UNIVERSITY OF THE BAHAMAS

School of Nursing and Allied Health Professions

NURS228 Adult Nursing I Lecture

Chapter 26

Assessment of
Cardiovascular Function

Shamel Y. Sands RN, MSN, CM

Assistant Professor, SNAHP, UB
OBJECTIVES

Review the A & P the cardiovascular system.

Review the cardiac conduction system.
Discuss:
- Areas of assessment relevant to the cardiovascular system.
- Common signs and symptoms associated with disorders of the
cardiovascular system.
- Health promotion/preventative measures relevant to disorders of the
cardiovascular system.
- Diagnostics relevant to the cardiovascular system.
Overview of Anatomy and Physiology - Heart

• Three layers
• Endocardium
• Myocardium
• Epicardium
• Four chambers
• Heart valves
Overview of Anatomy and Physiology – Heart
(cont’d)
• Coronary arteries
• Cardiac conduction system
• Cardiac hemodynamics
Structure of the Heart
Cardiac Conduction System
Terms - Cardiac Action Potential

• Depolarization: electrical activation of cell caused by influx of sodium

into cell while potassium exits cell
• Repolarization: return of cell to resting state caused by re-entry of
potassium into cell while sodium exits
• Refractory periods
• Effective refractory period: phase in which cells are incapable of depolarizing
• Relative refractory period: phase in which cells require stronger-than-normal
stimulus to depolarize
Cardiac Action Potential
Terms - Cardiac Output

• Stroke volume: amount of blood ejected with each heartbeat

• Cardiac output: amount of blood pumped by ventricle in liters per
minute
• Preload: degree of stretch of cardiac muscle fibers at end of diastole
• Contractility: ability of cardiac muscle to shorten in response to
electrical impulse
Terms - Cardiac Output (cont’d)

• After load: resistance to ejection of blood from ventricle

• Ejection fraction: percent of end diastolic volume ejected with each
heart beat
 CO = SV x HR

• Control of heart rate

• Autonomic nervous system, baroreceptors
• Control of strike volume
• Preload: Frank-Starling Law
• After load: affected by systemic vascular resistance, pulmonary vascular resistance
• Contractility increased by catecholamines, SNS, some medications
• Decreased by hypoxemia, acidosis, some medications
Assessment

• Health history
• Demographic information
• Family/genetic history
• Cultural/social factors
• Risk factors
• Modifiable
• Nonmodifiable
Most Common Clinical Manifestations

• Chest pain
• Dyspnea
• Peripheral edema, weight gain
• Fatigue
• Dizziness, syncope, changes in level of consciousness
Assessment

• Medications • Self-perception, self-concept

• Nutrition • Roles, relationships
• Elimination • Sexuality, reproduction
• Activity, exercise • Coping, stress tolerance
• Sleep, rest • Prevention strategies
Health Promotion, Perception, and
Management Questions
• Ask regarding health promotion, preventive practices
• What type of health issues do you have? Are you able to identify any family
history or behaviors that put you at risk of this health problem?
• What are your risk factors for heart disease? What do you do to stay healthy?
• How is your health? Have you noticed any changes?
Health Promotion, Perception, and
Management Questions (cont’d)
• Ask regarding health promotion, preventive practices
• Do you have a cardiologist or primary health care provider? How often do
you go for check-ups?
• Do you use tobacco or alcohol?
• What medications do you take?
Laboratory Tests

• Cardiac biomarkers
• CK, CK-MB
• Myoglobin
• Troponin T and I
• Lipid profile
• Brain (B-type) natriuretic peptide
• C-reactive protein
• Homocysteine
Electrocardiography

• 12 lead ECG
• Continuous monitoring: hardwire, telemetry
• Signal-averaged electrocardiogram
• Continuous ambulatory monitoring
• Transtelephonic monitoring
• Wireless mobile monitoring
Electrocardiography (cont’d)

• Cardiac stress testing

• Exercise stress testing
• Pharmacologic stress testing
Diagnostic Tests

• Radionuclide imaging
• Myocardial perfusion imaging
• Test of ventricular function, wall motion
• Computed tomography
• Positron emission tomography
• Magnetic resonance angiography
Cardiac Catherization

• Invasive procedure study used to measure cardiac chamber

pressures, assess patency of coronary arteries
• Requires ECG, hemodynamic monitoring; emergency equipment
must be available
• Assessment prior to test; allergies, blood work
• Assessment of patient postprocedure; circulation, potential for
bleeding, potential for dysrhythmias
• Activity restrictions
• Patient education pre-, postprocedure
Hemodynamic Monitoring

• CVP
• Pulmonary artery pressure
• Intra-arterial BP monitoring
REFERENCE

Smelter, S. C., Bare, B. G., Hinkle, J. L. & Cheever, K. H.

(2014). Brunner & Suddarth's textbook of medical-surgical
nursing (Edition 13.). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins.