NCM112:
Oxygenation & Perfusion
LICEL ANITA A. DISTRITO, RN, MN
Lecturer
Nursingcaremngt112:
Cardiovascular
System
1: Introduction
2
Learning Outcomes
1. Describe the structure and function of the
cardiovascular system as well as associated cardiac
risk factors.
2. Explain and demonstrate the proper techniques to
perform a comprehensive cardiovascular assessment.
3. Discriminate between normal and abnormal
assessment findings identified by inspection, palpation,
percussion, and auscultation of the cardiovascular
system.
CARDIOVASCULAR SYSTEM
CARDIOVASCULAR SYSTEM
Comprises:
1. Heart
2. Blood
3. Blood vessels
HEART
hollow, muscular,
size: clenched fist
location: mediastinum
borders: 2nd to 5th ICS (V) & R
edge of sternum to L MCL
(H)
weight: 300g (10.6 oz)
Layers of the Heart
Heart’s Functions
- generate BP
- route blood
- ensure one-way flow of blood
- regulate blood supply
Chambers of the Heart
Associated Great Vessels
Superior and inferior vena cava
Pulmonary trunk
Pulmonary arteries.
Pulmonary veins.
Aorta
Coronary
arteries
Blood
Circulation
in the Heart
AnaPhy Review
Terms to Remember:
▪ Cardiac Output
▪ Stroke Volume
▪ Heart Rate
▪ Venous Return
▪ Preload
▪ Afterload
▪ Starling’s Law of the Heart
Electrical System of the Heart
Cardiac
Electrophysiology
3 physiologic
characteristics of the nodal
cells
and the Purkinje cells:
1. Automaticity
2. Excitability
3. Conductivity
Pacemakers of the Heart
SA node: - 60-100 bpm intrinsic HR
- dominant pacemaker
AV node: 40-60 bpm intrinsic HR
back-up pacemaker
Ventricular cells: 20-45 bpm
30-40 bpm intrinsic HR
Bundle of His
Purkinje Fibers
PQRST
Action potential
SA node
Spreads through
the walls of the Atria
contracts
atria
- P wave
Slowdown ( allows
ventricle fill with
blood)
AV node
Bundle of HIS
Q wave
Purkinje fiber Spreads to
ventricle
Ventricles
contract
RV - S wave
LV - R wave
Ventricles relax
- T-wave
Cardiac output
➢the total amount of blood ejected by one of the ventricles in liters
per minute
➢ SVxHR
Stroke volume
➢ is the amount of blood ejected from one of the ventricles per
heartbeat.
Factors that determines the stroke volume:
1. Preload – the degree of stretch the ventricular cardiac
muscle fibers at the end of the diastole
2. Afterload - resistance to ejection of blood from the
ventricle
- the second determinant to stroke volume
3. Contractility - the force generated by the contracting
myocardium
Blood Vessels
1. Arteries
2. Veins
3. Capillaries
Cardiovascular Assessment:
Subjective Data gathering
History:
A. Biographic and Demographic Data
- age, race, gender and heredity
B. History of present illness
Chief Complaint
- reason the patient is seeking health care
Cardiovascular Assessment:
C. Presenting symptoms
1. Date and mode of onset
- to find out when and how the symptoms first began
Example:
- has the shortness of breath been a problem
For weeks, or a new occurrence ?
COLD SPA
• describe the sign & symptom
C – character
• when did it begin.
O – Onset
L – location: • Where is it? Does it radiate?
D – duration: • how long does it last? Does it
recur?
COLD SPA
S – severity: • how bad is it?
P – pattern: • what makes it better/ worst?
• what are the other signs &
A – associated symptoms that occurs with it?
factors:
Clinical Manifestation
1. Chest pain or discomfort
2. Pain or discomfort in other areas of upper body,
including one or both arms, back, jaw, or stomach
3. Shortness of breath or Dyspnea
4. Peripheral edema, weight gain, abdominal distention
due to enlarged spleen and liver or ascites
5. Palpitation
6. Unusual fatigue, sometimes referred to as vital exhaustion
7. Dizziness, syncope, or changes in level of consciousness
PAIN ASSESSMENT
PQRST
P - precipitating/predisposing factors
etiology or provoking factors
Q – quality .
“ explain the feeling of pain “ Crushing?
burning ? Etc.
R –Region/radiation
“ where is the origin and how far does it
radiate “
PAIN ASSESSMENT
PQRST
S – severity
0= no pain; 1-3= mild; 4-6 moderate; 7-10= severe
in a range of 1-10, how painful it is ?
T –timing
( onset of duration )
is it recurrent ? Persistent ? Intermittent ?
Cardiovascular Assessment:
D. Past Medical History
1. Childhood illnesses and
immunizations
2. Previous Illnesses and hospitalization
3. Diagnostic/ Interventional Cardiac
procedures or surgeries
Ex. Cardiac catheterization,
2d Echo, ECG, hospital admission, etc.
4. Medications
5. Cultural considerations
6. Allergies
E. Family Health History
Disease Maternal Paternal
Hypertension x
Myocardial x
Infarction
Coronary Artery x
Disease
x
Diabetes mellitus
F. Risk factors
1. Non-Modifiable
- not subject to interventions to decrease their
significance
( gender, family History and race )
2. Modifiable
- cigarette smoking, hypertension,
hypercholesterolemia, physical inactivity, DM, stress, and
obesity
Cardiovascular Assessment:
G. Social History
H. Occupation - job stress
I. Culture
J. Environment - exposure to pollutants
and chemicals
K. Habits
- secondhand smoke
Formula = packs smoked per day
x years smoked
K. Habits
2. Coping and
Tolerance
- anxiety, depression,
- Stress ( sources, recent or
ongoing stressors)
K. Habits
3. alcohol consumption
4. eating habits
K. Habits
5. Activity and exercise
Exercise
1. Determine change in activity
pattern for the past 6 months
2. Fatigue
3. Exercise - intensity/ duration /
frequency
K. Habits
- low level of physical activity
- consumption of excess
calories,
- inherited genes
= obesity
K. Habits
6. Sexuality and reproduction
• physical demands are
greatest during orgasm
• reproductive history
• menopausal status
K. Habits
7. Rest and sleep
When/ how patient sleeps or rests:
- recent sleep changes
- sleeping upright in a chair instead
of bed
- no. of pillows
- awakening short of breath
K. Habits
8. Nutrition
Factors to consider:
1. Current height and weight
- waist measurement
- BP, Laboratory tests
K. Habits
2. How often the patient
self monitors
3. Level of awareness
4. He normally eats and
drinks
5. Eating habits
K. Habits
9. Elimination
✓ Nocturia
✓ straining during defecation/
Urination
✓ bloating, diarrhea,
constipation,
✓ Heartburn, nausea and
vomiting
K. Habits
10. Self perception and self concept
• Make difficult lifestyle changes – quit smoking
• NON COMPLIANCE - patient who do not understand
consequences fail to return to normal functioning
K. Habits
11. Roles and relationships