Running Head: CARDIOVASCULAR SYSTEM 1
CARDIOVASCULAR SYSTEM 8
NR509: Advanced Physical Assessment
June 17, 2020
The cardiovascular system (CS) is a transport system for blood and other materials to and from all the parts of the body. The system controls the amount and the speed of blood carried through the vessels in response to various stimuli. Conversely, the cardiovascular system is regulated by multiple stimuli mechanisms, including changing hormones, electrolytes, and osmolarity (Thorin & Clozel, 2010). Therefore, the analysis will focus on the physiology of the CS, subjective and objective data for CS, physical examination techniques, physical assessment techniques for special populations, and identify a disease that may impact the cardiovascular system.
Physiology of the Cardiovascular System
The cardiovascular system comprises of the heart and blood vessels that supply blood and nutrients throughout the body. The primary function of the heart is to pump blood through the body. It pumps the blood into arteries, particularly the pulmonary artery or aorta. The blood vessels are fundamental because they help in controlling the amount of blood flow to specific body parts. Arteries carry oxygenated blood from the heart to other parts of the body. Moreover, capillaries are single-layered cells that branch off arterioles and thin layer to help exchange gases, nutrients, wastes, and organs (Thorin & Clozel, 2010)
The purpose of the CS is to provide an adequate flow of blood through the body. To attain this, the systemic circulation helps in transporting the oxygenated blood and nutrients to the rest of the body while the pulmonary circulation provides for oxygenation of the blood. Furthermore, the physiology of the heart includes understanding different concepts such as cardiac output (CO), preload, afterload, stroke output, and ejection fraction (Thorin & Clozel, 2010). CO is the volume of the blood ejected from the left ventricle, while stroke volume is the volume of the blood pumped from the heart after one contraction. The preload is the pressure on the ventricular muscular between stroke volume and end-systolic volume, while afterload pressure exists when the left ventricular pressure is sufficient to push the blood forward.
Subjective Data for Cardiovascular System Assessment
During the history, the clinician should ask about the presenting symptoms, past health history, risk factors, current health status, and social history. The clinician should also ask about specific behaviors that jeopardize or promote cardiovascular health and uses this data in guiding health education. The health history begins by investigation of the chief complaint of the patient. The nurse should ask the patient in his/her own words the reason or problem for seeking care. At section, the nurse can ask several questions such as when did the symptom start? What triggers the symptoms? How would you describe the pain? Where does the symptom occur? “On a scale of 1 to 10, rate your pain or symptom” (Ball et al., 2019).
The above question can guide in the assessment of different cardiovascular symptoms such as chest pain, edema of ankles and feet, syncope, cough, dyspnea, cyanosis. Chest pain is a disturbing experience for patients with cardiovascular disease. Also, heart failure can cause swollen feet or ankle because the organ is unable to mobilize the fluid appropriately. Clinicians should ask about syncope symptoms, fainting, and dizziness associated with palpitation since cardiac arrhythmia may compromise blood flow in the brain. When taking a past health history, the nurse should also ask about childhood illnesses such as rheumatic fever as well as current diseases such as pulmonary embolism, diabetes, tuberculosis, and pneumonia (Ball et al., 2019). It is also imperative to inquire about exposure to cardiotoxic materials as well as information regarding vascular surgeries. In terms of family history, the clinician should inquire about the health, age, age and cause of death of immediate family members. Finally, social history also contributes to the health status of the patient. The clinician should inquire of the patients’ living conditions, sexual activity, coping patterns, occupation, and spiritual and cultural.
The physical examination for cardiovascular system starts by assessing patient’s general appearance. The nurse should also evaluate the overall heath appearance including the posture, if the client is experiencing pain when resting, or any signs of diaphoretic and dyspnea. Does the patient avoid a specific position to eliminate or reduce the pain, which can indicate acute pericarditis? Are there indications of chest abnormality with amplified “tachypnea, anterior-posterior diameter, or purse-lip breathing?” Thorin & Clozel, 2010). A chronically ill-appearing patient may be a suggestion of the presence of long-standing heart failure. Besides, the general appearance can be a reflection of blood flow as well as other cardiac diseases that significantly affect the heart. The clinician should observe the color of the client such as pale skin color as well as body fluids and facial feature. Vital signs such as blood pressure, heart rate, respiratory rate must be noted during the assessment to guide in proper diagnosis.
