Question

  Module 09 Lab Assignment – Documentation of a Cardiovascular System Examination

You will perform a history of a cardiac problem that your instructor has provided you or one that you have experienced, and you will perform a cardiac assessment. You will document your subjective and objective findings, identify actual or potential risks, and submit this in a Word document to the drop box provided.

Answer 1

ANSWER: Cardiac disorders are the most occurring diseases among men and women. It should be assessed before carefully to detect or diagnose the potential risk of any complications. Therefore a careful assessment should be done:

SUBJECTIVE DATA:

• Assess the patient for chest pain, ask the patient about pain scale, location, intensity, type, and characteristics of pain, whether it is radiating or not or associated with exertion or not.
• Then ask for palpitations, ask about flushing, fluttering or pounding sensation.
• Then assess and ask to the patient about the shortness of breath and dyspnea, dyspnea occurs when oxygen does not flow adequately to the lungs, heart, and other tissues.
• Ask about edema or swelling either on ankles or face, periorbital edema, assess for its grades
• At last ask the patient about orthostatic hypotension when it occurs, either standing or bending position.

OBJECTIVE DATA:

• The first step to measure the height, weight, and BMI of the client, then assess vitals for increased bp, pulse, respiration, spo2, and temperature.
• Analyze the pulse quality, depth, BP values either hypotensive or hypertensive, then assess respiration rate, the pattern of respiration, labored breathing, fast, deep or shallow.
• Consider the age factor that can change the values and consider it as normal.
• Also, use the measure tool accurately and reliable and valid. Cuff size should be accurate, location and it should be tie accordingly.
• Assess the fluid status, input-output and nutritional status. Losing weight or gaining weight have their own significance.

INSPECTION:

• Inspection starts with observing the patient from his level of orientation, his body composition either endomorphic, mesomorphic or ectomorphic, his level of cleanliness, check whether he is gloomy or cheerful, posture, gait
• Then assess skin for any diaphoresis, skin color whether pallor, cyanosed or not, skin turgor, skin temperature, hydration status, and texture.
• Then come to nails and assess nails for clubbing, its color, texture, shape, whether they are cyanosed or not or any deformity in nails. Check oral mucosa for its color.
• Let the patient lying and assess for the distended jugular vein, observe for heaves and lifts, pulsations, palpations, retraction and movement of the chest, the shape of the chest whether pigeon shaped or barrel-shaped, then assess the anteroposterior diameter of the chest.
• Examine the breast in female cases, for any abnormality.
• Locate the carotid artery and assess it. Also located the chest points, midclavicular line for axis, and check for any cardiomegaly.

PALPATIONS:

• Palpate precordium for any changes, pulsation, or to assess the apical impulse, also check for any thrills, heaves and vibrations. Note the size, location, intensity, amplitude, and duration of the apical impulse or any changes in these.
• Palpate the legs, feet, and arms to check the grade of edema, pitting edema can be a symptom of kidney problems.
• Check nails for a capillary refill, if it is less than 3 seconds then it is normal.
• Palpate and assess all the pulses, brachial, femoral, radial, temporal for its depth, rate pulsations, and intensity.

PERCUSSION:

• Percussion is not that helpful in cardiovascular assessment but it can be used to assess and locate the cardiac border like anterior axillary line.
• When you percuss more and move towards left the resonance sound change to dullness this indicates midclavicular line.
• As it is difficult to assess and do percussion over obese people.

AUSCULTATION:

• Use stethoscope carefully, high pitched sound is best heard from the diaphragm whereas low pitched heart sound heard from bell.
• while auscultating the heart sounds, avoid extra environmental noise, like a fan, cardiac monitor or tv sound, etc.
• Provide privacy and ask the client to remove the chest clothes, as auscultation with clothes can confuse the physician, also be careful about the friction that heard due to rubbing with skin.
• Assess and auscultate to listen S1, S2, S3, S4, heart sound, and auscultate the client in three positions that is lying on the back, left side, and in low fowlers position.
• S1 sound is best heard at apex, whereas S2 heard at base that is 2nd and 3rd intraventricular space.
• Assess for any abnormal sound like murmurs, midsystolic click, ejection click, opening snap, summation gallop, friction, gallops, S3, AND S4. S3 is normal in children and sometimes in the elderly and S4 in the elderly with hypertension or other heart diseases.
• Similarly assess and auscultate all the artery, brachial, radial, femoral etc and assess for any bruit like buzzing sound. It can be a sign of aneurysm.

ACTUAL AND POTENTIAL RISK CAN BE:

1. Family history of any cardiac disorder, inheriditary
2. obesity
3. high cholesterol level more than 200mg/dl, low VDL level and high LDL level
4. hypertensin
5. smoking, tobacco or alcohol intake
6. Sedentary lifestyle, poor habits
7. Associated with other disease like diabetes.
8. drug abuse and increase salt intake
9. risk factors can be prolong standing, thrombophlebitis, bleeding disorders, and intermittent claudication.