HEALTH ASSESSMENT

• Heart


  Hollow, muscular, four chambered organ located in the middle of the thoracic cavity between the lungs in the space called mediastinum
• Heart Chambers and Valves


  • AV Valves (Tricuspid and Bicuspid/Mitral)
  • Chordae Tendineae
• Phases of ECG


  1. P Wave (Atrial depolarization)

  2. PR Interval (Time from beginning of atrial depolarization to beginning of ventricular depolarization)

  3. QRS Complex (Ventricular depolarization)

  4. ST Segment (Period between ventricular depolarization and beginning of ventricular repolarization)

  5. T Wave (Ventricular repolarization)

  6. QT Interval (Total time for ventricular depolarization and repolarization)
• Cardiac Output


  Amount of blood pumped by the ventricles during a given period of time (usually 1 min), determined by stroke volume (SV) multiplied by heart rate (HR)
• Stroke Volume


  Amount of blood pumped from the heart with each contraction (usually 70 ml from left ventricle)
• Carotid Artery Pulse


  • Right and left common carotid arteries extend from brachiocephalic trunk and aortic arch, located in groove between trachea and sternocleidomastoid muscles, supply neck and head including brain with oxygenated blood, pulse has smooth, rapid upstroke in early systole and gradual downstroke
• Jugular Venous Pulse and Pressure

  • Internal and external jugular veins, assessment important for determining hemodynamics of right side of heart, level reflects right atrial (central venous) pressure and right ventricular diastolic filling pressure
• Health Assessment - Collecting Subjective Data


  Helps identify abnormal conditions affecting ability to perform activities of daily living, provides information on risks for cardiovascular disease, helps identify need for health education
• History of Present Health Concern

  COLDSPA (Chest pain and palpitations, Other symptoms, Last ECG, Diagnosed conditions, Surgeries, Prescribed medications, Alcohol/smoking, Family history)
• Past Health History


  Questions about heart defects/murmurs, prior heart surgery, rheumatic fever, ECG results, lipid profile results
• Family History


  Questions about history of hypertension, MI, CHD, elevated cholesterol, DM
• Lifestyle and Health Practices


  Questions about smoking, stress, diet, alcohol, exercise, daily activities, sexual activity, sleep
• Collecting Objective Data


  Major purpose is to identify signs of heart disease to initiate early referral and treatment, includes assessment of heart and neck vessels, BP, skin, nails, head, thorax, lungs, peripheral pulses
• Preparing the Client


  Expose anterior chest, supine position with head elevated 30 degrees, left lateral position, sitting up and leaning forward
• Equipment


  Stethoscope, small pillow, penlight, watch with second hand, centimeter ruler
• Understanding anatomy and function of heart and major coronary vessels is important to identify and interpret heart sounds and ECGs accurately
• Knowing normal cardiovascular variations in elderly clients is important