Category Archives: All about the heart

TEACHING PATIENTS ABOUT CARDIOVASCULAR EVENTS

     Teaching patients about their health conditions and how to improve their daily lives is an important task for every registered nurse. It can be a rewarding experience when our patients follow our instructions and thus experience improvement in their health condition. In order to develop a teaching plan that will be effective, a number of factors should be considered.

If a patient or her family is not educated on what is required, does not understand the importance or has barriers to self-care, they will not participate appropriately in care. The goal of education and counseling is to help patients and caregivers acquire skills and knowledge to better manage their lives. Patient may have a lack of knowledge which results in nonadherence to treatment plans; misperceptions are common. Patient and caregivers should receive individualized education emphasizing self-care. Elements of education should include recognition of worsening symptoms, use of medications, modifying risk factors, diet, and exercise. Physical, cognitive, social, and financial factors should be taken into account when developing an education plan. Assess factors such as barriers to change, readiness to change and internal motivation. Having the patient or caregiver do return demonstrations is an effective way to assess how well the patient understood her care plan.

          The following represents some of the more important points to teach patients regarding some commonly experienced conditions involving their cardiovascular health.  The list is presented in short points that will be easily understood by your patients.  We hope you will find this information informative and be able to use these points in your nursing practice.

(Smeltzer, Bare, Kinkle & Cheever, 2008).

CONGESTIVE HEART FAILURE

• Goal is to help your heart work more easily and not work harder.
• If you experience shortness of breath or swelling in your legs, call your doctor.
•  Weigh yourself everyday in the morning on same scale with same amount of clothing on and write down weight – This will show trends in gains or losses.
• Maintain healthy weight – being overweight causes your heart to work to work harder.
• Do not smoke – smoking narrows your blood vessels makes breathing difficult, and decreases the oxygen to your heart which will make it work harder.
• Plan rest periods between strenuous exercise or activities – strenuous exercise puts too much strain on your heart.
• Take your medication every day!
• Try to avoid temperature extremes – your heart works harder trying to keep your body temperature normal.
• Try not to be in the company of others who have a cold or flu – you do not want to become ill.
• Schedule regular appointments with your doctor so that your progress can be monitored.
• Read food labels – many foods contain large amounts of sodium/salt – example is canned soups – choose salt free or low sodium options.
• (Lindenfield, Albert, Boehmer, Collins, Ezekowitz, Givertz, & Walsh, 2010)  & (Patient Education Department, 2013)

STROKE

        The American Stroke Association has developed the acronym FAST to assist patients in identifying the symptoms of a stroke.

            In addition to FAST the patient should also be aware of the following symptoms which could indicate a stroke is occurring:

• Sudden numbness or weakness of the leg, arm or face
• Sudden confusion or trouble understanding 
• Sudden trouble seeing in one or both eyes.
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause
• (American Stroke Association, 2014)
  

HEART ATTACK AND CORONARY ARTERY DISEASE

          Some heart attacks are sudden and intense, but most heart attacks start slowly, with mild pain or discomfort. Often people affected aren’t sure what’s wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:

• Chest discomfort. 
• Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
• Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
• Shortness of breath with or without chest discomfort.
• Other signs may include breaking out in a cold sweat, nausea or lightheadedness.
• Women can have different symptoms such as: shortness of breath, nausea/vomiting, and back or jaw pain.
• Minutes matter! Fast action can save lives — maybe your own. Don’t wait more than five minutes to call 9-1-1 or your emergency response number. Watch this animation of a heart attack.
  

Calling 9-1-1 is almost always the fastest way to get lifesaving treatment.

(American Heart Association, 2014)

HEART ARRYTHMIAS

          Many heart arrhythmias can occur in a patient’s heart. We will provide patient education suggestions for a few of the more common abnormalities.

