Full body assessments are a routine part of patient care. Knowing how one system functions and affects another is critical. For example, cardiovascular issues can be a symptom of another system entirely. On top of solid nursing foundations, active listening skills, attention to detail, you will be using the following skills often: inspection, auscultation, and palpation. Knowing how to perform an accurate and thorough cardiac nurse assessment can be a very useful tool in your career arsenal. This article will go over the major parts of a nursing assessment and how to approach them.
Tips for Cardiac Nurse Assessment
Foundations: How to Frame Your Thinking
Cardiovascular issues can be a result of electrical, or structural issues. For example, is there anything abnormal happening to your patient’s heart valve, and is it electrical or structural? As a refresher, knowing the whole cardiovascular area will be critical to communicating to your fellow nurses. Included is a non-exhaustive list of terms to remember:
Cardiac Nurse Assessment; Chest (Thorax)
- ribs (12, 7 true and 5 false)
- Angle of Louis
- intercostal spaces (and their respective names)
- left sternal border (LSB)
- right sternal border (RSB)
- midclavicular line (MCL)
- midclavicular line (sometimes called the nipple line)
Another thing to note is the five landmarks of the chest. These include:
- The Aortic Valve – located at the second intercostal space right sternal border.
- The pulmonary valve – located at the second intercostal space left sternal border.
- Erb’s Point – located at the third intercostal space left sternal border.
- The Tricuspid Valve – located at the fourth intercostal space at the left sternal border.
- The mitral Valve – located at the fifth intercostal space midclavicular line
These are all foundational concepts to keep in mind prior to entering the floor. Let’s talk about stepping onto your unit.
Pre-Assessment: What Is Their Medical History?
The cardiovascular system, as we know, is strongly connected with the vascular and pulmonary systems. Check the notes on their lab reports. Double-check why their doctor or medication provider may have prescribed them their heart medication (if any). They will have recommendations on where and how long to stay in certain ranges for vitals. Potassium and sodium levels are something to look for as you are assessing your patient as well.
This should all be done prior to meeting with the patient by the way. The last thing you want is to be caught off guard in front of your patient.
Cardiac Nurse Assessment: Seeing Your Patient
This is where those three skills, inspection, asculatation, and palpation, are most active. The actual interview and meeting with your patient are meant to be spent eliminating and honing in on details that can further help you narrow down your assessment. There are active signs and passive signs to be looking for in your patient.
Besides asking about your patient’s history of cardiovascular disease, ask about congenital problems, strokes, things like myocardial infarction, hypertension, and other issues related to the pulmonary or vascular systems.
This is all to say that combined together, this should help you distinguish between what is normal or abnormal about their situation given your patient’s context. This is the time to confirm your conclusions based on your pre-assessment of your patient. It is also time to get an update of how they are feeling and if anything new has come up since their last check-in.
During the physical examination portion, you will know to check vital signs like orthostatic blood pressure (while standing, sitting, and lying if possible), respiratory rate, and heart rate. In your active assessment, you will auscultate the chest area. You may not have to do the whole area but you are listening for the rate, rhythm, and any extra sounds. Note whether this is normal, fast or slow, or regular or irregular. Checking the five landmarks is also part of the active assessment.
Secondary to their current medical condition is having an idea of their lifestyle and health patterns as part of patient history. We included some questions you could be asking your patient to assess the situation. These should be sprinkled into your conversation with your patient’s heart health.
Cardiac Nurse Assessment Questions:
- Have you been eating well? How would you describe your diet?
- Do you know your sodium intake? How would you rate your sodium intake?
- How much water do you drink a day?
- Has your weight changed significantly recently? (and whether that is attached to external factors)
- Are you exercising regularly?
- Do you get winded easily, even if performing daily tasks?
- Do you smoke or use tobacco? (and asking about frequency, type, and how long)
- Are you experiencing more stress than usual?
- Are you having difficulty performing your regular responsibilities at home or work?
- What medications are you on? (especially important if you are trying to keep their vitals within a certain range)
We don’t recommend asking about these risk factors concurrently, but if you find yourself at a loss, keep your questions open ended so they can best provide descriptions rather than binary answers. If a patient is currently experiencing pain, it is important to ask what they were doing when the symptom began.
The passive assessment happens almost concurrently as you are speaking with your patient. Besides looking at vitals pre-assessment, checking a patient’s skin temperature, general appearance, and overall state (emotional and behavioral) are all part of your patient’s assessment. This is also something that is tracked over time. Building rapport with your patient definitely helps grease the wheels and can help improve your information gathering on your patient’s state, helping you better assess their cardiovascular condition. As a nurse, you are responsible for being aware of all symptoms related to the cardiovascular system.
Checking their vitals for palpitations. This may be a sign or show risk of other issues. This is why the pre-assessment of your patient is important.
There are always extenuating circumstances related to a cardiovascular assessment that could direct you and your doctor to a new diagnosis. Your observations of your patient, both objective and subjective are part of it. For example, if you are hearing from your patient that they are experiencing symptoms that are leading away from a cardiac problem, follow the line of questioning. Problems related to sometimes cardiovascular symptoms include edema, cyanosis, hypotension, or respiratory issues.
You may need to extend your assessment if they are at risk of other complications. For example, after checking for pulsations and abnormalities at chest landmarks, it may be worthwhile to check your patient’s jugular veins (both internal and external) or their carotid artery for palpation there.
Another situation you might encounter is more relevant to dialysis patients. On occasion, you may have to check for a thrill and bruit. During your auscultation, you are feeling for a vibration against your finger, followed by a rushing sound in your stethoscope. This will be rhythmic, as turbulent blood flow causes a bruit. Again, if you know your patient has extenuating circumstances such as being on dialysis, you would be auscultating and checking palpation based on this information.
Ending The Assessment
These are just general tips on building good practices for patient care. Ending a conversation is just as, if not more important than the entire assessment itself. All your thorough work may be something your patient wants to be clued in on as well, so being sure to communicate clearly, especially if your patient has extenuating circumstances can definitely detract or add to their hospital or care experience. It is not always possible but try to provide a patient with next steps. Letting them know who else might be following up with can be helpful as well. At the end of your conversation, even just repeating what they want asked of you can assure them for their duration of stay.
Clearly communicate with your team on updates on the extent of assessment. Report these findings clearly and succinctly in your patient’s treatment plan. It is often better to provide the nurse following up with more information than less, at least from our experience. You will learn as you go to provide shorthands.
We broke down the steps of a cardiac assessment starting from foundations you may learn in nursing school, then in preparation for, during, and ending a cardiac assessment. We started with wide concepts like how to frame your thinking as you go into an assessment. Be sure to brush up on your anatomy because it is going to be vital in communicating with your team. The cardiovascular system is interconnected to the rest of your body. Being aware of not just heart problems that can arise from your assessment, but how the rest of your body, your wellbeing can affect it means your assessment might need to be more open-ended and take a holistic approach.
These tips are all meant to help inform you as you build out your routine for a patient’s cardiovascular assessment. This eventually will become second nature to you as you progress into your nursing career. And you will find a style and rhythm that works best for you.
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