Kamlian,Eliesha M. BSN III-C CARDIOVASCULAR SYSTEM-MODULE 1 Health History 1.

Current Health Status - chest pain angina pericarditis pneumothorax

myocardial infarction pneumonia

post-myocardial syndrome rib fracture esophageal rupture

dissecting aortic aneurysm pulmonary artery hypertension

esophageal reflux esophageal spasm - shortness of breath - syncope - swelling of ankles or feet - heart palpitations - fatigue 2. Past Health History

- congenital heart disease - rheumatic fever - heart murmur - high blood pressure, high cholesterol, diabetes mellitus - confusion - fatigue - dental work 3. Family History 4. Personal Habits - smoking - alcohol - sleep & rest - exercise - nutrition - stress & coping

ASSESSMENT Inspection and Palpation of the Heart Inspection and palpation reinforce each other and are time saving when done together. Tangential lighting helps you detect pulsations. The ball of the hand (at the base of the fingers) is the most sensitive at detecting thrills. The finger pads are more sensitive in detecting pulsations. Inspect and Palpate for: Pulsations, Lift or heaves, Thrills Auscultation of the Heart 1. Aortic Area 2. Pulmonic Area 3. ERB's Point 4. Tricuspid Area 5. Mitral Area (Apical) Listen for murmurs. CHECK TIMING. Are they systolic or diastolic? (systolic murmurs may be benign. Diastolic murmurs are never benign). LOCATION OF MAXIMAL INTENSITY. Where is the murmur best heard? FREQUENCY (pitch). This varies from low-pitched, caused by slow velocity of blood flow, to high pitched, caused by a rapid velocity of blood flow. 2nd right interspace close to the sternum. 2nd left interspace. 3rd left interspace. 5th left interspace close to the sternum. 5th left interspace medial to the MCL

PROCEDURE:

Cardiac Monitor
Equipment required for continuous cardiac monitoring includes:

cardiac monitor monitor cable leadwires electrodes dry washcloth or gauze pad alcohol sponges

Preparation All electrical equipment and outlets are grounded to avoid electrical shock and artifact (electrical activity caused by interference). The nurse should plug in the monitor, turn on power, and connect the cable if not already attached. He or she should connect the lead wires to the proper position and ensure that colorcoded wires match the color-coded cable. If the device is not color coded, the right arm (RA) wire should be attached to the RA outlet, the left arm (LA) wire attached to the LA outlet, and so forth. The nurse should open the electrode package, and attach an electrode to each lead wire. The hands should be washed and the procedure should be explained to the patient. Privacy should be ensured for the patient, and the patient should be clean and dry to prevent electrical shock. Next, the chest should be exposed and the sites selected for electrode placement. Using the rough patch on the electrode, a dry washcloth, or gauze pad, each site should be rubbed briskly until it reddens, but care should be taken not to damage or break the skin. An alcohol pad is used to clean the sites in patients with oily skin. Areas should dry completely to promote good adhesion. Alcohol should not become trapped beneath the electrode, as this can lead to skin breakdown.