Techniques for Physical Assessment
The standard techniques used in cardiovascular system examination include inspection, palpitation, percussion, and auscultation (Ball et al., 2019. Inspection begins immediately when the nurse and the patient interact. The initial inspections include crucial elements such as general appearance and presentation of the client. Critical examination shows the first impression of age, nutritional status, alertness, and overall physical health. One must consider the patient’s gait, posture, and musculoskeletal coordination. The nurse inspects the pressure on jugular veins to examine the cardiac function, the chest for signs of injury, chest contour, and symmetric, extremities for signs of ulceration, lesions, unhealed sores, and varicose vein, and skin for dryness, edema, thickness, and elasticity (Ball et al., 2019).
The cardiovascular examination continues with palpitation involving the use of the pad of fingers. Using the fingers, the carotid, branchial radial, popliteal, femoral, and posterior tibia pulses are palpated. Chest wall palpitation is conducted by assessing the “maximal impulse, thrills, and abnormal pulsations” (Sullivan, 2019). Percussion is used to determine heart size by percussion for the dullness that indicates cardiovascular abnormalities. Lastly, data from the auscultation of the heart are used in planning and evaluating the care of the critically ill patient. The technique is used to identify normal heart sounds and physiological conditions responsible for extra sounds, murmurs, and friction rubs
Interview Skills for Special Populations
Physical assessment skills and interview techniques are critical for a successful health examination. Most of the subjective data is gathered through interviewing the patients. When dealing with special populations with cardiovascular conditions, some of the interview skills include good communication and listening skills and establish rapport. For instance, a nurse needs to show interest in pediatrics in what he/she say to help both the child and caregiver feel comfortable. It is necessary to answer the questions of these populations to establish trust with the patients. A nurse may wish to ask additional history questions regarding infant, pediatric, pediatric patient. For further history for infants, the nurse should assess the health status of the mother during pregnancy, such as drug use or other infections, presence of any cyanosis while the child is feeding, and ascertain whether the baby is playing or eating without tiring (Seidel et al., 2011)
For pediatrics, the nurse should evaluate the ability of the patient to keep the same activity level with children of the same age. Does the child experience unexplained fever or unexpected joint pain, or if the child has a nosebleed? Additional history for pregnant patients includes blood pressure, such as if the mother experiences high blood pressure during pregnancies, whether she monitors pressure during pregnancies and any report of excessive weight gain. Finally, the geriatric population’s interview techniques should include assessing the health and lung disease and ascertain if they have a history of heart diseases such as coronary heart diseases and hypertension (Sullivan, 2019). It is also essential to evaluate the type of medication that older people take and the side effects of the medications.
Coronary Artery Disease (CAD)
CAD is one of the prevalent conditions associated with the cardiovascular system. Damaging of the major blood vessels supplying blood into the heart causes CAD. The leading cause of the state is deposits of cholesterol in the coronary arteries as well as inflammation of these arteries. Coronary arteries are known for supplying oxygen, blood, and nutrients to the heart. The deposition of a plague or inflammation causes the narrowing of these arteries, decreasing the blood flow to the heart. Eventually, the patient experiences reduced blood flow that may cause chest pain, shortness of breath, and other symptoms associated with CAD.
During a medical history and physical exam, the nurse should evaluate the symptoms and the risk factors of CAD. During the assessment, the clinician should focus on abnormal findings such history of chest pain that happens predictably, abnormally low or high blood pressure, irregular heart rate or rhythm, and new and changed heart murmur. The signs of heart failure include extra heart sounds, enlarged liver, and swelling in the feet. The disease is also associated with the abnormal sign of atherosclerosis, such as unequal and diminished in arms and legs
In summary, assessing the cardiovascular system is an integral component in the comprehensive assessment. The system consists of the heart and vessels responsible for pumping and transporting blood, respectively. The subjective information includes presenting symptoms, health status, risk factors, and the patient’s social history. The physical examination techniques include inspection, palpitation, percussion, and auscultation. Besides, special interviewing skills are required to address the needs of special populations. Finally, abnormal findings of CAD, such as low blood pressure, irregular heart rate, and a changed heart murmur, significantly affects the cardiovascular system.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Dampney, R. A. (2016). Central neural control of the cardiovascular system: current perspectives. Advances in physiology education, 40(3), 283-296.
Liou, K., Ho, S., Fildes, J., & Ooi, S. Y. (2016). High intensity interval versus moderate intensity continuous training in patients with coronary artery disease: a meta-analysis of physiological and clinical parameters. Heart, Lung and Circulation, 25(2), 166-174.
Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). History subjective data checklist. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.
Thorin, E., & Clozel, M. (2010). The cardiovascular physiology and pharmacology of endothelin-1. In Advances in pharmacology (Vol. 60, pp. 1-26). Academic Press.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.