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Cardiovascular Assessment - Coggle Diagram
Cardiovascular Assessment
There is two parts of the cardiovascular system
The first part is the primary cardiac assessment which includes the heart rate/rhythm and blood pressure.
This is then followed by a secondary multi-organ assessment which delves into neurological assessment, urine output, skin colour and perfusion.
When taking observations the following should be implemented
A well-lit environment with a child at rest will allow for the detection of any skin tone and perfusion impairments.
An observation of the child's body for the position, activity and colour.
While also monitoring vital signs and physiological parameters.
Activity level - normal activity level looks like
Alert, calm and comfortable
Good muscle tone
Vigorous movement
The skin should feel warm to the touch
Capillary refill less than 2 seconds
Colour
The colour of the body should be consistent over the trunk and extremities. Normal skin is pink and has mucous membranes.
Abnormalities could be
Pallor: poor cardiac output
Mottling: impaired circulation to skin
Cyanosis: deprivation of oxygen near skin surface
Peripheral cyanosis: Maybe hypothermia or reduced flow.
Central cyanosis: Inside mucous membranes.
Chronic cyanosis: Increased blood viscosity.
Low levels of oxygen in the blood can cause lips, fingers and toes to look blue. This is called cyanotic.
Clubbed fingers
Clubbed fingers are a symptom of disease, often of the heart or lungs which cause chronically low blood levels of oxygen.
Nutrition
Is the child feeding well? Drinking and eating?
Do they have the moist mucous membranes?
Are there any changes to their urine output? - the normal parameters <2 years- 2-3 ml/Kg/hr. > 2 years- 0.5-1 ml/Kg/hr.
Inspection
It's important to examine the chest from an angle as well as directly.
Look out for scarring on the skin
Precordium is there any obvious bulging in the left and right sternal borders and apical area this could indicate cardiomegaly which is an abnormal enlargement of the heart. It can also happen when the child has had multiple surgeries which have entered via the sternum.
Acsculations - when doing accusation its important to think about
Are they clear and distinct?
Are they synchronous with the pulse?
Are they regular?
What is the intensity?
vital signs - Pulse
Pulse needs to be evaluated for rate, rhythm and volume.
Cardiac output in an infant is rate dependent as relatively non- compliant ventricles.
Counting should be for a full minute - if irregularity is found then need to consider how regular it is?
The rate will alter due to age, distress, fever, excitement, and exercise.
Need to auscultate the apex - the most accurate way in infants.
Volume is assessed as weak, normal or bounding.
Thready, weak or small volume pulses = hypovolemic/shock.
Vital signs - Blood pressure
Defined as cardiac output X systemic vascular resistance.
Systolic - force of contraction of the left ventricle and blood ejected into systemic vessels.
Diastolic - recoil of the artery and relaxation of the heart.
Mean Arterial Pressure - perfusion to coronary arteries, and organs.
Use the correct size cuff with a bladder that completely encircles the arm.
Infants and small children - cuffs should cover almost full -2/3 of the upper arm.
Older children- cuffs should cover 2/3 of the upper arm.
Document size of cuff, limb used, position of child, anxiety state of child as well as readings.
Children compensate well for decreased cardiac output so hypotension is a late sign of decompensated shock.
ECG's
P wave = Atrial contraction. QRS wave= Ventricular contraction. T wave= ventricular relaxation. Normally 1 P wave followed by 1 QRS complex. Measurement of electrical impulses through the heart represented by the ECG wave form on a monitor screen.
Past History and Family History
In these circumstances, the mother or primary career is the key person to speak to. You must ask what they think might be wrong. This should all be documented. Pregnancy and birth details are important for a child if they are less than 2 years old. This is all-important to help set the scene.
History of Presenting illnessess
Feeding pattern- duration, associated distress, volume taken, stopping to rest, caloric supplementation required.
Fatigue- while feeding or playing.
Oedema.
Dyspnoea/Tachypnoea.
Cyanosis.
Squatting/’Spelling’- frequently seen in children with Fallot’s Tetralogy.
Growth.
Frequency of infections.
Palpitations.