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Contents
Health assessment task 2............................................................................................................................2
Nursing assessment.....................................................................................................................................3
History.........................................................................................................................................................3
Smoking...................................................................................................................................................3
Alcohol.....................................................................................................................................................3
Exercise....................................................................................................................................................3
Medications.............................................................................................................................................3
Family history..........................................................................................................................................3
Palpitations..................................................................................................................................................4
History.....................................................................................................................................................4
Family history..........................................................................................................................................5
Position....................................................................................................................................................5
Use of over-the-counter and illicit drugs.................................................................................................5
Psychiatric History...................................................................................................................................5
Physical examination...............................................................................................................................5
ECG..........................................................................................................................................................6
Blood tests...............................................................................................................................................6
Giddiness.....................................................................................................................................................6
Giddiness or vertigo.................................................................................................................................6
Cardiac factors.........................................................................................................................................6
Anti-hypertensive medicines...................................................................................................................7
Patient medical history............................................................................................................................7
Causes of dizziness..................................................................................................................................7
Ear...........................................................................................................................................................7
Thromboembolic factors.........................................................................................................................8
Migraine history......................................................................................................................................8
Psychiatric disorders................................................................................................................................8
Physical exam..........................................................................................................................................8
Electrocardiogram...................................................................................................................................8
Neurological assessment.........................................................................................................................8
Otological assessment.............................................................................................................................9
References.................................................................................................................................................10
Health assessment task 2

Nursing assessment

Assessment is a vital part of nursing care since it is necessary for the provision and
planning of patient care (The Royal Children’s Hospital Melbourne, 2017).

History

Nursing and health care staff should go through current disease, related previous records,
allergies, immunization records, drugs and social and family of a patient. A thorough
cardiovascular history would reveal potential or existing cardiovascular conditions. It is crucial
to obtain the patient‘s past medical history (Christalle et al., 2019, p.4). The health history of the
patient with cardiovascular problems elicits information about the increase in blood cholesterol,
triglycerides, hypertension, and congenital heart disease and heart murmurs. The nurse can ask
questions related to the history of heart disease, serum cholesterol levels, stress and surgeries.
Ask the questions about past hospitalization and the type of care and treatment they received
there.

Smoking
Find out whether your patient has the habit of smoking. Calculate the number of packs consumed
by your patient in a year.

Alcohol
Calculate the alcohol consumption by the patient on a regular or weekly basis.

Exercise
Also, ask about the level of activity and exercise performed by the patient. Obtain the
information about the sort of workout they do.

Medications
Obtain all information about medicines and drug they are taking including beta-blockers,
calcium channel blockers, anticoagulants and aspirin.
Family history
A patient’s family history is a major factor in determining risk for cardiovascular disease.
Investigate any family history of cardiovascular diseases such as hypertension, coronary artery
disease or sudden death of a family member suffering from cardiovascular diseases (Emery et al.,
2018).

Palpitations

Palpitations are a combination of symptoms accompanied by powerful fluttering, pounding or

jumping sensations in the chest region. The majority of palpitations are atrial i.e. nodal, atrial or
ventricular extrasystoles 1 associated with heart rhythm irregularities. The common causes of
palpitations are anxiety. They occur rarely but can cause syncope and sudden death (Brake and
Jones, 2017, ).

Cardiac causes Non-cardiac causes

Atrial fibrillation Caffeine
Autonomic dysfunction Anaemia
Atrial myxoma Cocaine
Atrioventricular tachycardia Alcohol
Premature atrial contractions B-blockers

History
Ask the patient about, frequency and regularity duration, quality, symptoms, precipitating factors
Recent life stressors

Ask the patient about how they first felt the palpitations and frequency and regularity of
palpitations. Palpitation that persists for a longer duration is arrhythmias and palpitation that
remains for a shorter time are premature ventricular contractions. Ventricular arrhythmias,
anxiety and supraventricular arrhythmias cause sustained palpitations.