Atrial Fibrillation

• In this condition, the top chambers or atria of the heart do no contract properly; the atria quiver instead of squeezing which causes pooling of blood in the heart.
• The pooling of blood may cause blood clots which can travel to other parts of the body and cause serious problems.
• Atrial fibrillation can  exist for a lifetime or can only be a short term issue.
• Signs of atrial fibrillation include: a heart beat that feels different in some way or fast; feeling tired or weak; feeling dizzy; feeling short of breath; experiencing chest pain; and, possibly nauseated.
• Atrial fibrillation is diagnosed by an EKG.
• One of the most important issues with atrial fibrillation is the prevention of blood clots; patients need to be started on a form of blood thinner to prevent these clots from forming.
• Treatments for atrial fibrillation include: pacemaker; electrical cardioversion (an electric shock is given to the heart which helps it return to a normal beat); and, catheter ablation (wires are fed through an artery or vein to the heart and then the pathway for the abnormal beats is corrected).
• (Patient Education Department, 2013)
  

Sinus Bradycardia

•  Sinus bradycardia is a slower than normal heart rate – usually less than 60 beats per minute.
• This condition can be serious if the heart cannot pump enough oxygen rich blood through the body.
• It can be a normal condition for patients who are athletic or young and healthy.
• Symptoms include: dizziness, shortness of breath, feeling faint or actually fainting, fatigue, and chest pain.
• Sinus bradycardia has many causes. Some of the more common causes are:  high blood pressure; heart damage from a heart attack; certain medications; infections and, inflammatory conditions.
• This condition is diagnosed with and EKG.
• Treatments involve changes in medications that may be lower the patient’s heart rate or a pacemaker is commonly used.
• It is important for the patient to tell her doctor if symptoms worsen.
• (Mayo Clinic Staff, 2014)
  

EKG SHOWING SINUS BRADYCARDIA

Sinus Tachycardia

• ·Sinus tachycardia is a faster than normal heart beat – usually faster than 100 beats per minute.
• Symptoms can be similar to sinus bradycardia  and include: dizziness, shortness of breath, rapid pulse, heart palpitations, and chest pain.
• Causes of sinus tachycardia can include: high blood pressure, smoking, fever, drinking too much alcohol or too many caffeinated beverages, side effect of medications, abuse of illegal drugs such as cocaine, imbalance of electrolytes, and overactive thyroid.
• Sinus tachycardia is also diagnosed by an EKG.
• Treatments for this condition include:  medications known as anti-arrhythmic drugs such as Rythmol; drugs known as calcium channel blockers, such as Cardizem or beta blockers, such as Lopressor.
• Treatments for can be also include: pacemaker; electrical cardioversion (an electric shock is given to the heart which helps it return to a normal beat); and, catheter ablation (wires are fed through an artery or vein to the heart and then the pathway for the abnormal beats is corrected).
• (Mayo Clinic Staff, 2014)
  

EKG SHOWING SINUS TACHYCARDIA

NUTRITION FOR YOUR CARDIOVASCULAR SYSTEM

• Eat a variety of nutritious foods from all the food groups such as;  fruits, vegetables, whole grains, low-fat dairy products, poultry, fish and nuts, while limiting red meat and sugary foods and beverages.
• Eating a variety of fruits and vegetables may help you control your weight, cholesterol and your blood pressure.
• Eat less of the nutrient-poor foods such as those that are high in calories and low in nutrients like desserts or “junk foods” – chips, Doritos, etc.
• Limit the amount of saturated fat, trans fat and sodium you eat.
• Choose lean meats and poultry without skin and prepare them without added saturated and trans fat.  
• Eat fish at least twice a week. Recent research shows that eating oily fish containing omega-3 fatty acids (for example, salmon, trout and herring) may help lower your risk of death from coronary artery disease.
  
• Select fat-free, 1 percent fat and low-fat dairy products.
• To lower cholesterol, reduce saturated fat to no more than 5 to 6 percent of total calories. For someone eating 2,000 calories a day, that’s about 13 grams of saturated fat.
  
