Cardiac nurses use assessment skills as they work directly with patients. This is what you need to know when you assess a cardiac patient.
These tips are for nurses that are brand-new to cardiac. If that’s you – keep reading!
3 Common Cardiac Issues
Before we get to tips about the cardiac assessment, you need to learn the three different issues that can happen with a person’s heart. If you understand these three things, it will make educating the patient easier and help you with your reports and assessments.
The three cardiac issues that normally arise are:
- Electrical Abnormalities – the electrical system that tells the heart to beat. This shows itself in heart arrhythmias, dysrhythmias, or a-fib.
- Structural Heart Problems – bad mitral valve regurgitation or heart muscle issues
- Heart Blockages – blockages in vessels that supply the heart with blood (coronary artery blockages), this looks like a heart attack.
It’s really important that as you give your report, you differentiate in your mind the exact issue the patient is having with their heart.
Knowing this will help you educate the patient and help you make more informed assessments about their health and needs.
What To Learn At Report Before You See The Cardiac Patient
Before you even go in and assess the patient, you will be getting a report from the previous nurse. This is the information you need to have before you walk in. This will help you make a better decision about them.
- Why is this patient here? You need to understand what sent them here now. Was it a heart attack?
- What other issues does this patient have? You also need to understand whether they have other heart issues or vascular issues.
Cardiac overlaps with other issues. Overlap with pulmonary and vascular issues in other parts of the body. Take note of overlapping issues before you see your patient.
Working in a cardiac unit you may see vascular patients as well, so you need to ask these questions before you finish the report.
How To Do A Cardiac Assessment
Now that you have all the information you need, let’s look at how to do a thorough cardiac assessment. These are the exact steps I take as a cardiac nurse after I get my report.
1. Look At The Cardiac Monitor
Refer back to the nurse sheet you received at report. I look at the telemetry monitor to make sure that it matches what I heard from report.
2. Look At The Patient’s Vitals, Labs, and Medications
I look for anything that might impact their vitals signs. Some cardiac patients – especially ones that just had procedures will usually have blood pressure or heart rate parameters, within which they are expected to fall.
If their heart rate or blood pressure falls or jumps outside of the parameters, the physicians will have “as-needed” or PRN medications you can use.
I look for the trend of their vitals over the last shift or two – not just the most recent vitals. If any vitals were out of range, I look in the chart to see if any medications were given.
I also look for any cardiac-related medications I’ll have to give within the next hour or so.
I also look for the potassium levels from the labs. Cardiac physicians always want to know what the potassium levels are. Patients should be well within the 3.0-5.5 range.
3. Do A Cardiac Assessment On The Patient
This is what you will do as you do the cardiac assessment on the patient at their bedside. Remember, as you assess the patient, you will be comparing everything you see and hear to the report and charts you just read.
Listen To Their Heart
After I know what issues they have from their chart, I know what to expect as I listen.
As a new nurse, you just need to know if the patient has a clean “lub-dub” sound – S1/S2. If they don’t, this is abnormal. Check the chart. Is this a brand-new abnormal? You don’t have to know all the different kinds of murmurs and their implications. You just need to know whether it is a new finding or not.
Listen To The Pulmonary System
The pulmonary and cardiac systems overlap physically and figuratively. Listen to their lung sounds. Make sure they are getting good air exchange in all of their lobes.
Look At Their Skin
Is it consistent with their ethnicity? Does it feel warm or cold? This all tells me how good or bad their circulation is.
Ask The Patient Questions
Then, ask the patient how they are feeling. These are some common questions you can ask to get a better understanding of how they are doing.
- Do you feel short of breath?
- Do you have any pain?
- Can you feel your heart beating?
- Do you feel dizzy?
- Do you feel cold or clammy?
Final Thoughts About Cardiac Assessment
Remember, it’s very important to understand their chart and the information you received from report before you go in and assess the patient. Everything you learn from the patient you will compare to what you learned from their charts. If something is newly abnormal, let their physician know.
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