Also, inquire about

 Type of activity patient was involved in when they experienced palpitations.

  The place of the patient
 The timing of palpitation

Family history
Cardiac causes are determined by genetics, which indicates that a family history of cardiac
disorders has significant value in causing palpitations.

Psychiatric causes should be assessed by asking the patient about the history of anxiety disorders
and panic attacks.

Position
Patients with palpitations caused by atrioventricular nodal reentrant tachycardia can find that
standing up after bending over triggers their symptoms. When lying in bed, they can notice
symptoms. Supraventricular tachycardia (SVT) or ventricular pacing complexes (VPCs) are the
most common causes of this.

Use of over-the-counter and illicit drugs

Supplements, polyunsaturated fatty acids, carnitine and decongestants can induce palpitations.

Cocaine, Marijuana and methamphetamine also cause palpitations.

Psychiatric History
Anxiety is the most common non-cardiac cause of palpitations. Patients with psychological
issues have a disability, engage in hypochondria-like behaviour, and may suffer from
somatization disorder.

Physical examination
Auscultation can reveal the sequence of arrhythmia, which can assist in detecting the cause.
Atrial fibrillation is specified by an irregular rhythm with no continuous line. A cannon is a
weapon that is used to fire in ventricular tachycardia, a wave can be seen while looking for a
jugular venous pulse. The most common structural heart disease that causes palpitations is mitral
valve prolapse. The existence of a holosystolic murmur or a midsystolic tap may indicate this.
Cardiomyopathy should be regarded as the root issue if the murmur is especially loud. Atrial
septal defects, pulmonary stenosis, atrial septal defects, and bicuspid aortic valve are all
examples of this. (Gale and Camm, 2016).

In palpitation, nurses palpitate the peripheral arteries that include femoral, popliteal, dorsalis
pedis, posterior tibial and brachial artery.

Inspection of the chest for pulsation and auscultation of areas to hear the S1 and S2 sounds are
also performed in circulatory assessment (Muntner et al., 2019). Examine the following:

 Carotid artery
 Palpate the jugular veins,
 Precordium
 Cardiac borders
 Listen to heart sound in a Z pattern
 Recognize S1 and S 2 patterns
 Feel the dorsalis pedis, femoral, popliteal, brachial, posterior tibial and radial pulses
(Muntner et al., 2019, p.47).

ECG
Inpatient with palpitations, 12 lead ECG is required. Polymorphic ventricular tachycardia is
indicated by a long QT interval. Tachycardia is indicated by a short PR interval/delta wave. T
wave defects and non-specific ST-segment changes can be important factors for CVDs.

Blood tests
To rule out renal disease, electrolyte or thyroid disorders, a full blood count, blood urea nitrogen, serum
creatinine, anaemia, and electrolyte levels, as well as thyroid function tests, should be performed.

Giddiness

It is the sensation of fainting, blacking out or feeling lightheadedness.

Giddiness or vertigo
It is necessary to distinguish between giddiness and vertigo. There should be a question asked
about the sense of rotation that demonstrates vertigo.
If the patient is feeling giddy and has no sense of rotation then there are some important factors
to take into account.

Cardiac factors
Giddiness is frequently caused by orthostatic hypertension. Its common causes are arrhythmias,
shock and autonomic neuropathy. The sympathetic system does not give an adequate response to
change in posture and this causes fainting while trying to stand up. Pallor which is also
experienced by patients cans initiates pre-scope.

Giddiness can be caused by tachyarrhythmias like atrial fibrillations and supraventricular

tachycardia as well as by bradyarrhythmias, breathlessness, palpitations or chest pain can
indicate a cardiovascular trigger for syncope. Pulmonary embolism, myocardial infarction and
acute coronary syndrome can cause extreme faintness and giddiness.

Anti-hypertensive medicines
Prazosin is a drug that causes hypotension. Patients are warned not to try to stand up after
consuming alpha-blockers.

