1 Cardiovascular Assessment and Nursing Priorities

Systematic cardiovascular assessment

Start by assessing airway, breathing, and circulation (ABCs), level of consciousness, vital signs, and whether symptoms are new or worsening. Compare findings with the patient’s baseline: a sudden change can be more significant than a value that is chronically outside the usual range.

Focused history

Ask about chest discomfort, including its onset, location, duration, character, severity, what makes it better or worse, and whether it radiates to the arm, back, neck, jaw, or abdomen. Ask about shortness of breath at rest or with activity, difficulty breathing when lying flat, and waking at night short of breath.

Assess for fatigue, weakness, dizziness, fainting, reduced exercise tolerance, confusion, swelling, abdominal fullness, and recent weight change. Ask about palpitations or a racing, irregular, or skipped-beat sensation. Review prior heart or vascular disease, hypertension, diabetes, kidney disease, tobacco use, family history, and current prescription, over-the-counter, and nonprescription drug use.

Physical assessment

Use a consistent sequence and compare both sides of the body:

1. Observe skin and lips for pallor or cyanosis, breathing effort, and visible swelling. Inspect the neck for jugular venous distention (JVD), with the patient positioned according to clinical protocol.

2. Measure blood pressure, heart rate, respiratory rate, oxygen saturation, temperature as indicated, and mental status. When the patient’s condition allows, recheck unexpected results using correct technique and an appropriately sized cuff.

3. Auscultate the heart for rate, regularity, and abnormal or extra sounds, identifying normal first and second heart sounds (S1 and S2). Listen to the lungs for crackles or other changes that may accompany fluid buildup.

4. Compare peripheral pulse rate and amplitude bilaterally. Note skin temperature and color, sensation, movement, capillary refill, and peripheral edema.

5. Follow up and document new or worsening findings, when they occurred, actions taken, and the patient’s response. Report concerns promptly according to local escalation procedures.

An irregular pulse, new crackles, JVD, cool or pale extremities, delayed capillary refill, altered mentation, or increasing edema may indicate a change in cardiac output or fluid status. Interpret findings together rather than in isolation.

Hemodynamics and perfusion

Cardiac output (CO) is the volume of blood pumped by a ventricle per minute:

Here, $\mathrm{HR}$ is heart rate and $\mathrm{SV}$ is stroke volume, the amount of blood ejected with each beat. Stroke volume is influenced by three main factors:

• Preload: ventricular filling and stretch before contraction. Changes in circulating volume and venous return affect preload.

• Contractility: the force of the heart’s contraction.

• Afterload: the resistance the ventricle must overcome to eject blood. Increased vascular resistance can increase afterload.

A change in heart rate does not always improve cardiac output. A very fast or very slow rate, or an ineffective rhythm, can reduce filling and forward blood flow. When perfusion is inadequate, findings may include hypotension, weak pulses, cool skin, reduced urine output, dizziness, or altered mental status. Use the patient’s overall condition and trends to help determine urgency.

Blood pressure measurement and classification

Blood pressure reflects the pressure of blood against arterial walls and is influenced by cardiac output and vascular resistance. For a more reliable reading, use a correctly sized cuff on the bare arm. Have the patient rest quietly, sit with the back supported and feet flat, and support the arm at heart level when feasible. A single reading is a measurement, not by itself a complete assessment of the patient’s usual blood pressure.

For nonpregnant adults, the American Heart Association’s 2025 classification defines:

• Normal: systolic pressure below $120\ \mathrm{mmHg}$ and diastolic pressure below $80\ \mathrm{mmHg}$.

• Elevated: systolic pressure from $120$ to $129\ \mathrm{mmHg}$ and diastolic pressure below $80\ \mathrm{mmHg}$.

• Stage 1 hypertension: systolic pressure from $130$ to $139\ \mathrm{mmHg}$ or diastolic pressure from $80$ to $89\ \mathrm{mmHg}$.

