Module 6 Blueprint

Purpose of Cardiovascular Assessment

Identify signs of cardiovascular disease or dysfunction, establish baseline cardiac and vascular health, detect early changes that require intervention, monitor effectiveness of treatments

Base of Heart Landmark

2nd ICS (intercostal space)

Apex of Heart Landmark

5th ICS

PMI (Point of Maximal Impulse)

5th ICS, midclavicular line (mitral valve location, apical pulse)

Cardiovascular Assessment - Health History

Comprehensive cardiac and vascular history

Cardiovascular Assessment - Inspection

Visual examination of jugular veins, carotid arteries, anterior chest

Cardiovascular Assessment - Palpation

Carotid arteries (one at a time), apical impulse

Cardiovascular Assessment - Auscultation

Carotid arteries, heart sounds at 5 key areas

Explain procedure to reduce anxiety

Patient Preparation - Reduce patient anxiety by explaining what will happen during the examination

Position patient supine or slightly left lateral

Patient Preparation - Optimal positioning for cardiac auscultation

Ensure privacy (drape appropriately)

Patient Preparation - Maintain patient dignity and comfort during examination

Patient should be relaxed and quiet

Patient Preparation - Necessary for accurate cardiac assessment

Have patient remove clothing from chest area

Patient Preparation - Required for proper inspection and auscultation

Quiet room (minimize noise for auscultation)

Environment Preparation - Essential for hearing heart sounds clearly

Adequate lighting for inspection

Environment Preparation - Necessary to visualize chest wall and assess color/perfusion

Warm room temperature

Environment Preparation - Prevent shivering/vasoconstriction that can affect assessment

Comfortable examination table/bed

Environment Preparation - Ensures patient can relax during examination

Stethoscope (with bell and diaphragm)

Equipment Needed - Primary tool for cardiac auscultation

Watch or clock for pulse timing

Equipment Needed - Required for accurate pulse rate measurement

Good lighting

Equipment Needed - Necessary for visual inspection of chest and extremities

Warm hands

Equipment Needed - Prevents patient discomfort and vasoconstriction during palpation

Chest pain/discomfort

Location, character, radiation (neck, left shoulder, back)

Palpitations

Skipped beats, irregular rhythm

Dyspnea

Shortness of breath (at rest, with exertion, orthopnea)

Cough

Productive or dry

Edema

Location (legs, ankles, sacral)

Nocturia

Frequent nighttime urination (sign of heart failure)

Fatigue

Activity tolerance

Cyanosis

Bluish discoloration

Pallor

Pale skin

Smoking history

Document pack years

Alcohol consumption

Document frequency and amount

Exercise habits

Document activity level and tolerance

Current medications

List all medications patient is taking

Heart problems/disease

Previous cardiac conditions or diagnoses

Heart murmurs

History of abnormal heart sounds

Congenital heart defects

Birth defects affecting heart structure

Rheumatic fever

History of inflammatory disease affecting heart

Hypertension or hypotension

High or low blood pressure history

Diabetes mellitus

History of blood sugar regulation disorder

High cholesterol/hyperlipidemia

Elevated lipid levels

Previous cardiac surgeries or procedures

Past interventions (CABG, stents, valve replacement, etc.)

Health history

First step in cardiovascular assessment sequence

Inspect

Second step: visual examination of cardiovascular structures

Palpate

Third step: tactile examination of cardiovascular structures

Auscultate

Fourth step: listening to cardiovascular sounds

Document

Fifth step: record all findings

Report abnormals

Sixth step: communicate unusual findings to appropriate personnel

Jugular Vein Assessment - Patient Position

30-45 degree angle

Jugular Vein Assessment - Normal Finding

Veins not visibly distended

Jugular Vein Distention Significance

Sign of increased central venous pressure (right heart failure)

Carotid Artery Palpation Safety Rule

Palpate one side at a time (never both simultaneously—can compromise cerebral blood flow)

Carotid Artery Normal Contour

Smooth, rapid upstroke, slower downstroke

Carotid Artery Normal Strength

Moderate and equal bilaterally

Apical Impulse (PMI) Normal Location

5th ICS, midclavicular line (left side)

