N050 NCM112N

BSN III-3 23 SEPTEMBER 20

STUDY GUIDE 1: ASSESSMENT OF CARDIOVASCULAR FUNCTION

CASE STUDY 1:
Patient Profile:
L.P., a 63-year-old man, is brought to the emergency department by ambulance at 6 AM after
calling 911.
Subjective Data:
Complaints of chest pain, shortness of breath (SOB), palpitations, and dizziness.
Immediate Management:
The paramedics have started an IV and oxygen at 2 L/min via nasal cannula. They also
administered four ASA and a nitroglycerin tablet, and they obtained a 12-lead ECG. L.P. is pain-free on
arrival but still complains of palpitations and dizziness.

DISCUSSION QUESTIONS:
1. What are the possible causes of L.P.’s chest pain, SOB, palpitations, and dizziness?
The possible causes are hyperlipidemia, hypertension, cigarette smoking, diabetes
mellitus, obesity, and physical inactivity. But those are modifiable causes yet.
Non-modifiable cause might be the patient’s age, gender, race, or illness/es.
2. What would be your major focus when assessing L.P.?
I have to check L.P.’s past medical history such as: past illness/hospitalization, allergies,
and if he takes any cardiac drugs.
3. What questions would you ask L.P.?
 Ask for the chest pain’s characteristics such as: nature and intensity, onset and duration,
location and radiation, precipitating and relieving factors, and associated signs and
symptoms.
 Ask what type of dyspnea he is experiencing either exertional, paroxysmal nocturnal, and
or orthopnea.
 Ask for the palpitations’ onset and duration. Follow up question: “What do you do to
relieve your palpitations?”
 Lastly is about dizziness: Is his dizziness characterized as light-headedness, feeling faint,
off balance, vertigo, or spinning
4. What should be included in the physical assessment? What would you be looking for?
 General appearance and cognition
-assess level of consciousness
-check for Levine’s sign
-check if jugular distention is present
 Skin Inspection
-check if diaphoresis is present
-observe for cyanosis, xanthelasma, pallor, ecchymosis and clubbing
 Vital Signs
-monitor BP and check if pulsus alterans ot pulsus paradoxus is present
-assess for orthostatic hypotension is present
-determine pulse and heart rate
  Check if pitting edema is present
 Heart inspection and Auscultation (inspection, palpation, chest percussion, and cardiac
auscultation)
 Inspection of extremities
-check capillary refill time
-check if any hematoma is present
-check for clubbing of fingers and toes
-check for lower extremity ulcers

5. What diagnostic studies would you expect to be ordered?

 Electrocardiography
 Echocardiography
 Roentgenologic Studies (chest x-ray, fluoroscopy, coronary angiography)
 Transesophageal Echocardiography
 Cardiac Catheterization
 Magnetic Resonance Imaging
 Hemodynamic Monitoring

CASE STUDY 2:
Mr. Anderson is a 45-year-old executive with a major oil firm. Lately, he has experienced frequent
episodes of chest pressure that are relieved with rest. He has requested a complete physical examination.
The nurse conducts an initial cardiac assessment.

1. The nurse immediately inspects the patient’s skin. She observes a bluish tinge around the patient’s lips.
She knows that this is an indication of:
a. central cyanosis c. peripheral cyanosis
b. pallor d. xanthelasma

2. The nurse takes a baseline blood pressure measurement after the patient has rested for 10 minutes in a
supine position. The reading that reflects a reduced pulse pressure is:
a. 140/90 mm Hg. c. 140/110 mm Hg.
b. 140/100 mm Hg. d. 140/120 mm Hg.

3. Five minutes after the initial blood pressure measurement is taken, the nurse assesses additional
readings with the patient in a sitting and then in a standing position. The reading indicative of an
abnormal postural response would be:
a. lying, 140/110; sitting, 130/110; standing, 135/106 mm Hg.
b. lying, 140/110; sitting, 135/112; standing, 130/115 mm Hg.
c. lying, 140/110; sitting, 135/100; standing, 120/90 mm Hg.
d. lying, 140/110; sitting, 130/108; standing, 125/108 mm Hg.

4. The nurse returns Mr. Anderson to the supine position and measures for jugular vein distention. The
finding that would initially indicate an abnormal increase in the volume of the venous system would be
obvious distention of the veins with the patient at what angle?
a. 15 degrees c. 35 degrees
b. 25 degrees d. 45 degrees

5. The nurse auscultates the apex of the heart by placing a stethoscope over:
a. Erb’s point. c. the pulmonic area.
b. the fifth intercostal space d. the tricuspid area.