• Cut back on beverages and foods with added sugars.
  
• Choose and prepare foods with little or no salt. 
• If you drink alcohol, drink in moderation. That means one drink per day if you’re a woman and two drinks per day if you’re a man.
  
• It is important to watch your portion sizes. Restaurant portions are usually much greater than you might realize.
• Review the following graphics for some additional easy to follow details.
• (American Heart Association, 2011)
  

CORONARY ARTERY DISEASE

What is CAD?

Most people develop coronary artery disease (CAD) due to atherosclerosis. Atherosclerosis occurs when plaque made up of fat, cholesterol, calcium, and fibrin form inside of our arteries.  High blood pressure, smoking, and cholesterol all can contribute to Atherosclerosis. Our focus is on the arteries that supply the heart muscle.  

What happens with plaque buildup?

When plaque settles inside of the artery it cuts off the important blood supply feeding a specific organ, in the case the heart.   The blood passing through arteries is very crucial to vital organs; it provides this important muscle with oxygen and nutrients.  If this muscle is deprived of oxygen and nutrients it will result in an injury and eventually death.   There is a higher risk of clot formation in these arteries if plaque is present.

Why is CAD so important to understand, prevent, and treat?

 CAD is the most common form of heart disease, leading cause of death in both men and women in the U.S.  CAD can lead to chest pain and a myocardial infarction (heart attack).  Medical management can help prevent or delay further plaque formation. An example of surgical treatment would be a coronary artery catheterization with stent placement, allowing the artery to stay open for adequate blood supply to the cardiac muscle.

(National Heart, Lung and Blood Institute, 2013) & (Texas Heart, 2013).

MYOCARDIAL INFARCTION

What is a myocardial infarction?

A myocardial infarction (MI) happens when an artery that supplies oxygenated blood to the heart becomes blocked. The blood is unable to pass through and supply the cardiac muscle properly. The American Heart Association (AHA) estimates that about every 34 seconds an American will have a heart attack.

Causes of a myocardial infarction:

The main cause of a MI is blockage of artery from atherosclerosis with acute clot formation. Spasm of the artery causing occlusion could also occur.  Blood flow can also be decreased during times of shock or severe bleeding ultimately leading to inadequate blood supply to the cardiac muscle.

How to prevent a myocardial infarction:

Genetics and family history may cause someone to be at a higher risk for having a MI, but there are also many modifiable risk factors that people can control. These are some of the risk factors that are preventable.

1.     Smoking tobacco products. This includes second hand smoke/exposure to smoke.

2.    High blood cholesterol. The goal is to have more “good” cholesterol, than bad cholesterol. This can be managed through diet.

3.    High blood pressure.This can be reduced with better diet, exercise, stress management, medication.

4.    Uncontrolled Diabetes.Checking glucose frequently and properly taking care of your DM through diet and correct medication regimen.

5.    Physical inactivity.Exercise is important in overall health and can help prevent the risk of a MI.

What to do during a myocardial infarction:

As nurses, our biggest life saver is education and prevention. It is important to teach our patients the signs and symptoms of a heart attack, the importance of quick treatment, and to call 911 if symptoms do not go away after 5 minutes!

Signs and symptoms include:

• Pressure, burning, tightness in the chest
• Constant indigestion-like discomfort
• Uncomfortable pressure in your chest that moves to your shoulders, arms, neck, jaw, or back
• Lightheadedness, fainting, sweating, or a sick stomach
• Shortness of breath
• Anxiety, weakness, nausea or tiredness
• Irregular heart beat “flutter” feeling

Women may experience slightly different sign and symptoms, these include:

• Pain or discomfort in the center of the chest
• Pain or discomfort in other areas of the upper body, including the arms, back, neck, jaw, or stomach
• Shortness of breath
• Breaking out in a cold sweat
• Nausea
• Light-headedness

If the patient has a nitroglycerin order it’s important to educate them to use them as instructed. If chest pain continues after 5 minutes, remind them to call 911.

