Beginning Assessment

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

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veins2

 

(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).

2137_18_05_12_2_25_00(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 sustainedr8a024ac101 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)

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