Guided Lecture Notes
Chapter 25, Assessment of Cardiovascular Function
Learning Objective 1. Describe the relationship between the anatomic structures and the
physiologic function of the cardiovascular system.
 Review the pattern of blood flow through the body.
 Review the anatomy and function of the structures of the heart. (Refer to
PowerPoint slides 2 and 3, Figure 25-1.)
 Describe the anatomy and function of the coronary arteries.
o Anatomy of the heart
 Heart chambers
 Heart valves
 Atrioventricular valves
 Semilunar valves
 Coronary arteries
 Myocardium
o Function of the heart
 Cardiac electrophysiology
 Cardiac action potential
 Refractory periods
 Cardiac hemodynamics
 Cardiac cycle
 Cardiac output
o Control of heart rate
o Control of stroke volume
 Explain the cardiac conduction system. Trace the pattern of normal impulse
conduction through the heart. Briefly relate this pattern to the ECG tracing. (Refer
to PowerPoint slide 4, Figure 25-3.)
 iClicker question (Refer to PowerPoint slides 5 and 6.)
 Explain the cardiac action potential. Define and discuss the terms listed. (Refer to
PowerPoint slides 7 and 8.)
 Describe the movement of the ions in relation to depolarization and
repolarization. (Refer to PowerPoint slide 9, Figure 25-4.)
 Describe the pressure changes that occur in the vessels and chambers of the heart
with systole and diastole. (Refer to PowerPoint slide 10, Figure 25-2.)
 Define cardiac output and the terms listed. (Refer to PowerPoint slide 11 and
12.)
 Explain the factors that affect cardiac output. (Refer to PowerPoint slides 13 and
14.)
 iClicker question (Refer to PowerPoint slides 15 and 16.)
Learning Objective 2. Incorporate assessment of cardiac risk factors into the health
history and physical assessment of the patient with cardiovascular disease.
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When discussing the assessment of the patient with cardiovascular disease,
mention that the assessment must be modified to the needs of the patient and the
clinical situation.
Describe the health history as it applies to cardiovascular disease.
List and differentiate modifiable and nonmodifiable cardiac risk factors. (Refer to
PowerPoint slide 17.)
Describe the most common clinical manifestations related to cardiac dysfunction.
(Refer to PowerPoint slide 18.)
iClicker question (Refer to PowerPoint slides 19 and 20.)
Learning Objective 3. Explain the proper techniques to perform a comprehensive
cardiovascular assessment.
 Discuss the complete assessment of the patient as it applies to the cardiac system.
(Refer to PowerPoint slides 21 and 22.)
o Assessment of the cardiovascular system
 Health history
 Common chief complaints
o Chest pain
o Symptoms of acute coronary syndrome
 Past health, family, and social history
o Age-related changes
o Medications
o Nutrition
o Elimination
o Activity and exercise
o Sleep and rest
o Self-perception and self-concept
o Roles and relationships
o Sexuality and reproduction
o Coping and stress tolerance
o Prevention strategies
Learning Objective 4. Discriminate between normal and abnormal assessment
findings identified by inspection, palpation, percussion, and auscultation of the
cardiovascular system.
 Physical assessment
 General appearance
 Inspection of the skin
 Blood pressure
o Pulse pressure
o Postural blood pressure changes
 Arterial pulses
o Pulse rate
o Pulse rhythm
o Pulse quality
o Pulse configuration
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o Effect of vessel quality on pulse
o Palpation of arterial pulses
Jugular venous pulsations
Heart inspection and palpation
Heart auscultation
o Normal heart sounds
 S1: first heart sound
 S2: second heart sound
o Abnormal heart sounds
 S3: third heart sound
 S4: fourth heart sound
 Opening snaps and systolic clicks
 Murmurs
 Friction rub
o Auscultation procedure
o Interpretation of heart sounds
Inspection of the extremities
Assessment of other systems
o Lungs
o Abdomen
Learning Objective 5. Recognize and evaluate the major manifestations of
cardiovascular dysfunction by applying concepts from the patient’s health history and
physical assessment findings.
 Discuss the assessment of functional health patterns as these relate to the
cardiovascular disease.
 Discuss the specific questions that may be asked in assessment of the patient’s
perception and management of his or her health as this relates to cardiovascular
disease (Refer to PowerPoint slides 23 and 24.)
Learning Objective 6. Discuss the clinical indications, patient preparation, and other
related nursing implications for common tests and procedures used to assess
cardiovascular function and diagnose cardiovascular diseases.
 List and explain the common laboratory tests used to assess the cardiovascular
system. Include indications and nursing implications in this discussion. Include
patient preparation and posttest care. For example, state that the patient is NPO
prior to lipid profile.
 Ask students if they know their cholesterol and other blood lipid levels. Use the
students’ answers to emphasize health promotion and patient teaching.
 Relate the results of tests to the nursing care of the patient.
 Discuss other common laboratory tests and their implications for patients with
cardiovascular disease (Refer to PowerPoint slide 25, Table 25-4.)