If a patient has never experienced this before, educate your patient to chew 1 aspirin or Tylenol and ibuprofen if aspirin is not available until the paramedics arrive.

(Cleveland Clinic, 2013), (National Heart, Lung and Blood Institute, 2013) & (Texas Heart, 2013).

Congestive heart failure (CHF) is defined as “an abnormal clinical syndrome involving impaired cardiac pumping and/or filling (Lewis, et al, 2011.)”  The primary causes of heart failure include: coronary artery disease, hypertension, congenital heart defects, cardiomyopathy, hyperthyroidism, and valvular disorders.  Heart failure can be categorized into left and right sided (Lewis, et al, 2011).

Left Sided Heart Failure

Let’s take a look closer into left sided failure.  In left sided heart failure, the left ventricle doesn’t pump effectively.  This causes blood to back up into the left atrium and into the pulmonary circulation.  As the blood backs up, the pressure rises and causes fluid to escape, which may manifest itself as pulmonary edema.  Left sided heart failure is the most common type of failure (Lewis, et al, 2011). 

Clinical manifestations that occur during left sided heart failure include: increased heart rate, decreased PaO2 with slightly elevated PaCO2, crackles in the patient’s lungs as well as pleural effusions.  Mental status changes and restlessness may also occur.  Symptoms that the patient may complain about are weakness, fatigue, anxiety, depression, shortness of breath, shallow, fast respirations, dry, hacking cough, nocturia and paroxysmal noctural dyspnea (Lewis, et al, 2011).

Right Sided Heart Failure

Right-sided heart failure occurs when blood backs up into the right atrium and into the venous circulation.  This results in venous congestion, which causes hepatomegaly, splenomegaly, vascular congestion of the gastrointestinal tract as well as peripheral edema.  The most common cause of right-sided heart failure is left sided heart failure (Lewis, et al, 2011).

Clinical manifestations that occur during right sided heart failure include: heart murmur, jugular vein distention, edema, weight gain, increased heart rate, ascites, and anasarca.  Symptoms that the patient may complain about are fatigue, anxiety, depression, dependent edema of the lower extremities, anorexia and nausea (Lewis, et al, 2011).

DIAGNOSIS

The physician, along with complete history and physical examination, will order some diagnostic tests to aid in the correct diagnosis.   A chest x-ray will be ordered,  along with a 12 lead EKG, an echocardiogram as well as blood chemistries including a B-type natriuretic peptide (BNP), liver function test and cardiac enzymes (Lewis, et al, 2011).

NURSING ASSESSMENT

Auscultation

When auscultating the client’s heart you may hear tachycardia and murmurs.  When listening to lung sounds you may hear crackles, rhonchi and even wheezes.  You may also notice they are tachypneic (Lewis, et al, 2011).   

Palpation

When palpating the client’s skin you may notice the skin is cool and diaphoretic.  You may also notice cyanosis or pallor.  When palpating the lower extremities, they may have a pitting edema (Lewis, et al, 2011). 

Assessing For Arrhythmias

Let’s Refresh!

This week we will be looking further at the cardiovascular system and specifically focus on arrhythmias and the heart. Over the past few weeks, we have looked at obtaining a health history related to the patient’s heart, observed the normal heart and circulatory system, and learned ways to assess the extremities and neck vessels. We also learned where to locate the main assessment points of the heart and we learned about nutrition related to the heart. Today we will learn about the electrical conduction throughout the heart and how the heart may be altered if the electrical conduction system is altered.

