Assessment of circulatory system
• The method for assessment done by:
1. History.
2. Physical assessment.
3. Diagnostic studies.
4. Laboratory Tests.
1. History:
• Demographic Data:
1. Age
2. Sex.
3. Occupation
4. Lifestyle.
• Ask about S&S:
Intermittent claudication:
Muscular pain caused by : decrease blood
supply → increase demand →↑ energy cycle
without nutrient →↑ lactic acid release
→affect nerves ending.
• Chareteristics of this pain:
• If we have occlusion › 50- 75% this pain is present &
increase with exertion.
• If pain persist & become worse at night →that indicate
severe degree of arterial insufficiency.
• Ask about any change in:
1. WT gain or loss.
2. Medication taken.
2. Physical assessment.
• Inspection of skin:
• Inspect skin in color: pale & cool due to decrease blood
flow.
• Cyanosis indicates decrease in O2.
• Gangrene is due to severe ischemia.
• Loss of hair brittle nails, ulcer is due to malnutrition.
• Palpation of peripheral pulses:
• The monitoring of pulses is very important to
determine the presence of peripheral arterial
blood.
• We must have both extremities having the
same pulse result→ the absence of pulse
indicates "Stenosis".
3. Diagnostic studies.
A. Exercise Test( stress Test):
• Used to determine :
– How long patient is able to walk.
– Measuring the ankle systolic blood pressure.
– All persons can walk at least 5 minutes except:
•
•
•
→cardiovascular problem.
→pulmonary problem.
→orthepedic problem.
• B. Duplex ultrasound:
• Used to determine :
– Blood flow.
– The health of blood vessels & tissues.
– The presence of occlusion.
• It doesn’t need a preparation.
C. CT-Scan(computed tomography):
• Used to determine: If there is a blood vessels
change.
• We use contrast agent.
• Patient is exposed to X-rays.
* NI for patient taking contrast agent:
Pre:
1. Ask patient if has allergic to iodine, shellfish, or other
seafood since many contrast media contain iodine.
2. NPO for 4hrs before test.
3. Inform the patient that he/she may experience a
temporary feeling of warmth, flushing of face, unusual
taste (seafood sensation in the mouth when the contrast
is infused).
4. Check creatinin level in blood, to determine kidney
function.
5. Teach patient about S&S of allergy if happen during
procedure, & must tell.
6. Tell patient that after procedure he/she must drink a lot
of water to flush the dye from body
• During:
– Monitor s&s of allergy.
– Monitor s V/S.
– A CT scan usually takes 30 to 60 minutes but could
take up to 2 hours
After ct scan
1. Tell patient that must drink a lot of water to
flush the dye from body
2. Monitor urine output.
3. Give IV fluid as order that help in flushing
D. MRI: Magnetic Resonance Imaging:
Purposes:
To find problems such as Occlusion or aneurysm.
MRI also may be done to provide more
information about a problem seen on an X-ray,
ultrasound scan, or CT scan
Prior to a MRI scan the following questions are asked:
1. Is the client pregnant?
2. Does the client weight move than 260 pounds?
3. Does the client have magnetic metal fragments or
implants
4. Is the client claustrophobic?
5. Does the client have a pacemaker or electronic implant?
6. Can the client be without supplemental oxygen for an
hour?
7. Can the client tolerate the supine position for 20-30
minutes?
8. Can the client lie still for 20-30 minutes?
9. Can the client communicate clearly and understand
verbal communication
E. Contrast phlebographay:
Use contrast media through femoral vein.
- x-ray done.
- used to determine thrombosis.
N.B: Veins are not normally seen in an x-ray.
That is why the special dye is used
F. Angiography:
- used to determine occlusion, aneurysm.
- use contrast media.
G.Lymphangiogram:
Used to determine lymph node: infection,….
We use contrast agent through lymphatic
vessels in each foot.
X-Ray is done after 24hrs.
4 Laboratory Tests:
1. Cholesterol level.
2. Triglyceride.
3. Lipoprotein: LDL, HDL.
* Cholestrol :
It's a waxy like substance that is essential for growth of blood cells .
Cholesterol is found mostly in body cells only 7 % is circulating in
blood .
Cholesterol has 2 sources
Food
It's excreted in bile salt .
Synthessized by liver
Transport of :
Cholesterol is transported in blood by :
LDL : ( 60 – 75 % )
HDL : ( 15 – 35 % )
Types of Lipoproteins :
Lipoproteins are synthesized in liver and small intestine.
1. VLDL: very low density lipoprotein.
It transports triglyceride into capillaries.
2. Low density lipoproteins LDL
Called bad cholesterol.
It's function to deposit cholesterol in and around smooth muscle in
arteries.
3. High density lipoprotein HDL
Called good cholesterol .
It's function is to remove cholesterol from body cells and transport
it to liver for elimination .