 List and explain the types of electrocardiography. Describe the clinical
indications, patient preparation, and nursing implications for each. (Refer to
PowerPoint slides 26 and 27.)
o Electrocardiography
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Continuous electrocardiographic monitoring
 Hardwire cardiac monitoring
 Telemetry
 Lead systems
 Ambulatory electrocardiography
 Transtelephonic monitoring
 Wireless mobile cardiac monitoring systems
List and explain the diagnostic tests used to assess the cardiovascular system.
Include indications and nursing implications for each. (Refer to PowerPoint slide
28.)
o Radionuclide imaging
o Myocardial perfusion imaging
o Test of ventricular function and wall motion
o Computed tomography (CT)
o Positron emission tomography (PET)
o Magnetic resonance angiography (MRA)
Describe the specific nursing care of the patient undergoing a cardiac
catherization. (Refer to PowerPoint slides 29 and 30.)
o Nursing responsibilities before cardiac catheterization include the
following:
 The patient is instructed to fast, usually for 8 to 12 hours, before
the procedure. If catheterization is to be performed as an outpatient
procedure, a friend, family member, or other responsible person
must transport the patient home.
 The patient is informed of the expected duration of the procedure
and advised that it will involve lying on a hard table for less than 2
hours.
 The patient is reassured that IV medications are given to maintain
comfort.
 The patient is informed about sensations that will be experienced
during the catheterization. Knowing what to expect can help the
patient cope with the experience. The nurse explains that an
occasional pounding sensation (palpitation) may be felt in the chest
because of extra heart beats that almost always occur, particularly
when the catheter tip touches the endocardium. The patient may be
asked to cough and to breathe deeply, especially after the injection
of contrast agent. Coughing may help disrupt a dysrhythmia and
clear the contrast agent from the arteries. Breathing deeply and
holding the breath help lower the diaphragm for better
visualization of heart structures. The injection of a contrast agent
into either side of the heart may produce a flushed feeling
throughout the body and a sensation similar to the need to void,
which subsides in 1 minute or less.
 The patient is encouraged to express fears and anxieties. The nurse
provides teaching and reassurance to reduce apprehension.
o Nursing responsibilities after cardiac catheterization may include the
following:
 The catheter access site is observed for bleeding or hematoma
formation. Peripheral pulses are assessed in the affected extremity
(dorsalis pedis and posterior tibial pulses in the lower extremity,
radial pulse in the upper extremity) every 15 minutes for 1 hour,
and then every 1 to 2 hours until the pulses are stable.
 Temperature, color, and capillary refill of the affected extremity
are evaluated frequently, per local nursing standards. The patient is
assessed for affected extremity pain, numbness, or tingling
sensations that may indicate arterial insufficiency. Any changes are
reported promptly.
 Dysrhythmias are screened carefully by observing the cardiac
monitor or by assessing the apical and peripheral pulses for
changes in rate and rhythm. A vasovagal reaction, consisting of
bradycardia, hypotension, and nausea, can be precipitated by a
distended bladder or by discomfort from manual pressure that is
applied during removal of an arterial or venous catheter. The
vasovagal response is reversed by promptly elevating the lower
extremities above the level of the heart, infusing a bolus of IV
fluid, and administering IV atropine to treat the bradycardia.
 Bed rest is maintained for 2 to 6 hours after the procedure. If
manual or mechanical pressure is used, the patient must remain on
bed rest for up to 6 hours with the affected leg straight and the
head of the bed elevated no greater than 30 degrees. For comfort,
the patient may be turned from side to side with the affected
extremity straight. If the cardiologist deployed a percutaneous
vascular closure device or patch, the nurse checks local nursing
care standards and anticipates that the patient will have fewer
activity restrictions. The patient may be permitted to ambulate
within 2 hours. Analgesic medication is administered as prescribed
for discomfort.
 The patient is instructed to report promptly chest pain and bleeding
or sudden discomfort from the catheter insertion sites.
 The patient is monitored for contrast agent-induced nephropathy
by observing for elevations in serum creatinine levels. Oral and IV
hydration is used to increase urinary output and flush the contrast
agent from the urinary tract; accurate intake and output are
recorded.
 Patient safety is assured by instructing the patient to ask for help
when getting out of bed the first time after the procedure. The
patient is monitored for bleeding from the catheter access site and
for orthostatic hypotension, indicated by complaints of dizziness or
lightheadedness.
Learning Objective 7. Compare the various methods of hemodynamic monitoring (e.g.,
central venous pressure, pulmonary artery pressure, and arterial pressure monitoring)
with regard to indications for use, potential complications, and nursing responsibilities.
 Explain and compare hemodynamic monitoring: CVP, PA, and arterial pressure
monitoring. (Refer to PowerPoint slide 31.)
 Describe how to obtain a reading for each. (Refer to PowerPoint slides 32 and
33, Figures 25-10 and 25-12.)
 State normal values. Discuss interpretation of data.
 Discuss the potential complications, required nursing assessments, and the
nursing responsibilities related to each of these monitoring procedures.