The Conduction System

Below, is a picture of the conduction system throughout the heart. Impulses within the heart, innervated by nerve tissue, are responsible for depolarization of the heart (causes the heart to contract). In a normal heart, the person’s sinoatrial node (SA node) is responsible for the heart’s electrical impulse. This is the pacemaker of the heart. In many arrhythmias, however, the electrical impulse comes from an area other than the SA node. With normal conduction, the impulse will start with the SA node, located in the atria of the heart. It then travels via internodal pathways to the atrioventricular node (AV node) and then the Bundle of His. From there, the impulse goes to the right and left bundle branches. On the left side, the bundle branch transitions to two fascicles, the anterior and posterior. From here, the heart’s Purkinje Fibers are excited which are located on either side of the ventricle’s walls. All of this happens in approximately 0.12 seconds in the normal heart! Once the impulse has traveled to the Purkinje Fibers a ventricular contraction occurs (Lewis, Heitkemper, Dirksen, O’Brien, & Bucher, 2007).

So What is an Arrhythmia?

In short, it is very important as the nurse, to understand what arrhythmias are. Although the SA node is the normal pacemaker for the heart, cardiac cells in any part of the heart may take on the role of the pacemaker. Arrhythmias are typically categorized according to the site of the pacemaker and therefore include sinus arrhythmias, atrial arrhythmias, junctional arrhythmias and AV blocks and ventricular arrhythmias and bundle-branch blocks.  Three commonly seen arrhythmias are sinus bradycardia, sinus tachycardia and atrial fibrillation (Huff, 2012).

The Most Common Arrhythmias

(Below, please find a list of the most common arrhythmias. Without going in depth on each arrhythmia, a rhythm strip is provided for each to better visualize what to expect when heart monitoring is utilized.)

Assessing for the Signs and Symptoms of an Arrhythmia

When assessing the patient for dysrhythmias, the nurse wants to look for several different indicators. Signs of symptoms that the patient may be experiencing if he/she had an arrhythmia includes the following: palpitations, nausea, vomiting, pallor, diaphoresis, weakness, fatigue, numbness and/or tingling of arms, dyspnea, restlessness, cold and clammy skin, dizziness, syncope, confusion, anxiety, decreased level of consciousness, decreased oxygen saturation, either hypotension or hypertension, irregular rate and rhythm of heart, tachycardia, and bradycardia. The patient may also be experiencing pain. Common locations of pain linked with dysrhythmias include the chest, shoulder, back, neck, jaw, and arm (Lewis, et al., 2007).

Questions the Nurse Should Be Asking to Assess for Arrhythmias

1. Do you have any history of an irregular heartbeat?
2. Have you ever had any heart abnormalities as a child?
3. Do you ever experience palpitations (or any of the other signs and symptoms listed above)?
4. Are you having any chest pain? If so, please describe where the pain is, if it radiates, what it feels like, and if anything appears to make it worse (deep breath, eating, exposure to cold)?
5. Do you take any medications for your heart? The nurse should be looking for antidysrhythmic medications such as:

·        – Sodium Channel blockers such as Dilantin (phenytoin), or -Rhythmol (propafenone)

·         –Beta Adrenergic Blockers such as Tenormin (atenolol), -Lopressor (metoprolol), or Betapace (sotolol)

·         –Potassium Channel Blockers such as Betapace (sotolol), or -Cordarone (amiodarone)

·         –Calcium Channel Blockers such as Cardizem (diltiazem), or Calan (verapamil)

·         –Others: Lanoxin (digoxin), or Adenocard (adenosine) (Lewis, et al., 2007)

6. Are you experiencing any shortness of breath, swelling in your legs, dizziness, feelings that you will pass out?
7. Have you had any history of heart testing (EKGs, echocardiogram, Holter monitoring) If so, what were the findings of the test?
8. Have you had any surgeries to your heart or around your heart? Any history of a pacemaker? Any cardioversion? Any cardiac ablation? Any cardiac catheterization?
9. Do you have any family history of having an arrhythmia or any other heart related issues?
10. Have you had recent cholesterol levels checked? How has your blood pressure been lately?

