Introduction
Assessment of cardiovascular system is a very important part of a nurse’s daily patient care. A good knowledge of the anatomy and physiology of the cardiovascular system is crucial for carrying out an accurate assessment.
Components Of Cardiovascular Assessment
- History taking.
- Physical examination- inspection, palpation, auscultation.
Articles
- Gloves (optional).
- Drapes.
- Gown for patient.
- Stethoscope.
- Pen and paper to record.
Procedure
History Taking
Assessment begins with a focused history taking of the patient. History taking includes general information about the patient.
Chief Complaints
When focusing on the cardiovascular system, the common symptoms that should be taken into consideration include:
- Chest pain
- Shortness of breath
- Activity intolerance
- Nausea/vomiting
- Syncopal episode
- Exertional dyspnoea
- Palpitations
- Fatigue
- Weakness
- Diaphoresis
- Light headedness
All these symptoms may indicate an underlying cardiac pathology. When collecting data, the clinician must obtain comprehensive information regarding symptom characteristics, severity, and time of onset, precipitating factors and relieving factors.
Past Medical History
- Cardiovascular system history taking should include medical conditions such as hypertension, high cholesterol and triglycerides, coronary heart diseases, rheumatic fever, valvular heart disease, peripheral vascular diseases, recurrent throat infections and chronic anaemia. This will give the examiner an insight into the patient’s health condition.
- When collecting data, include smoking history (number of packs/day x number of years of smoking = number of pack year), list of home medications, including antihypertensives, medications for high cholesterol, beta blockers and other cardiac medications. Also include surgeries such as open-heart surgeries or procedures such as cardiac catheterization, etc.
- Include diagnostic tests of the cardiovascular system, such as electrocardiograms, stress test, echocardiogram, imaging studies of the heart, which were done recently and their findings.
Physical Examination
| Steps of procedure | Rationale |
| Inspection Check general appearance of the patient such as posture, gait, colour of skin and mucous membrane, activity tolerance, and breathing. Inspect skin for any generalized or localized redness, or discoloration. Observe for any abnormalities in texture, temperature and moisture and check for edema in any part of body. Check nails for colour, abnormal morphology or any other abnormalities. | Checking general appearance, such as observing for signs of shortness of breath when resting or during exertion, will help in identifying common cardiac abnormalities such as congestive heart failure. Colour of the skin will help in identifying underlying cardiac issues Cyanosis or clubbing of the nails will point to congenital cardiac abnormalities. Redness and loss of hair in lower extremities will indicate compromised arterial blood supply. Edema of lower extremities may be a sign of heart failure or venous insufficiency. Jugular vein distention also is indicative of cardiac disorders. Clubbed fingers, cyanosed nail beds are a few symptoms indicative of cardiac disorders. |
| Assessment of chest or precordium Observe the external anatomy of the chest. Also observe for any shortness of breath or any visible lift or heave or pulsation in any part of the chest. The point of maximum impulse (PMI) is over the apex of the heart that is on the 5th left intercostal space. Palpate for any thrills over the point of maximum impulse that may feel like a small vibration. | The PMI is normally felt on the 5th left intercostal space. A shift further to left in the PMI will indicate a cardiomegaly. |
| Auscultation Position the patient sitting in 30-45°. Expose chest as needed, using drapes. Ensure that the diaphragm of the stethoscope is in contact with the skin and not placed over clothes. Auscultation of the chest must be done over the precordium in an organized and systematic manner. Start at the aortic area (2nd right intercostal space (ICS)), Move on to the pulmonic area (2nd left ICS), then to the tricuspid area (4th left intercostal space, sternal border) and finally to the mitral area (4th ICS, midclavicular). | Auscultation of different sites will help in identifying physiologic functioning of different heart valves. Abnormal heart sounds like murmurs will be clearly heard over different sites of the precordium. The diaphragm of the stethoscope is best used to hear high pitched sounds, and the bell of the stethoscope is best used to hear low-pitched sounds like S3 and S4. |
| Assessment of jugular vein Place the patient in a sitting position at 45° angle. Turn the patient’s neck to the left side. Identify the sternomastoid muscle on which the jugular vein rests. If the vein is bulging>8 cm, it reflects a high jugular venous pressure (JVP). | Increased JVP indicates conditions like congestive heart failure, fluid overload and high central venous pressure. |
| Assessment of pulses The peripheral pulses that are commonly assessed are carotid, radial, brachial, femoral, popliteal, dorsalis pedis and posterior tibial. The common carotid artery is palpated on the neck below the jaw and lateral to the larynx/trachea using the middle and index fingers. carotid pulse should be palpated one side at a time. The brachial artery is palpated on the anterior aspect of the elbow by gently pressing the artery against the underlying bone with the middle and index fingers. The radial pulse is palpated immediately above the wrist joint near the base of the thumb. The pulse is palpated by gently pressing down the radial artery to the underlying bone using the thumb and the middle finger. The femoral pulse is palpated over the ventral thigh between the pubic symphysis and anterior superior iliac spine with the middle and index fingers. The popliteal pulse is palpated on the posterior knee with the middle and index fingers; the knee must be slightly bent to feel the pulse accurately. The posterior tibial pulse is palpated posterior and inferior to the medial malleolus by gently pressing the tibial artery against the underlying bone with the middle and index fingers. The dorsalis pedis pulse is palpated in the groove between the first and second toes slightly medial on the dorsum of the foot with the middle and/or index fingers. | The pulse is assessed for rate, rhythm and volume. The pulse reflects circulatory status and is best assessed when checked for a whole minute. Applying more than necessary pressure on the artery can obstruct the blood flow in the artery and the examiner may not be able to feel the pulse. |
| Assessment of extremities Assess extremities for temperature, hair growth, color,clubbing, swelling, presence of wounds moisture and pain. Assess for capillary refill of upper and lower extremities by pressing on end of toe or nail bed and releasing. If colour returns in less than 2-3 seconds, then capillary refill is normal. If pitting edema is present, check for the extent of edema | Cool, clammy skin indicates poor arterial circulation and vasoconstriction. Redness and warmth could indicate inflammation or chronic arterial insufficiency. Capillary refill is poor in hypoperfusion conditions. Bluish discoloration to lip or extremities could denote congenital heart disease or poor oxygenation. Claudicating pain also indicates arterial insufficiency and poor circulation. Edema or swelling could mean poor venous return, as in congestive heart failure. Pallor indicates anaemia. |
| Wash hands. | Prevent cross infection. |
| Document the findings. | To ensure adequate documentation of the procedure performed and its findings. |
Checking extends of pitting Edema
| 1+ | 2 mm depression. Barely detectable Immediate rebound. |
| 2+ | 4 mm deep pit. A few seconds to rebound. |
| 3+ | 6 mm deep pit. 10-12 seconds to rebound. |
| 4+ | 8 mm: Very deep pit. >20 seconds to rebound. |
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
