Cardiovascular

Assessing the Cardiovascular System
1. Perform hand hygiene and put on PPE, if indicated.

2. Introduce yourseld and Identify the patient.
3. Close curtains around bed and the door to the room, if possible. Explain the purpose of the health examination and what you
are going to do. Answer any questions
- Do u have a history of chest pain, tightness, palpitations, dizziness or fatigue?
- Swelling in the ankles and feet
- History of alcohol use
- do u have a history of smoking?
- Family history of hypertension?
4. Help the patient undress, if needed, and provide a patient gown. Assist the patient to a supine position with the head elevated
about 30 to 45 degrees and expose the anterior chest. Use the bath blanket to cover any exposed area other than the one being
assessed.
5. Inspect and palpate the left and then the right carotid arteries. Only palpate one carotid artery at a time. Use the bell of the
stethoscope to auscultate the arteries. Palpation of both arteries at the same time can result in reduced cerebral blood flow.
- Palpation of this area evaluates the circulation through the arteries and auscultation can detect a bruit.
- Arteries are elastic and no thrills are noted.
- Loss of elasticity may indicate arteriosclerosis and thrills may indicate a narrowing of the artery.
- No blowing or swishing or other sounds are heard
- A bruit , blowing or swishing sound may indicate occlusive arterial disease
6. Inspect the neck for jugular vein distention, observing for pulsations.
- This technique helps to detect right sided heart pressure.
- Make sure that the head and torso are on the same plane.
- Ask the patient to turn head slightly to the left
- Use penlight to increase visualization of pulsations and shadows on the neck
- The jugular venous pulse is not normally visible with the patient sitting upright
- Jugular vein should not be distended, bulging, or protruding at 45 degress or greatee
- Distention, protrusion, or bulging at 45, 60, 90 degress may indicate right-sided heart failure.
7. Inspect the precordium( heart) for contour, pulsations, and heaves. Observe for the apical impulse at the fourth to fifth
intercostal spaces (ICS).
- Precordium inspection helps detect pulsations. There are normally no pulsations except for a slight apical
impulse
- The apical impulse is a result of the left ventricle moving outward during systole
- A heave of lift may occur as the result of an enlarged ventricle from an overload of work
8. Use the palmar surface with the four fingers held together and palpate the precordium gently for pulsations. Remember that
hands should be warm. Palpation proceeds in a systematic manner, with assessment of specific cardiac landmarks-the aortic,
pulmonic, tricuspid, and mitral areas and Erb's point. Palpate the apical impulse in the mitral area. Note size, duration, force,
and location in relationship to the midclavicular line.
- This helps identify any precordial thrills, which are fine, palpable, rushing vibrations over the right or left
second ICS, and any lifts or heaves, which involve a rise along the border of the sternum with each heartbeat.-
- Normal findings include no pulsation palpable over the aortic and pulmonic areas, with a palpable apical
impulse.
- The apical impulse js palpated in the mitral area and may be the size of 1-2 cm
- Amplitude is usually small. Duration is brief.
9. Use systematic auscultation, beginning at the aortic area, moving to the pulmonic area, then to Erb's point, then to the tricuspid
area, and finally to the mitral area. Ask the patient to breathe normally. The stethoscope diaphragm is first used to listen to
high-pitched sounds, followed by use of the bell to listen to low-pitched sounds.Focus on the overall rate and rhythm of the
heart and the normal heart sounds.
- Auscultation evaluates heart rate and rhythm and assesses for normal sounds (the lub, S1; the dub, S2) and
abnormal heart sounds (S3 and S4). The normal heart sounds (S1 and S2) are generated by the closing of the
valves (the aortic, pulmonic, tricuspid, mitral). S3 could be a normal finding in a pregnant woman in the third
trimester due to increased cardiac output.
- S1 loudest at the apex of the heart and S2 is loudest at the base
10. Assist the patient in replacing the gown. Remove PPE, if used. Perform hand hygiene. Continue with assessments of specific
body systems as appropriate or indicated. Initiate appropriate referral to other healthcare practitioners for further evaluation, as
indicated.
Patient denies chest pain. No lifts , pulsations,, or heaves were noted when inspection and palpation of chest. S1 loudest at the
apex of the heart during auscultation and S2 loudest at the base. No S3 and S3 auscultated.

Cardiovascular

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Assessing the Cardiovascular System

1. Perform hand hygiene and put on PPE, if indicated.

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