Nursing Cardiovascular Assessment: Perfusion, Pulses, Edema & Heart Sounds

What is perfusion?

The passage of fluid through blood vessels to organs and tissues.

What is the purpose of perfusion?

Deliver oxygen and nutrients and remove carbon dioxide and metabolic waste.

What is the function of the heart?

Pumps blood throughout the body.

What does the arterial system carry?

Oxygen-rich blood.

What is the function of capillaries?

Exchange oxygen, carbon dioxide, nutrients, and waste.

What does the venous system carry?

Deoxygenated blood back toward the heart.

What is the function of the lymphatic system?

Collects excess tissue fluid and returns it to the bloodstream.

What are the components of blood?

Red blood cells, white blood cells, platelets, and plasma.

What are the functions of blood?

Transport substances, regulate temperature/pH/fluid volume, prevent infection and blood loss.

What does OLDCARTS assess?

Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, Timing, Severity.

What cardiac symptoms belong in the health history?

Chest pain, dyspnea, orthopnea, cough, fatigue, cyanosis, pallor, edema, nocturia.

What peripheral vascular/lymphatic symptoms belong in the health history?

Leg pain or cramps, skin changes, limb swelling, enlarged lymph nodes.

What should be asked about during a cardiovascular health history?

Medical/surgical history, medications, family history, risk factors, and smoking.

What are the four main parts of the cardiovascular physical exam?

Pulse and BP, extremities, neck vessels, and precordium.

What should be inspected on the extremities?

Skin color, nail beds, temperature, texture, turgor, hair distribution, and symmetry.

What is a normal peripheral pulse grade?

2+.

What does a 3+ pulse indicate?

Increased, full, or bounding pulse.

What does a 1+ pulse indicate?

Weak pulse.

What does a 0 pulse indicate?

Absent pulse.

What is normal capillary refill?

Color returns in less than 1-2 seconds.

What is the purpose of the modified Allen's test?

Assess collateral circulation before radial artery cannulation.

What is a positive modified Allen's test?

Blood flow returns quickly after release.

What is a negative modified Allen's test?

Blood flow takes longer than 15 seconds to return.

How is edema assessed?

Press firmly on the skin for 5 seconds, release, and assess for indentation.

What is normal edema assessment?

No indentation.

What does 1+ pitting edema indicate?

Mild pitting with slight indentation and no perceptible leg swelling.

What does 2+ pitting edema indicate?

Moderate pitting; indentation subsides rapidly.

What does 3+ pitting edema indicate?

Deep pitting; indentation remains briefly and the leg looks swollen.

What does 4+ pitting edema indicate?

Very deep, persistent indentation with a grossly swollen, distorted leg.

How should varicosities be assessed?

Inspect visible, tortuous veins with the patient standing.

What does Buerger's test assess?

Arterial sufficiency through lower-extremity color changes.

What is expected during Buerger's test?

Color returns within 10 seconds when the legs are dependent.

What lymph node characteristics should be assessed?

Size, consistency, mobility, warmth, and tenderness.

What are normal palpable lymph node findings?

Small, nontender, and movable.

How is the carotid artery palpated?

Medial to the sternocleidomastoid, one side at a time.

Why should carotid arteries be palpated one at a time?

Excessive pressure can stimulate the vagus nerve and decrease heart rate and blood pressure.

What is a carotid bruit?

A sound caused by turbulent blood flow.

What does the jugular vein reflect?

Fluid status and right-sided heart function.

What can unilateral jugular vein distention suggest?

Venous flow obstruction.

What can bilateral jugular vein distention suggest?

Heart failure or fluid overload.

Where is the apical impulse normally located?

At the fifth intercostal space, at or inside the midclavicular line.

What causes the apical impulse?

The left ventricle pulsating against the chest wall during systole.

What should normally be felt when palpating across the precordium?

No additional pulsations.

What should be assessed during heart auscultation?

Rate, rhythm, S1, S2, extra heart sounds, and murmurs.

What causes S1 (LUB)?

Closure of the atrioventricular valves; beginning of systole.

Where is S1 loudest?

At the apex.

What causes S2 (DUB)?

Closure of the semilunar valves; beginning of diastole.

Where is S2 loudest?

At the base.

What is a heart murmur?

A whooshing sound caused by turbulent blood flow through the heart.

What causes a heart murmur?

Valve stenosis or valve regurgitation can cause turbulent flow.

What is an S3 heart sound?

A ventricular gallop associated with rapid ventricular filling; occurs after S2.

Where is S3 best heard?

At the apex with the patient in the left lateral position.

What is an S4 heart sound associated with?

Hypertension or a valve problem.

What is a heave?

A sustained, forceful thrust of the ventricle during systole; associated with ventricular hypertrophy.

What is a thrill?

A palpable vibration associated with turbulent blood flow and high-grade murmurs.

What are common findings of coronary artery disease?

Chest pain/pressure, diaphoresis, pallor, dyspnea, tachycardia, nausea/vomiting, and activity-related symptoms.

What are common findings of heart failure?

