an evaluation of the condition, function, and abnormalities of the heart and circulatory system.
method The patient is asked to describe the onset, duration, location, and characteristics of any pain present and the occurrence of weakness, fatigue, shortness of breath, fever, coughing, wheezing, and palpitations. Questions are asked about episodes of fainting, indigestion, nausea, edema of extremities, cyanosis, and vision changes, and whether the hands and feet ever feel numb or cold. The person's general appearance, assumed position, rate and rhythm of all arterial pulses, presence of pulsus paradoxus or pulsus alternans, and the distention, pulsation, and pressure of neck veins are observed. Blood pressure, temperature, and rate and character of respirations are checked. The precordium is examined for the point of maximal impulse, symmetry, the cardiac border, pulsations, and evidence of lifts or bulges. Auscultation of the chest is performed to determine the intensity, pitch, duration, timbre, origin, and frequency of heart sounds and murmurs and to identify the location and character of breath sounds, including crackles, rhonchi, and rubs. Color, temperature, turgor, and dryness or sweating of the skin are noted, and the appearance of the extremities, capillary filling time, nails, and lesions are described. The patient's level of consciousness, reflexes, neurological signs, and responses to pain are recorded, along with data on concurrent hypertension, obesity, diabetes, and any pulmonary and renal conditions. Information is obtained about any previous cardiovascular surgery and illnesses, such as rheumatic fever, myocardial infarction, angina, congenital heart disease, occlusive vascular disease, and lung and kidney disorders. Pertinent background data include the patient's response to stress; coping methods; relationships; occupation; environment; sleep pattern and number of pillows used; exercise level, including number of blocks walked and flights of stairs climbed; leisure activities; and use of alcohol, tobacco, and other drugs. Other factors considered in the evaluation are the patient's history of medication with digitalis preparations, antihypertensives, diuretics, aspirin, sleeping pills, over-the-counter cold and influenza remedies; use of illegal drugs such as cocaine; and family history of heart disease, hypertension, diabetes, obesity, vascular disorders, stroke, and renal disease. Diagnostic aids are electrocardiogram, chest x-ray film, echocardiogram, radionuclide imaging, coronary arteriogram, cardiac catheterization, and arterial and pulmonary wedge pressure readings. Appropriate laboratory studies include a complete blood count, hemoglobin and hematocrit determinations, electrolyte and clotting profiles, and assays of serum cholesterol, triglycerides, aspartate aminotransferase, alanine aminotransferase, creatine phosphokinase, and lactic acid dehydrogenase.
interventions The nurse usually obtains the patient's history, records the external observations, checks the vital signs, auscultates the chest, and assembles the pertinent background information and reports on diagnostic tests. In specialty areas such as a coronary care unit, the nurse may interpret electrocardiographic tracings, and the health care provider may adjust medications.
outcome criteria An accurate and complete assessment of cardiovascular function is an essential adjunct to a complete physical examination and is vital to the diagnosis and proper continuing care of a patient with cardiovascular disease.