Week 5 NR 302

NR302 - Health Assessment 1: Week 5 - Cardiovascular Assessment

Weekly Outcomes

  • Perform the basic physical assessment techniques to assess the cardiovascular system.
  • Differentiate between normal and abnormal assessment findings for the cardiovascular system.
  • Explore the normal physiological effects of aging on the cardiovascular system.
  • Associate health history findings, environmental, and developmental factors on the cardiovascular system.
  • Identify assessment-based educational opportunities to promote health of the cardiovascular system.
  • Document cardiovascular system assessment findings using appropriate terminology and technology.

Weekly Objectives

  • Describe the steps of completing the cardiovascular assessment.
  • Discuss the appropriate nursing techniques used in completing the cardiovascular assessment.
  • Consider cultural, spiritual, and nutritional considerations when completing the health history and assessment.

Cardiovascular Health Influences

  • Discussion Points:
    • Diet and Nutrition Habits: Explore how food choices impact cardiovascular health.
    • Medication Adherence and Access: Consider the importance of following prescribed treatments.
    • Chronic Stress and Emotional Health: Link emotional well-being to heart health.
    • Sedentary Lifestyle: Assess the effects of inactivity on cardiovascular function.
    • Financial, Housing, or Insurance Barriers: Analyze socio-economic factors affecting health access.
    • Family History/Genetics: Investigate hereditary influences on cardiovascular diseases.
    • Cultural or Spiritual Beliefs: Discuss how these beliefs shape health practices and perceptions of illness.

Anatomy and Physiology Refresher

  • Key Components of the Cardiovascular System:
    • Heart Chambers: Right atrium, right ventricle, left atrium, left ventricle.
    • Valves: Tricuspid valve, mitral valve, aortic valve, pulmonic valve.
    • Blood Flow Pathways: Systemic and pulmonary circulation.
    • Electrical Conduction System: Components include SA node, AV node, bundle of His, Purkinje fibers.
    • Major Arteries and Veins: Aorta, vena cavae, pulmonary arteries, pulmonary veins.

Physical Assessment Techniques

  • Inspection:
    • Observing chest movements, skin color, and jugular vein distention.
  • Palpation:
    • Assessing pulses, thrills, and heaves.
  • Auscultation:
    • Listening to heart sounds: S1 (first heart sound), S2 (second heart sound), murmurs.

Heart Sounds Locations

  • Aortic: Right second intercostal space.
  • Pulmonic: Left second intercostal space.
  • Erb's Point: Left third intercostal space.
  • Tricuspid: Left fourth intercostal space.
  • Mitral (Apical Pulse): Left fifth intercostal space at midclavicular line.
    • Heart Sound Mnemonic: "A PET Monkey," representing Aortic, Pulmonic, Erb's point, Tricuspid, Mitral locations.
  • Point of Maximal Intensity (PMI): Typically located at the apex of the heart.

Normal vs. Abnormal Findings

  • Characteristics of Normal Heart Sounds and Rhythms:
    • S1: Closure of the mitral & tricuspid valves at the start of systole.
    • S2: Closure of aortic & pulmonic valves at the end of systole.
  • Common Abnormalities:
    • Murmurs: Abnormal heart sounds due to turbulent blood flow.
    • Bruits: Abnormal sound indicating turbulent blood flow in arteries.
    • Arrhythmias: Irregular heartbeat rhythms.
  • Heart Sound Visualization:
    • "LUB-DUB": Represents the normal heart sounds during systole and diastole.

Aging and Cardiovascular Changes

  • Structural Changes:
    • Arterial Stiffening: Loss of elasticity in blood vessels.
    • Myocardial Thickening: Increased thickness of heart muscle walls.
  • Functional Changes:
    • Decreased Cardiac Output: Overall reduction in the heart's ability to pump blood.
    • Increased Systolic Blood Pressure (BP): Often seen with aging due to stiff arteries.
  • Key Terms:
    • Heart Rate (beats/min): Number of times the heart beats in a minute.
    • Cardiac Output (ml/min): Volume of blood the heart pumps per minute.
    • Stroke Volume (ml/beat): Amount of blood pumped by the heart in one contraction.
  • Additional Influencing Factors:
    • Nerves, hormones, blood volume, vascular resistance.

Health History and Environment

  • Key Questions for Patient Interviews:
    • Focus on gathering lifestyle, environmental, and developmental cues in cardiovascular health.
  • Open-ended Questions Examples:
    • Encourage patients to discuss their health challenges and concerns comprehensively.

Health Promotion and Patient Strategies

  • Educational Strategies for lifestyle modifications:
    • 7 Steps to a Healthier Heart:
    • Avoid Smoking
    • Move Your Body: Regular physical activity
    • Improve Your Diet: Focus on heart-healthy choices
    • Get to a Healthy Weight
    • Maintain Healthy Cholesterol, Blood Pressure/Sugar
    • Lower Stress Levels
    • Practice Good Hygiene

Documentation Practices

  • Importance of Standardized Terminology:
    • Ensure clear and precise communication in electronic health records (EHR).
  • Utilization of Electronic Health Records:
    • Document findings concisely and accurately for continuity of care.

