. Why do people who stand still for a long period of time, especially in heat, pass out? Select all that apply: Lack of stamina Lack of skeletal muscle movement Increased afterload Decreased blood return to the heart Varicose veins 24 Age-Related Changes ⬤ Increased collagen, decreased elastin ⬤ Decreased response to physical and emotional stress; less sensitive to β-adrenergic agonist drugs ⬤ Affects heart muscle’s ability to stretch and contract Much smaller increase in CO in response to exercise Heart valves become thick and stiff From lipid accumulation, collagen degeneration, fibrosis Causes regurgitation or stenosis Murmurs ⬤ Numbers of pacemaker cells decrease Dysrhythmias; heart blocks Abnormal resting ECG – increases in PR and/or QT intervals 25 Age-Related Changes ⬤ Blood vessels thicken and less elastic Arteries more sensitive to vasopressin Increase in SBP and pulse pressure with decreased or unchanged DBP ⬤ Incompetent venous valves Dependent ⬤ edema Increased risk of falls Orthostatic hypotension Postprandial hypotension Decreased BP > 20 mm Hg within 75 after eating 26 Assessment of Cardiovascular System ⬤ Subjective data Health information History of present illness  Why seeking health care Health history Direct or indirect cardiovascular, all symptoms, allergies Past and current medications  Prescription, OTC, herbal, noncardiac Surgery or other treatments; ECG, chest x-ray 27 Risk Factors for Cardiovascular Disease Non-Modifiable: Age Gender? Family history Ethnic background? + Covid history Diabetes Modifiable: High cholesterol Smoking, Alcohol Physical inactivity Hypertension Pre-Diabetes Obesity Stress Illegal drug use Assessment of Cardiovascular System Functional health patterns Health perception—health management pattern  Cardiovascular risk factors, allergies, genetics Nutritional–metabolic pattern  Weight, dietary habits Elimination pattern  Diuretics, swelling, constipation/ValSalva maneuver Activity–exercise pattern  Dyspnea, chest pain, claudication 29 Assessment of Cardiovascular System Functional health patterns Sleep–rest pattern  Shortness of breath, orthopnea, sleep apnea, nocturia Cognitive–perceptual pattern  Syncope, language/memory problems, pain Self-perception–self-concept pattern  Body image, activity level, self care prioritization,  Time management for healthy habits (cooking, exercise, etc.) 30 Assessment of Cardiovascular System Functional health patterns Role–relationship pattern   Support systems; areas of stress/conflict Prioritization of self vs. other care Sexuality–reproductive pattern  Fear of death; fatigue; chest pain; dyspnea; ED or drugs for it; hormone therapy Coping–stress tolerance pattern  Sources of stress; support Values–belief pattern  Culture, religion 31 Assessment of Cardiovascular System ⬤ Objective data Physical assessment (see previous lecture notes) General appearance: color (pale? Cyanotic?) Vital signs   Manual BP: bilateral Postural BP and HR Activity tolerance (DOE? SOB at rest?) 32 Assessment of Cardiovascular System ⬤ Physical examination Thorax: Inspection and palpation Auscultatory areas: aortic, pulmonic, tricuspid, mitral, and Erb’s point Abnormal pulsations or thrills  Epigastric area—abdominal aorta Heaves—precordium Point of maximal impulse (PMI/apical pulse)  Mitral 5th ICS, MCL Pulse deficit—Palpate radial pulse when listening to apical 33 Assessment of Cardiovascular System Anatomic Landmarks 34 Assessment of Cardiovascular System ⬤ Auscultation S1—closure of tricuspid and mitral valves; “lubb”; beginning of systole S2—closure of aortic and pulmonic valves: “dupp”; beginning of diastole Listen in sequence: Use diaphragm first then switch to bell 35 Assessment of Cardiovascular System ⬤ ⬤ ⬤ Auscultation of extra heart sounds: S3 and S4 best heard with bell in Mitral area between S2 and S1 sounds with pt lying on left side. S3 —ventricular gallop “Kentucky” LUB-duppa, right after S2    ⬤ New S3 sound can be early sign of heart failure! Can be normal in people