Dyspnea, orthopnea, tachypnea, cough/frothy sputum, crackles, fatigue, edema, JVD, S3, enlarged liver/spleen, and decreased urine output.

What is arteriosclerosis?

Thickening and stiffening of blood vessels.

What is atherosclerosis?

Abnormal accumulation of lipid deposits and fibrous tissue in arteries.

What is a carotid bruit associated with?

Turbulent blood flow; may indicate carotid disease.

What are the Six P's of acute arterial insufficiency?

Pain, Pallor, Pulselessness, Paresthesia, Poikilothermia, Paralysis.

What causes acute arterial insufficiency?

Decreased or absent blood flow, potentially from a clot, trauma, or a post-procedure complication.

What are common findings of deep vein thrombosis (DVT)?

Unilateral leg swelling, tenderness or severe pain, warmth, and redness.

What are risk factors for DVT in the slides?

Prolonged immobility, varicose veins, trauma, infection, malignancy, obesity, and hormones.

How is DVT evaluated according to the slides?

Ultrasound imaging.

What are abnormal lymph node findings?

Enlarged, palpable, tender, immovable nodes or painful red streaks.

What conditions may cause abnormal lymph nodes?

Infection, malignancy, or systemic disease.

What questions help assess abnormal lymph nodes?

Unilateral or bilateral, duration, fluctuance, and other symptoms.

What are chronic venous disease skin findings?

Warm skin, thickening, hyperpigmentation, and a spotty appearance.

What is the typical pain of chronic venous disease?

Aching or cramping, regardless of activity.

What are typical chronic venous pulses?

Pulses are generally present.

What is common in chronic venous disease?

Edema.

Where are chronic venous ulcers commonly located?

Around the malleolus.

What are typical chronic venous ulcer findings?

Moderately painful ulcers with a pink base.

What are chronic arterial disease skin findings?

Cool skin that is hairless and shiny; Buerger's test may be positive and ABI low.

What is the typical pain of chronic arterial disease?

Sharp or stabbing pain that increases with activity and decreases when the limb is lowered.

What is claudication?

Activity-related limb pain associated with inadequate arterial blood flow.

What happens to pulses in chronic arterial disease?

Pulses may be absent or diminished.

What happens to capillary refill in chronic arterial disease?

Capillary refill is decreased or delayed.

Is edema common in chronic arterial disease?

No, it is not common.

Where are chronic arterial ulcers commonly located?

Toes, heels, and dorsum of the foot.

What are typical chronic arterial ulcer findings?

Severely painful ulcers with a pale or gray base.

How do chronic venous and arterial ulcers differ?

Venous: pink base, moderately painful, often near malleolus. Arterial: pale/gray base, severely painful, toes/heels/foot.

What are cardiac health promotion measures?

Avoid tobacco, exercise 30-60 minutes daily, eat a heart-healthy diet, maintain healthy weight, manage stress, screen BP/cholesterol/diabetes, vaccinate, and take medications.

What promotes peripheral vascular health?

Avoid tobacco, exercise, eat a heart-healthy diet, maintain healthy weight, manage stress, get screenings/vaccinations, take medications, and care for skin.

What promotes lymphatic health?

Exercise, avoid prolonged immobility, stay hydrated, obtain breast/testicular screening, vaccinate, and maintain good nutrition.

What changes may occur in the cardiovascular system with aging?

Higher systolic BP, possible irregular rhythms, abnormal heart sounds/murmurs, and need for caution during carotid assessment.

What cardiac history is important in infants?

Maternal health during pregnancy, fatigue during feeding, expected growth, and activity.

What is important when assessing an infant's apical pulse?

Expected location is the fourth intercostal space, left of the midclavicular line.

What changes may occur in pregnancy during cardiac assessment?

Heart rate increases, blood pressure decreases, and weight gain/swelling may occur.

What peripheral vascular changes may occur with aging?

Systemic arteriosclerosis/atherosclerosis, decreased peripheral pulses, and skin changes.

What does HEENT stand for?

Head, Eyes, Ears, Nose, and Throat.

What does OLDCARTS assess?

Onset, Location, Duration, Characteristics, Precipitating factors, Associated factors, Relieving factors, Timing/Pattern, and Severity.

What head and neck symptoms should be assessed?

Headache, head injury, dizziness, neck pain or limited motion, lumps, swelling, and prior surgery.

What nose symptoms should be assessed?

Discharge, frequent colds, sinus pain, trauma, nosebleeds, allergies, and altered smell.

What mouth and throat symptoms should be assessed?

Sores, sore throat, bleeding gums, toothache, hoarseness, dysphagia, altered taste, and sleep apnea.

What additional HEENT history is important?

Chronic conditions, allergies, radiation, occupational risks, UV exposure, tobacco use, and safety practices.

What eye symptoms should be assessed?

Vision changes, pain, strabismus, diplopia, redness, swelling, watering, discharge, glaucoma, and corrective lenses.

What ear symptoms should be assessed?

Earache, infections, discharge, hearing loss, noise exposure, tinnitus, and vertigo.

What are normal head and face findings?

Normocephalic, smooth head, no tenderness, and facial symmetry.