Patient medical history

Questions about consciousness level and breathing system are the first steps in taking a medical
history. Inquire about the type and severity of symptoms. To build an immediate clinical
understanding of the problem, history should address the following concerns. Was the patient
was conscious and what was the pattern of breathing and circulation at that time? Hypotension
and hypoxia ate major causes of dizziness. A metabolic disorder, acute stroke and hypoglycemia
can affect consciousness level and causes unconsciousness. The neck and head region should be
checked and treated quickly to lessen the damage.

Causes of dizziness
Ask the patient about the causes, the time it happens, duration of time and its frequency. Asking
only about the form of giddiness(sway or rotational vertigo) is insufficient. Stimuli like postural
adjustments (arm movements, stress response, standing up or turning neck) should be
investigated. A positional vestibular syndrome is a condition in which giddiness occurs due to
posture adjustment.
Ear
History should consist of question and investigations related to hearing loss, tinnitus and upper
respiratory tract infections. This is due to the close connection between the connection between
eight cranial nerve and the ear.giddinessis caused by otitis media which is also associated with
pain in the ear. Investigate the use of a drug such as aminoglycosides which is linked to hearing
loss.

Thromboembolic factors
Questions related to the history of hypertension, hypoglycemia, smoking, hypercholesteremia
and diabetes should be asked.

Migraine history
There is no double vision observed in patients with giddiness but a patient can experience
disturbances in vision. Concomitant double vision may suggest telencephalic mass lesions or
upper brain stem lesions, so questions about it should be asked.

Psychiatric disorders
Non-specific giddiness is caused by psychiatric disorders. Sweating, lightheadedness and
tachycardia are some indications of a panic attack.

Physical exam
Vital sign assessment includes breathing, airway, impairment determining neurological status
and environmental assessment. Hypervolemia follows dizziness, so the test should be conducted
on volume status. Test for vestibular etiologies such as the Dix-Halllpike manoeuvre should be
considered.

Aortic valve stenosis is confirmed by murmurs on heart auscultation. Subclavian and carotid
artery stenosis is indicated by subclavian or carotid artery auscultation. The carotid stenosis
alone does not cause dizziness.

Gastrointestinal bleeding will be identified by rectal examination (anaemia presence).

Electrocardiogram
It should be performed after physical examination to diagnose heart rhythm irregularities.
Neurological assessment
Observing the visual field abnormalities, cerebellar symptoms (ataxia, gait, dysmetria, irregular
Romberg test, and measuring sensation in the upper and lower extremities), examining the
cranial nerves, searching for Horner's syndrome are done in neurological assessment.

Otological assessment
A hearing test, examination of the ear drum, ear canal and mastoid are done. The mastoid is
palpated, mastoiditis symptoms should be observed.

Besides eye movement (HINTs examination), laboratory analysis and diagnostic neuroimaging
are also done (Gowan and Ruler, 2018).

The patient is suffering from heart disease that is cardiac arrhythmias in which he feels
palpitations and lightheadedness. The patient has undergone heart surgery which states that the
patient was already suffering from heart disease. Above mentioned techniques are best to assess
the health status of the patient as it covers all physical, physiological and phycological aspects of
this diseases. Also, they are helpful to categorize different tpe of heart rate irregularities like
bradycardia and tachycardia.

The nurse observes the vital signs of patients: blood pressure, temperature, and glucose level and
pulse rate. She inquires about the history, time and duration of heart palpitation and giddiness,
food intake, alcohol intake, medications, physiotherapy and pain. She observed the skin soars or
rashes on the patient’s body. She also asks about the patient family: whether he is living alone or
with his family. The nurse is communicating in a very friendly manner. She also questions about
physiotherapy. Problems with sensation, tightness or swelling in feet, sit forwards, use of
antibiotics and throat swallowing are also discussed in communication between nurse and
patient.