Other Ways to Assess for Dysrhythmias

Auscultation

Perhaps one of the best ways to assess the conduction system is by directly listening to the heart. Turbulence caused by movement of the valves of the heart creates heart sounds which are heard through the stethoscope. In earlier weeks, we learned about S1 and S2/lub dub sounds. The nurse again wants to use this technique to assess the patient’s current heart rhythm (Lewis, et al., 2007).

Palpation

The nurse should also be using palpation to better assess the patient’s rhythmic status. While simultaneously auscultating the apical area, the nurse should be palpating the radial pulse. The nurse should be feeling for regularity of heart beat. If the apical and radial pulses are not equivalent, one nurse should count the apical pulse while a second nurse counts the radial pulse through palpation. The difference between these two values is known as a PULSE DEFECIT. If the patient is experiencing a pulse deficit, a dysrhythmia is indicated (Lewis, et al., 2007).

WARNING!!

As the nurse, it is important to not rely solely on cardiac monitoring related to cardiac assessment. Computerized monitoring is not fail-proof. When in doubt, check your patient! The heart monitor should not be the only tool the nurse uses to assess the patient’s cardiac status (Lewis, et al.).

Check Out These Videos

1. This video, “Electrocardiogram – What is an ECG – Performing an EKG Video.flv” briefly discusses what an ECG is and why the test is performed. It also discusses a stress test, as well.

2. This video provides an easy to follow visual to better understand how electrical impulses conduct within the heart & the most common dysrhythmias. “The Different Types of Heart Arrhythmia.”

This week we will be discussing nutrition related to the cardiovascular system. Let’s begin with a quick overview of what nutrition really is. Nutritional status refers to the degree of balance between nutrient intake and nutrient requirements. This balance is influenced by five factors: physiologic, psychosocial, developmental, cultural, and economic (Jarvis, 2012).

Optimal nutritional status is accomplished when adequate nutrients are consumed to support day-to-day body needs and any increased metabolic demands due to growth, pregnancy, or illness. Those with optimal nutritional status are more active, have less physical illnesses, and live longer (Jarvis, 2012).

Undernutrition occurs when nutrients are depleted or when nutrient intake is insufficient to meet day-to-day needs or added metabolic demands. Those at risk for undernutrition include infants, children, pregnant women, recent immigrants, individuals with low incomes, hospitalized people, and aging adults (Jarvis, 2012).

Overnutrition occurs when there is a consumption of nutrients, especially calories, sodium, and fat, in excess of body needs. Overnutrition, which is a major nutritional problem today, can lead to obesity and a risk factor for heart disease, type 2 diabetes, high blood pressure, and stroke (Jarvis, 2012).

Body mass index (BMI) is a numerical value of your weight in relation to your height. This tool is a good indicator to determine if your weight is healthy or unhealthy. Click here to learn more & calculate your BMI (American Heart Association, 2014).

Guidelines for a Healthy Eating Plate:

(Harvard School of Public Health, 2014)

To learn more about creating a healthy meal plate click here(ChooseMyPlate.gov, n.d.).

Risk Factors for Heart Disease that can be Controlled:

• Smoking
• High LDL (bad cholesterol) and low LDL (good cholesterol)
• Uncontrolled high blood pressure
• Sedentary lifestyle
• Obesity
• Uncontrolled diabetes
• High C-reactive protein (produced by the body during a process of inflammation, for example, inflammation of the arteries which can lead to heart disease, heart attack, or stroke)
• Uncontrolled stress and anger                        (WebMD, 2014)
  

Important Questions to Ask:

When performing a nutritional assessment on a cardiac patient, it is important to ask specific questions regarding personal habits as these can be cardiac risk factors. You should ask the patient to describe their usual diet. Take note if this diet is representative of the basic food groups, the amount of calories, cholesterol, and any additives such as salt. You should also ask the patient about their usual weight and if there has been any recent change in weight (Jarvis, 2012).

