ASSESSMENT OF THE CARDIOVASCULAR SYSTEM

Subjective Data:-

A careful health history and physical examination should aid the nurse in differentiating
symptoms that reflect a cardiovascular problem from problems of other body systems that
reflect. Common chief cues that should alert the nurse to the possibility of underlying
cardiovascular problems should be explored.

Important health information:-

Past Health History:-Patient should be questioned about a history of chest pain, shortness of
breath, alcoholism and /or tobacco use, anemia, rheumatic fever, streptococcal sore throat,
congenital heart disease, stroke, syncope, hypertension, varicosities and edema.

Medications:- An assessment of the patient’s current and past use of medications should be
made. This includes over the counter drugs(OTC) and herbal supplements, and prescription
drugs. For example Aspirin which prolongs the blood clotting time is contained in many drugs
used to alleviate the cold symptoms.

Functional Health Patterns:- The strong correlation between components of a patient’s

lifestyle and cardiovascular health supports the need to review each functional health pattern.

 Health perception-Health Management Pattern:-The nurse ask the patient about the
presence of cardiovascular risk factors. Major risk factors include elevated serum lipids,
hypertension, tobacco-use, sedentary lifestyle and obesity. Stressful lifestyle and diabetes
mellitus should also be investigated.

If the patient use tobacco, the number of pack years of tobacco use ( number of years the
patient has smoked per day multiplied by the number of years the patient has smoked) should
be estimated.

A question about the patient allergies is appropriate. The nurse should determine whether a
drug reaction or an allergic reaction was ever experienced.

 Nutritional- Metabolic pattern:-Being underweight or overweight may indicate

potential cardiovascular problems. Thus it is important to assess the patient’s weight
history in relation to height and build. A typically diet should be examined for its
adequacy in relation to the patient lifestyle.
 Elimination pattern:- The patient on diuretics may report increased urinary elimination.
Problems with constipation should be investigated and documented.
 Activity –Exercise Pattern:- The benefit of exercise to cardiovascular health is
indisputable; with sustained aerobic exercise being most beneficial. The nurse should
inquire about the types of exercise done, the duration ad frequency of each, and the
 occurance of any unwanted effects. The length of time the exercise program has been
practiced.
 Sleep- rest Pattern:- Paroxysmal nocturnal dyspnea( attacks of shortness of breath
especially at night that awaken the patient) and Cheyne-stroke respiration are associated
with heart failure. Sleep apnea has been associated with an increase risk of lifethreatening
dysrhythmias, especially in patients with left ventricular failure should be investigated.
 Sexuality- Reproductive pattern:- The patient should be asked about the effect of the
cardiovascular problem on sexual pattern on satisfaction. Erectile dysfunction may be a
symptom of cardiovascular problem.
 Coping- Stress Tolerance Pattern:-The patient should be asked to identify the areas that
cause stress or anxiety. The usual methods of coping with stress should be investigated.
High levels of anxiety and anger are the factors associated with cardiac disease.

Objective Data:-

Physical Examination:-
 Vital Signs:-After the patient’s general appearance has been observed , vital
signs, including BP, heart and respiratory rate and temperature are taken.
Orthostatic BP’s and HRs should be measured while the patient is lying, sitting
and standing. A great variance includes pathology.

Peripheral Vascular System:-

 Inspection:- Inspection of the skin should include color, hair distribution and
venous pattern. The extremities should be inspected for conditions such as edema,
thrombophlebitis, clubbing of the nail beds, lesions such as stasis ulcers.
 Palpation:- Palpation of the upper and lower extremities for temperature,
moisture, pulses and edema should be done bilaterally to assess for symmetry.
Edema is assessed by depressing the skin over the tibia or media malleolus for 5
seconds. Palpation of the pulses in neck and extremities provides information on
atrial blood flow. The judgment often is graded using the following scale:

0= Absent
1+ = weak
2+ = normal
3+ =increased
4+ = bounding

 Auscultation:- An artery that has a narrowed or bulging wall may create

turbulent blood flow. This normal blood flow can create a buzzing or hummering
 termed a bruit. It can be heard with a stethoscope placed over the vessel.
Auscultation of the major arteries such as carotid arteries, femoral arteries should
be done. The movement of the cardiac valves creates some turbulence in the
blood flow resulting in normal heart sounds. These sounds can be heard through
a stethoscope placed on the chest wall. The first heart sound(S1) which is
associated with the closure of the tricuspid and mitral(AV) valves, has a soft lub
sound. The second heart sound (S2) which is associated with the closure of the
aortic and pulmonic valves has a sharp dup sound.

PHYSICAL EXAMINATION:-

1. General Appearance and Level of Consciousness:- It provides an initial composite

picture of the client and indicates the level of comfort and distress. The LOC reflects the
adequacy of the cerebral perfusion and oxygenation.
 Vital signs:- Vital signs include bilateral arm blood pressures, heart and
respiratory rates and temperature. A weight should also be obtained to aid in
body mass index.
 Blood pressures:- Blood pressure measurements should be made with the
appropriate cuff size and with the client lying, sitting and standing. Orthostatic
hypotension is a blood pressure drop of more than 15 mm hg with position
changes.
 Pulse :- Pulse characteristics can vary. If the pulse is irregular, assess for a pulse
deficit by taking apical pulse and radial pulses simultaneously, noting
differences in rate. Pulse volume can be described as bounding, thread or absent.
 Respiratory rate:- Note the rate, rhythm, depth and quality of the breathing
pattern. Look for accessory muscle use.
2. Head and Neck:- When examining the head, pay particular attention to the eyes,
ear lobes, lips and buccal mucosa.
 Neck Vein Assessment:-Neck vein distention can be used to estimate central
venous pressure(CVP). The amount of distention reflects pressure and volume
changes in the right atrium. Twisting of the neck can be assessed.
 Carotid Artery Assessment:- It indicates the adequacy of the stroke volume and
the patency of the arteries. Using your finger tips, gently palpate the carotid
arteries one side at a time in order to avoid vagal stimulation.
3. Thorax :- Perform inspection and palpation of the precordium together to determine the
presence of normal and abnormal pulsations.
4. Abdomen :- Information of the abdomen provides information regarding cardiac
competence. It can clues about cardiovascular function including electrolyte imbalance or
artheriosclerois. Aortic bruits are heard just above the umbilicus.
5. Extremities:-
 Skin :-Observe the skin and mucous membrane for abnormalities such as central
or peripheral cyanosis. Peripheral cyanosis is seen in lips, ear lobes, and nail beds.
Assess capillary refill by putting slight pressure on a nail bed until it blanches.
Quickly release the pressure. When circulation is adequate, nail color returns to
baseline in less than 3 seconds.
 Skin turgor:-Assess skin turgor (elasticity) by lifting a fold of skin over the
sternum or lower arms and releasing it. Normal skin immediately returns to the
baseline position, but skin with decreased turgor stays pinched for upto 30
seconds.
 Temperature:- The temperature of the skin may reflect cardiac disease. Along
with the locations of the warm or cold skin areas, the location of the temperature
changes.
 Clubbing :- Check fingers for clubbing, in which the distal tips of the fingers
become bulbous and the angle between the base of the nail and the skin next to
the cuticles increases from the normal.
 Edema :- Inspect dependent areas for edema. In the mobile client, edema is best
seen in the feet, ankles and lower legs. In the chair ridden or bed-ridden client
edema may be palpate over the sacrum, abdomen and scapula. Assess the severity
of edema by pressing a thumb or finger carefully into the area
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Delhi;1998.Pp:-1369-1376
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