Mini Case Study: Mr. Howard James

  • Patient Profile:
    • Name: Howard James
    • Age: 66
    • Height: 5'10"
    • Weight: 228 lbs
    • Chief Complaint: Reports heaviness in legs when walking, shortness of breath when climbing stairs.
    • Notable Symptoms:
    • Fatigue climbing stairs
    • Ankle swelling noted at night
    • Family history of heart disease
    • Reports of shortness of breath when laying on the side
Health History Notes:
  • History:
    • Former smoker, diagnosed with hypertension.
    • Sedentary lifestyle, high sodium intake from carrying out food.
Nurse Assessment:
  • Inspection:
    • No visible chest deformities.
  • Palpation:
    • Apical impulse located at 5th ICS, midclavicular line.
    • No thrills or heaves noted.
    • Pulses:
    • Jugular veins flat at 45° angle.
    • Radial pulse: +2 bilaterally.
    • Slight bilateral pedal edema: +1
    • Dorsalis Pedis Pulse: Diminished +1 bilaterally.
    • Auscultation:
    • Regular rate and rhythm, S1 and S2 audible, no murmurs, rubs, or gallops.
    • BP: 148/92 mmHg, HR: 88 bpm, RR: 20 breaths/min, Temp: 98.4°F, SpO2: 96% on room air.

Example - EMR-Style Cardiovascular Documentation

  • Patient: James, Howard
  • Age: 66
  • Date/Time: 06/05/2025 - 1100 CST
  • Nurse: S. Adams, BSN Student Nurse
  • Subjective Findings:
    • Reports bilateral leg heaviness and fatigue, particularly when ambulating.
    • History of hypertension and prior tobacco use; diet high in sodium with no regular exercise.
  • Objective Findings:
    • Vital Signs:
    • BP: 148/92, HR: 88 bpm regular, RR: 20, Temp: 98.4°F, SpO2: 96% RA
    • Inspection Findings:
    • No chest deformities; flat jugular veins; mild bilateral pedal edema.
    • Palpation:
    • Apical impulse at 5th ICS midclavicular line; no lifts/thrills; radial pulses +2 bilaterally.
    • Auscultation:
    • Regular S1/S2 noted; no murmurs or gallops.
    • Skin: No cyanosis or pallor.
  • Assessment:
    • Signs of ineffective tissue perfusion related to diminished pulses and activity intolerance.?
  • Plan/Next Steps:
    • Elevate legs, educate on a low-sodium DASH diet, and encourage hydration.
    • Promote daily activity, recommend follow-up for blood pressure management, and discuss daily weight tracking.

Cultural, Spiritual, and Nutritional Considerations

  • Understanding Diverse Backgrounds:
    • Assessing how cultural and spiritual beliefs can impact health perceptions and behaviors.

Scenario - Group Activity: Cardiovascular Education Plan Case Scenario

  • Patient Profile:
    • Name: Robert Jackson
    • Age: 58
    • Ethnicity: African American
    • Occupation: Truck driver
    • Medical History: Hypertension, obesity, family history of stroke.
Clinical Encounter Summary:
  • Current Symptoms:
    • Complains of "chest pressure" and lightheadedness.
    • Adverse feedback on medications and unhealthy eating habits due to lifestyle.
Follow-Up Vital Signs:
  • BP: 158/94
  • HR: 90
  • Weight: 290 lbs
  • BMI: 39
  • SpO2: 97%
  • Lipids: LDL 143, HDL 36

Questions to Address in Care Plan

  1. Identify one modifiable risk factor for education.
  2. Describe a tailored educational strategy for his unique lifestyle.
  3. Identify a spiritual or emotional motivator for behavior change.
  4. Outline documentation in EMR post-education.
  5. Provide a SMART goal for cardiovascular improvement.

Sample Cardiovascular Education Plan

  • Priority Risk Factor Identified:
    • Medication non-adherence due to side effects and irregular lifestyle.
  • Education Strategy:
    • Implement motivational interviewing and provide accessible education materials and management tools.
  • Possible Teaching Tools:
    • Printed guides, mobile app reminders, and role-playing scenarios for medication management.

Key Takeaways

  • Understanding Heart Sounds:
    • Unique identification of normal sounds (S1, S2) and abnormal sounds (murmurs).
  • Effective Documentation:
    • Transformation of subjective health reports into formal, measurable outcomes for records.
  • Holistic Health Imperative:
    • The necessity of considering cultural and spiritual factors in cardiovascular assessments.
  • Education as Nursing Intervention:
    • Leverage every patient interaction as an opportunity for teaching healthy lifestyle habits.
  • SMART Goals for Accountability:
    • Formulating clear, specific, and measurable plans for patient adherence to health outcomes.