Additional Important Questions to Ask:

• Do you smoke cigarettes or other tobacco? At what age did you start? How many packs per day? How long? Have you ever tried to quit?
• How much alcohol do you drink? When was your last drink? What was the number of drinks during that episode?
• What is your usual amount of exercise each day or week? What type of exercise? What is your usual amount (light, moderate, heavy)?
• Do you take any antihypertensives, beta-blockers, calcium channel blockers, digoxin, diuretics, aspirin/anticoagulants, over-the-counter or street drugs?                        (Jarvis, 2012)

Healthy Tips:

Simple but effective strategies to reduce a patient’s risk for cardiovascular  disease include recommending foods such as fish and other lean proteins, fruit, whole grains, and vegetables. Replacing juices and sweetened beverages with whole fruit reduces the amount of calories consumed, increases volume and nutrient content, and lowers insulin and triglyceride levels by slowing absorption. Portion control is crucial, as well as limiting foods high in fat, cholesterol, and salt. Thirty to 60 minutes of exercise is recommended on most days of the week to achieve and maintain a healthy weight and to reduce the risk of chronic disease (Olendzki, Speed, & Domino, 2006). To learn more about 25 foods loaded with heart-healthy nutrients that help protect your cardiovascular system click here (WebMD, 2014).

To check out more heart-healthy foods, recipes, weight management, stress management, and tips to quit smoking please visit www.heart.org (American Heart Association, 2014).

Before discussing the assessment of the cardiovascular system let’s first review the anatomy of the heart & major arteries and veins:

(Normal heart, n.d.)

                                                                                    (Circulatory system, n.d.)

PREPARING FOR ASSESSMENT

        Before collecting objective data, it is important to first collect subjective data from the patient.  When assessing the cardiovascular system be sure to ask the patient if they have any chest pain, shortness of breath, difficulty breathing when laying flat, blue or ashen skin, cough, fatigue, swelling, or frequent voiding at night.  Other subjective information should include past medical history, family history and lifestyle. When performing a cardiovascular assessment begin with blood pressure and pulse followed by the extremities, then neck vessels and ending with the anterior chest (Jarvis, 2012).

PERIPHERAL EXTREMITIES

Begin your assessment with inspection and palpation of the arms, followed by the legs.  Note the color, temperature and turgor of the skin. In the legs, also assess hair distribution, venous pattern and edema.  First check capillary refill of the nail beds; color should return within 1-2 seconds in a healthy individual.  Palpate bilateral radial pulses, followed by brachial pulses in the arms.  When assessing peripheral pulses, note rate, rhythm, elasticity of vessels and force. Grade the force of the pulses as:   0 (absent), 1+ (weak), 2+ (normal) and 3+ (bounding).  In the legs palpate bilateral femoral, popliteal, posterior tibial and dorsalis pedis pulses.  Note any edema and grade accordingly (Jarvis, 2012).

(Pitting edema grading scale, n.d.)

NECK VESSELS

           Begin by palpating the carotid artery, do so gently and only on one side of the body at a time. Note the contour which should be smooth and the force which is normally graded 2+. Auscultate carotid arteries in individuals who are middle aged or older or show signs of cardiovascular disease. When auscultating the carotids, listen for a bruit which is an abnormal blowing or swishing sound. In a more advanced cardiovascular assessment jugular venous pulse and pressure may be assessed (Jarvis, 2012).

ANTERIOR CHEST

Begin by inspecting the anterior chest. The apical impulse may be visible at the mitral area (see image below) in children and thin individuals. Palpation of the apical pulse is not always possible particularly in the obese and those with thick chest walls. Continue with palpation across the chest noting the apex, left sternal border and base; pulses should not be present on palpation. Note if a heave, a sustained forceful thrusting (at the sternal border or apex) or thrill, a palpable vibration is present.  Auscultate at each of the five assessment points (refer to image). During auscultation note the rate and rhythm, identify S₁ (lub) and S₂ (dub) and listen for any extra heart sounds or murmurs. Click here to listen to heart sounds. Finish auscultation with placing the patient in the left lateral position and listening with the bell at the apex for any diastolic filling sounds (Jarvis, 2012).    