She also inquires whether lightheadedness makes him sick and also other associated symptoms
like sweating. She also did a cardiovascular assessment in which she obtains information about
any heart disorder. She also asses the consciousness level. She asks the patient about medications
he had used in the past and after heart surgery. She asks the patient to bend his index finger and
to squeeze his index fingers. She heard the chest sound by placing a stethoscope at the front and
back in the chest region. She also performs ECG.
As an entry-level nurse, I would examine the history of the patient and would implement the
physical, physiological and psychological assessment. Vital signs examination is essential. How
nurse is communicating is excellent and I would also like to adopt soft communications skills. I
would also like to use a focused history assessment. The nurse would have provided education
about the heart palpitation and giddiness problem. The nurse did not consider the psychological
issues and has not recommended diet modification for the patient. High salt intake can induce
palpitations. The nurse has not documented all the observations. The nurse did not question
about kidney system (Carmody, Asaly & Blackstock, 2016, ). I would do these practices to
patients instead of ignoring them.
References

1. Assessment of patient information needs(2019).: A systematic review of measures. PloS

one, 14(1), e0209165. https://doi.org/10.1371/0209165

2. Brake, R., & Jones, I. D. (2017). Chronic heart failure part 1: pathophysiology, signs and

symptoms. Nursing Standard (2014+), 31(19), 54. https://doi.org/7748/ns.2017.e10349

3. Carmody, K., Asaly, M., & Blackstock, U. (2016). Point of care echocardiography in an

acute thoracic dissection with tamponade in a young man with chest pain, tachycardia,

and fever. The Journal of emergency medicine, 51(5), e123-e126.

https://doi.org/10.1016/j.jemermed.2016.06.046

4. Christalle, E., Zill, J. M., Frerichs, W., Härter, M., Nestoriuc, Y., Dirmaier, J., & Scholl,

I. Examination to Early Program Performance. Journal of Nursing Education, 57(10),

578-583. https://doi.org/10.3928/01484834-20180921-02

5. Dunham, M., & MacInnes, J. (2018). Relationship of Multiple Attempts on an

Admissions Examination to Early Program Performance. Journal of Nursing

Education, 57(10), 578 583. https://doi.org/10.3928/01484834-20180921-02

6. Emery, C. F., Stoney, C. M., Thayer, J. F., Williams, D., & Bodine, A. (2018). Sex and

family history of cardiovascular disease influence heart rate variability during stress

among healthy adults. Journal of psychosomatic research, 110, 54-60.

https://doi.org/10.1016/j.jpsychores.2018.04.011

7. Gale, C. P., & Camm, A. J. (2016). Assessment of palpitations. bmj, 352.

https://doi.org/10.1136/bmj.h5649 
8. Gowan, J., & Roller, L. (2018). Disease state management-Dizziness, vertigo, or

giddiness: assisting patients. AJP: The Australian Journal of Pharmacy, 99(1170), 60-67.

https://doi.org/10.3316/informit.439619081901433

9. history of cardiovascular disease influence heart rate variability during stress among

healthy adults. Journal of psychosomatic research, 110, 54-60.

https://doi.org/10.1016/2018.04.011

10. J. T. (2019). Measurement of blood pressure in humans: a scientific statement from the

American Heart Association. Hypertension, 73(5), e35-e66.

https://doi.org/10.1161/HYP.0000000000000087

11. Muntner, P., Shimbo, D., Carey, R. M., Charleston, J. B., Gaillard, T., Misra, S., ... &

Wright Jr, J. T. (2019). Measurement of blood pressure in humans: a scientific statement

from the American Heart Association. Hypertension, 73(5), e35-e66.

https://doi.org/10.1161/HYP.0000000000000087

12. The Royal Children’s Hospital Melbourne. (2017). Clinical Guidelines (Nursing).

thoracic dissection with tamponade in a young man with chest pain, tachycardia, and

fever. The Journal of emergency medicine, 51(5), e123-e126.

https://doi.org/10.1016/j.jemermed.2016.06.046/