• Stage 2 hypertension: systolic pressure of at least $140\ \mathrm{mmHg}$ or diastolic pressure of at least $90\ \mathrm{mmHg}$.

Classification and treatment decisions require clinical context and appropriate measurement. Do not diagnose hypertension from one isolated reading.

Cardiovascular risk factors

Risk factors guide prevention and teaching, but they do not determine whether an acute symptom is an emergency.

Important modifiable cardiovascular risk factors include high blood pressure, unhealthy cholesterol levels, tobacco use, diabetes, excess body weight, physical inactivity, and an unhealthy eating pattern. Other risks include increasing age, family history, and established cardiovascular disease. Kidney disease and other health conditions may also contribute to cardiovascular risk.

Ask about access to care, medications, and barriers to recommended lifestyle changes so that education and referrals are practical for the individual.

Nursing priorities across cardiovascular disorders

Recognize instability and escalate

Prioritize threats to life and organ perfusion. New or severe chest pressure, acute shortness of breath, fainting, sudden confusion, signs of shock, or rapid deterioration in vital signs requires immediate assessment and escalation. Possible heart attack symptoms include chest discomfort, discomfort in other upper-body areas, shortness of breath, sweating, nausea, or lightheadedness. Symptoms can vary; do not dismiss them because they are mild, atypical, or intermittent.

For a suspected heart attack in the community, call 911. In a clinical setting, activate the appropriate emergency response and follow local protocol. Communicate symptom onset and changes promptly. Do not delay emergency evaluation while attempting nonurgent tasks.

Assess breathing, oxygenation, and circulation

Position the patient to support breathing as appropriate, assess oxygen saturation and work of breathing, and obtain help when deterioration is suspected. Provide oxygen when indicated by hypoxemia or protocol rather than assuming it is required for every patient. Monitor vital signs, mental status, skin perfusion, and symptoms after interventions.

Evaluate chest symptoms and possible ischemia

Treat new chest discomfort as potentially serious until assessed. Obtain and communicate a focused symptom history, monitor the patient, and facilitate timely ECG and further evaluation according to protocol. Reassess for persistent or recurrent discomfort and changes in breathing, blood pressure, rhythm, or level of consciousness.

Watch for dysrhythmia-related instability

A rhythm’s clinical importance depends on its effect on the patient. Palpitations accompanied by chest pain, shortness of breath, hypotension, fainting, altered mental status, or signs of shock require urgent escalation. Check the patient and pulse, obtain monitoring or an ECG as directed, and follow the applicable emergency response protocol. Interpret an abnormal monitor tracing alongside the patient’s clinical condition.

Monitor for congestion and fluid change

For patients with heart failure or suspected fluid overload, assess breathing, lung sounds, edema, JVD, weight trends, and intake and output as ordered. Report rapid worsening in shortness of breath, new or increasing swelling, or sudden weight change according to the care plan. Support prescribed self-monitoring and medication plans; do not independently change fluid or medication instructions.

Support blood-pressure control and prevention

Use consistent measurement technique, record readings, and report severe or symptomatic changes according to protocol. Reinforce the individualized plan for medications, follow-up, and heart-healthy habits, including tobacco cessation, regular physical activity as appropriate, nutrition, and adherence to prescribed treatment. Encourage patients to discuss persistent high readings and medication concerns with their healthcare team.

Reassess, communicate, and document

After an intervention or change in condition, reassess symptoms, vital signs, perfusion, and response. Communicate urgent concerns clearly, including the patient’s baseline, the change observed, relevant measurements, and actions already taken. Document objective findings and the timeline.

Applying priorities to a change in condition

A patient with a history of hypertension reports new chest pressure and shortness of breath. The nurse first assesses the patient’s ABCs, vital signs, oxygenation, mental status, and perfusion; stays with the patient; and activates the appropriate emergency response. The nurse reports symptom onset and changes, facilitates ECG and monitoring according to protocol, and reassesses the patient. Routine education or documentation should not delay urgent evaluation.