(Locating the assessment points, n.d.)

PUTTING IT ALL TOGETHER

(Hippocratv, 2013)

During care for a patient, it is important to have a complete health history. This allows for the patient to receive proper care while considering their previous or underlying conditions. This is also important to determine if they have had previous care for similar conditions and what worked well for them in the past.

It is important to start the health history by obtaining their name, date of birth, gender, contact information, race, ethnic origin, and occupation. Much of this information has been gathered by the time the patient sees the nurse but still deserves mentioning for those cases that this information is not yet collected. Nurses also need to consider this information and determine if the patient will need assistance with and communication barriers, whether it be a language barrier or if the patient needs assistance with hearing or seeing.

While collecting the health history, document who is providing you with the information, if they are reliable and if any special circumstances occurred, such as utilizing an interpreter or devices for the hearing impaired. This allows for others to read the information and understand what was occurring at the time of the interview. Also include why the patient sought treatment and use the patient’s words in quotation whenever possible.

When discussing the patient’s present illness, it is important to ask them when it started and what has occurred since, and why they decided to seek treatment that day if it has been an ongoing problem.  Also ask them how they view their health; do they find themselves to be overall healthy or sickly?

After discussing their current illness, it is also important to discuss their previous illnesses. Health history needs to include childhood illness, accidents or injuries, chronic conditions, previous hospitalizations, surgical history, obstetrical history, immunizations, allergies, and last related exam, depending upon illness or complaint. The more complete the health history, the better care we can provide.

Once we have established the patient’s personal history, family history also needs to be considered. By understanding the family history of certain diseases, we can assess the patient’s risk for these conditions. We can also use this to educate our patients to prevent them from developing certain diseases or reduce the impact of these diseases. In addition, a patient’s culture needs to be considered for their religious and spiritual practices and beliefs and restrictions. Are there any restricts on treatments, testing or foods?

Discussion of the home life is also important during the collection of the health history. Are they able to care for themselves or is someone there to help them? Do they feel safe at home or are they being abused? Do they smoke and does it occur in the home? Who is their support system? Also consider their occupation when considering any occupational hazards or exposures.

There are times in which a patient is unable to provide their health history. If this occurs we need to utilize medical records on the patient or discuss the history with the family, as long as they are reliable.

Below are two examples of health history forms that can be utilized to collect information. Check them out!

Health History- Includes Cultural Variances

Health History- Extensive Past Medical & Family History

By acquiring a comprehensive health history, we ensure that everything is “on the table”. When discussing health history with patients, we need to ensure them that they can trust us with this information and it will be used to help treat them. By creating a trusting relationship with our patients, the more likely they are to trust us with this information. 

(Jarvis, 2012)

Thanks for stopping in and learning all about the heart! :]

We have chosen to present information regarding assessment of the cardiovascular system. Our team will detail the major structures of heart. We will explain how the heart functions and how it circulates blood through itself using the cardiac cycle. We will then present questions to ask the patient to in order to obtain a complete health history and how the system can be assessed.

We will continue with normal versus abnormal assessments and explain what the abnormal might mean for the patient. We will present some visual and auditory aides to further help explain EKG and normal heart sounds. Common laboratory values and their meaning will be explained such as troponins and creatine kinase. A few major diseases relevant to this system, such as congestive heart failure will be presented and explained. These diseases will be explained using a list of assessments and diagnostic tests that might apply to determining whether a patient is suffering from the disease.

We will approach our individual assignments based on the strengths of our team members, for example, some of us are creative and some of us have strong writing skills. We will work together as a team to provide the class members with information they may use to enhance their assessment skills of the cardiovascular system.