Assessment and Diagnostic Measures in Cardiovascular and Thoracic Nursing

 

Assessment and Diagnostic Measures in Cardiovascular and Thoracic Nursing :

History Taking

Accurate history-taking forms the cornerstone of cardiovascular and thoracic assessments. A detailed medical history provides insights into symptoms, predisposing factors, and lifestyle influences. Nurses should focus on:

• Presenting complaints such as chest pain, dyspnea, palpitations, or syncope.

• Past medical history, including prior cardiac or thoracic conditions.

• Family history of cardiovascular diseases.

• Lifestyle habits such as smoking, alcohol intake, diet, and exercise.

• Medication history, including adherence and side effects.

Physical Assessment

Physical assessment involves systematic evaluation to identify signs of cardiovascular and thoracic dysfunction. Key components include:

• Heart Rate Variability (HRV):

  • Mechanisms: HRV reflects autonomic regulation of the heart, balancing sympathetic and parasympathetic inputs.

  • Measurements: Time-domain, frequency-domain, and non-linear methods.

  • Patterns: Reduced HRV indicates poor autonomic control and heightened cardiovascular risk.

  • Factors: Age, stress, sleep, medications, and physical fitness.

  • Impact of Interventions: Exercise, stress management, and pharmacological therapies can improve HRV.

Diagnostic Tests

Hemodynamic Monitoring

• Technical Aspects: Use of invasive (Swan-Ganz catheter) and non-invasive devices.

• Monitoring: Continuous assessment of arterial blood pressure, central venous pressure, and pulmonary artery pressure.

• Functional Hemodynamic Indices: Assessment of fluid responsiveness and tissue perfusion.

• Ventricular Function Indices: Left and right ventricular performance metrics.

• Output Measurements: Cardiac output and systemic vascular resistance.

• Blood Gases: Analysis of oxygenation and acid-base status, critical for evaluating oxygen supply-demand balance.

Radiologic Examination of the Chest

• Interpretation: Systematic analysis of chest X-rays for structural and pathological findings.

• Chest Film Findings: Evaluation for pulmonary congestion, cardiomegaly, effusions, and other abnormalities.

Electrocardiography (ECG)

• Electrical Conduction: Evaluation of heart’s electrical activity.

• Basic Electrocardiography: Identification of normal and abnormal rhythms.

• 12-Lead ECG: Comprehensive assessment for diagnosing cardiac conditions.

• Axis Determination: Evaluation of electrical axis for detecting abnormalities.

• ECG Changes:

  • Intraventricular conduction abnormalities.

  • Arrhythmias, ischemia, injury, and infarction.

  • Atrial and ventricular enlargement.

  • Electrolyte imbalances.

Echocardiography

• Technical Aspects: Real-time imaging of cardiac structures and function.

• Special Techniques: Doppler echocardiography, transesophageal echocardiography.

• Applications: Assessment of valvular disease, ventricular function, and congenital anomalies.

• Newer Techniques: 3D echocardiography and strain imaging.

Nuclear and Other Imaging Studies

• Magnetic Resonance Imaging (MRI): Detailed structural and functional imaging of the heart.

• Cardio Electrophysiology Procedures:

  • Diagnostic studies and interventional procedures.

  • Catheter ablation for arrhythmias.

  • Comprehensive nursing care for patient preparation and recovery.

Exercise Testing

• Indications and Objectives: Functional assessment of cardiac reserve and ischemia.

• Pretest Considerations: Baseline evaluation and informed consent.

• Procedure: Graded exercise with ECG monitoring.

• Interpretation: Assessment of symptoms, ECG changes, and functional capacity.

• Recovery Period: Monitoring for post-exercise complications.

Cardiac Catheterization

• Indications and Contraindications: Detailed evaluation of coronary artery disease and structural abnormalities.

• Patient Preparation: Pre-procedural education, fasting, and medication adjustments.

• Procedure: Invasive imaging and pressure measurements.

• Interpretation: Identification of blockages and functional impairments.

Pulmonary Function Tests

• Bronchoscopy and Graphies: Visual and radiological assessment of respiratory structures.

Interpretation of Diagnostic Measures

• Nurses play a critical role in correlating diagnostic findings with clinical presentations to guide care planning.

Laboratory Tests Using Blood

• Blood Specimen Collection: Proper technique to ensure accuracy.

• Cardiac Markers: Troponin, CK-MB for myocardial injury.

• Blood Lipids: Cholesterol and triglycerides for cardiovascular risk.

• Hematologic Studies: Evaluation of anemia and clotting disorders.

• Blood Cultures: Identification of infectious endocarditis.

• Coagulation Studies: PT, INR, and APTT for anticoagulation management.

• Arterial Blood Gases: Oxygenation and acid-base balance assessment.

• Blood Chemistries: Electrolytes, glucose, renal and liver function tests.

• Cardiac Enzyme Studies: Enzymatic indicators of myocardial damage.

• Serum Concentrations: Monitoring therapeutic drug levels.

Nurse’s Role in Diagnostic Tests

• Educating patients about the purpose and procedure of tests.

• Ensuring proper preparation and consent.

• Monitoring for adverse reactions and complications.

• Assisting with positioning and equipment setup.

• Communicating findings to the healthcare team.

• Supporting patients emotionally during invasive procedures.

• Interpreting results to plan and deliver optimal care.