Cardiac Assessment In Nursing – Nursology101

Cardiovascular Assessment: Introduction

My previous cardiac related articles discussed blood flow through the four heart chambers, the hearts conduction system as well as ECG interpretations. In this article, however, I will dive in more into the cardiac physical assessment. The cardiac assessment includes inspection, palpation, and auscultation of heart sounds.

Remember you must also review your patients vital signs to see if they appear stable along with your patients level of consciousness. If your patient appears restless or drowsy, it may be a sign of hypoxia.

Inspect your patients skin color for cyanosis or pallor. Cyanosis will present as a bluish color and pallor as a loss of color with a paleness due to reduced blood flow. You can also look for jugular vein distention or JVD. JVD is when there is an increased pressure in the superior vena cava, which causes the jugular vein to bulge. This should not be present in a patient in an upright position or 35-40 degrees. Inspect your patients chest area for any abnormalities, deformities, or pulsations.

During palpation, you will have your patient in a 3045-degree angle and then palpate your patients precordium. You will palpate the apical pulse 4th/5th intercostal space, midclavicular line. Thrills can also be palpated as well which are vibrations that can be felt which are associated with heart murmurs (see video below). You also palpate the carotid arteries (one side at a time) and peripheral pulses. Pulses are graded with +2 meaning normal pulsation (see below).

You will also assess the extremities for capillary refill and edema. When checking for capillary refill, pressure is placed on the fingernail or toenail until it becomes pale. Once it becomes pale, the pressure is removed, and you look for when the nailbed becomes pink again. Normal capillary refill should be 2-3 seconds.

How to check for capillary refill

Image from brainstudy.info

When assessing edema, press on the skin to assess the indentation. If there is indentation, then the patient is noted to have pitting edema. See below for grading edema:

Auscultation of the heart is actually performed over 5 specific areas on the chest that corresponds to sounds produced by the heart valves.

See below:

Auscultation takes place at those 5 main areas in the picture to the left. You can use the pneumonic All People Enjoy Time Magazine to remember the 5 points which are Aortic, Pulmonic, Erbs point, Tricuspid and Mitral.

Image from Medicine eStudy.

There are different heart sounds you may hear when auscultating. Normal heart sounds include hearing S1 and S2 or lub dub. S1 is when the AV valves close and systole begins with contraction of the ventricles. S2 represents the closing of the semilunar valves (aortic valve and pulmonary valve).

There are extra heart sounds you may hear such as S3 and S4. S3 is usually heard after the S2. S4 is heard right before S1. You may also hear murmurs which I describe as a whooshing sound. When it comes to auscultation and interpreting different heart sounds, you must watch visuals and practice as well.

See below video that I found that breaks this down very well (make sure your volume is up to hear the sounds):

I hope this summary of the cardiac assessment is helpful. In my opinion, it is easier to understand and master the cardiac assessment by visuals and practice. Feel free to reach out to me if there is anything I have not touched on but want me to go over.

ECG Basics and Rhythm Review: AV Blocks & Pacer Rhythms

ECG Basics and Rhythm Review: Junctional Rhythms

ECG Basics and Rhythm Review: Sinus Rhythms and Sinus Arrest

The 4 Heart Chambers and Blood Flow

The Hearts Electrical System

Read the rest here:
Cardiac Assessment In Nursing - Nursology101