![]() Does the patient have a cardiac history?.Some general questions to ask a patient with a known or suspected cardiac condition will be aimed at identifying risk factors and evaluating symptoms. Oxygen saturation levels can be low with cardiac dysfunction, especially when bradycardia is severe or pulmonary edema is present in patients with heart failure. Symptomatic bradycardia definitely warrants treatment. Bradycardia related to a pathological process could also result in shortness of breath, pulmonary edema, chest pain and lightheadedness. However, if the heart rate is 53, the blood pressure is 82/54 and the patient seems disoriented, then this is symptomatic bradycardia. ![]() I’ll take a peek at the chart to see what the heart rate has been, and many times you’ll see this patient has a low heart rate at baseline. If I see that my patient has a heart rate of 53, a blood pressure of 116/74 and is alert and oriented, then this patient has asymptomatic bradycardia. So, when I have a patient with a low heart rate the first thing I do is correlate that against their blood pressure, their LOC, and any other associated signs/symptoms. Many patients, especially athletes, will have asymptomatic bradycardia at baseline. When heart rate is below 60 bpm, this is bradycardia and it can be asymptomatic or symptomatic, depending on the patient. When we look at treating tachycardia, we almost always identify and address the underlying cause. When heart rate is elevated above 100 bpm, this is tachycardia and can be present for a wide variety of reasons such as fever, dehydration, anxiety, infection, hypoxia, use of stimulants, and pain, as well as in uncontrolled atrial fibrillation and other cardiac dysrhythmias. Hypertensive crisis: SBP > 180 mmHg and/or DBP > 120 mmHg.Normal blood pressure: SBP 140 mmHg or DBP > 90 mmHg.In a patient with CHF, you would also do a full and focused respiratory assessment, which you can learn more about here. If the patient has heart failure with corresponding pulmonary congestion, then respiratory rate will be taken into account as well. The key vital signs for a cardiac assessment are blood pressure, heart rate and oxygen saturation level. When your patient is experiencing an acute cardiac event such as acute coronary syndrome or cardiac arrest, you will follow ACLS guidelines and your facility’s protocols to get patients immediate treatment. Note that if your patient is in acute distress, you will not be conducting this lengthy of an assessment. Listen wherever you get your podcast fix or straight from the website here. Review the following cardiac assessment tips on the go in episode 250 of the Straight A Nursing podcast. ![]() You can learn more about performing a head-to-toe assessment here. While you do perform a basic cardiac assessment with the head-to-toe, note that a focused cardiac assessment will be much more in depth. A cardiac assessment will be indicated on patients with a known cardiac history, suspected cardiac issue, and may even be conducted as part of a full physical assessment.
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