Apical Impulse (PMI) Normal Size

1 cm × 2 cm

Apical Impulse (PMI) Normal Amplitude

Short, gentle tap

Carotid Artery Auscultation - Stethoscope Piece

Bell (for low-pitched sounds)

Carotid Artery Auscultation - Technique

Apply lightly on patient's neck, have patient hold breath while listening

Carotid Artery Auscultation - Normal Finding

No sound

Bruit

Whooshing sound indicating turbulent flow, possible stenosis

Heart Sound Auscultation - Patient Position

On left side (slightly)

Heart Sound Auscultation - Equipment

Both diaphragm (high-pitched) and bell (low-pitched)

Aortic Area

Right 2nd ICS - Aortic valve

Pulmonic Area

Left 2nd ICS - Pulmonic valve

Erb's Point

Left 3rd ICS - Both semilunar valves

Tricuspid Area

Left lower sternal border, 4th ICS - Tricuspid valve

Mitral (Apical) Area

Left 5th ICS, midclavicular line - Mitral valve

APE To Man Mnemonic

Aortic, Pulmonic, Erb's, Tricuspid, Mitral (order for heart auscultation)

S1 Heart Sound

Closure of mitral and tricuspid valves (beginning of systole), best heard at apex, "Lub"

S2 Heart Sound

Closure of aortic and pulmonic valves (beginning of diastole), best heard at base, "Dub"

Normal Capillary Refill

Less than 3 seconds

Pulse Grading Scale

0 (absent) to 4+ (bounding)

Peripheral Pulses to Assess

Carotid, radial, brachial, femoral, popliteal, posterior tibial, dorsalis pedis

Peripheral Vascular Assessment Rule

Always assess bilaterally and compare side to side

Lower Extremity Peripheral Assessment

Color, hair distribution, lesions, temperature, wound healing, varicose veins, edema

Document Findings of Cardiovascular Assessment - Vital Signs

Heart rate and rhythm, Blood pressure (both arms if indicated)

Document Findings - Inspection

Jugular vein distention (present/absent), Visible apical impulse (present/absent), Skin color (normal, pale, cyanotic)

Document Findings - Palpation

Carotid pulses: bilateral, equal, 2+/4+, regular; Apical impulse: palpable at 5th ICS MCL, 1×2 cm; Peripheral pulses: present, equal bilaterally

Document Findings - Auscultation

Heart sounds: S1 and S2 present, regular rhythm; Rate: beats per minute; Bruits: absent over carotid arteries; Murmurs: absent or describe (location, timing, grade)

Document Findings - Peripheral Vascular

Edema: absent or present (location, pitting/non-pitting, grade); Capillary refill:

Red Flags - When to Notify Healthcare Provider

Chest pain, Bruit over carotid arteries, Pulse

Incivility

Rude or discourteous actions

Horizontal violence

Nurse-to-nurse aggression

Lateral violence

Peer-to-peer bullying

Nurse bullying

Repeated harmful behavior

Professional incivility

Undermining professional conduct

Characteristics of Aggressive Behavior

Violates rights of others, verbal or physical intimidation, communication marked by tension and anger, angry tone, condescending, threatening, focus on "winning at all costs", blocks collaboration and relationship formation

Assertive Response to Disruptive Behavior

Maintain professional demeanor, respond assertively not aggressively, address issue directly with those involved, use clear concise "I" statements, remain calm under pressure

Characteristics of Assertive Nurse

Confident with open body posture and eye contact, shares thoughts/feelings/emotions effectively, works to capacity with or without supervision, asks for help when necessary, gives and accepts compliments, admits mistakes and takes responsibility, remains calm under supervision

Organizational Response to Disruptive Behavior

Seek guidance and support from nurse managers, use appropriate channels (HR, chain of command), report through incident reporting systems, follow facility policies on workplace violence

Workplace Violence Definition

Violent acts (physical assaults, threats) directed at persons at work

Verbal Workplace Violence

Harassing, threatening, yelling, bullying, hostile sarcasm

Physical Workplace Violence

Assaults

Nurse Response to Workplace Violence

Maintain professional demeanor, respond assertively, address issue directly, seek guidance through proper channels, document incidentsRetryClaude can make mistakes. Please double-check responses.

Berlo's Communication Model - Stimulus

Initiates communication