NLE Cardiovascular Nursing — Cardiovascular Assessment and DiagnosticsConcept Map

Concept

Cardiac Physiology and Anatomy

Sub Concepts

• Four-chamber heart structure (atria and ventricles)
• Blood flow pathway through chambers and valves
• Cardiac output calculation (HR × SV)
• Determinants of stroke volume (preload, afterload, contractility)
• Electrical conduction system (SA node, AV node, bundle of His, Purkinje fibers)

Relationship To Central

Foundation for understanding normal cardiovascular function and recognizing deviations during assessment

Concept

Health History and Physical Assessment

Sub Concepts

• Chief complaint assessment (PQRST for chest pain)
• Symptom evaluation (dyspnea, orthopnea, palpitations, fatigue, syncope)
• Cardiovascular risk factor identification
• Inspection findings (cyanosis, clubbing, JVD, edema)
• Palpation techniques (pulses, PMI, capillary refill)
• Documentation of baseline vital signs and pulse characteristics

Relationship To Central

Systematic data collection for identifying cardiovascular problems using nursing assessment framework

Concept

Heart Sounds Auscultation

Sub Concepts

• Anatomical landmarks (APE To Man - Aortic, Pulmonic, Erb's, Tricuspid, Mitral)
• S1 (lub) - AV valve closure, systole onset
• S2 (dub) - semilunar valve closure, diastole onset
• S3 (ventricular gallop) - normal in children, pathologic in adults (heart failure)
• S4 (atrial gallop) - stiff ventricle, hypertension, ventricular hypertrophy
• Murmurs - graded I-VI, systolic vs. diastolic significance
• Pericardial friction rub - pericarditis indicator

Relationship To Central

Critical assessment skill for detecting normal and abnormal cardiac conditions through systematic listening

Concept

Electrocardiogram (ECG) Interpretation

Sub Concepts

• ECG paper standardization (small box 0.04 sec, large box 0.20 sec)
• P wave - atrial depolarization
• PR interval - normal 0.12-0.20 sec
• QRS complex - ventricular depolarization, normal 0.06-0.10 sec
• ST segment - normal isoelectric, elevation indicates injury (STEMI), depression indicates ischemia
• T wave - repolarization, peaked suggests hyperkalemia, inverted suggests ischemia
• QT interval - total depolarization-repolarization time
• Rate calculation using 300 rule
• Rhythm determination and analysis
• Normal sinus rhythm criteria

Relationship To Central

Essential diagnostic tool for detecting electrical abnormalities, ischemia, and arrhythmias

Concept

Cardiac Biomarkers

Sub Concepts

• Troponin (I and T) - most specific and sensitive marker, rises 3-6 hours, peaks 12-24 hours, elevated 10-14 days
• Creatine Kinase-MB (CK-MB) - cardiac-specific fraction, useful for reinfarction detection
• Myoglobin - earliest marker (1-3 hours), non-specific, rules out MI when negative
• B-type Natriuretic Peptide (BNP) - indicates heart failure and volume overload
• Lipid profile - cardiovascular risk assessment
• Electrolytes (K+, Mg2+, Ca2+) - dysrhythmia risk assessment

Relationship To Central

Biochemical indicators of myocardial damage essential for MI diagnosis and risk stratification

Concept

Hemodynamic Monitoring

Sub Concepts

• Central Venous Pressure (CVP) - right ventricular preload, normal 2-8 mmHg
• Pulmonary Artery (Swan-Ganz) catheter - PAWP measurement, normal 8-12 mmHg
• Pulmonary Artery Wedge Pressure (PAWP) - left ventricular preload indicator
• Arterial line - continuous BP monitoring and frequent ABGs
• Mean Arterial Pressure (MAP) - minimum 65 mmHg for organ perfusion
• Transducer leveling at phlebostatic axis (4th intercostal space, midaxillary line)
• Cardiac output measurement

Relationship To Central

Invasive measurement techniques for precise cardiovascular parameters in critical care settings

Concept

Cardiac Catheterization

Sub Concepts

• Coronary angiography - contrast visualization of coronary arteries
• Percutaneous Coronary Intervention (PCI) - angioplasty and stenting
• Access routes - femoral artery, radial artery, venous access
• Pre-procedure assessment and preparation
• Post-procedure nursing care and monitoring
• Complication identification and management

Relationship To Central

Gold standard invasive diagnostic and therapeutic procedure for coronary artery visualization and intervention

Concept

Pre-Procedure Nursing Care for Cardiac Catheterization

Sub Concepts

• Verify informed consent
• Assess for iodine/shellfish/contrast dye allergy - anaphylaxis risk
• Assess renal function (creatinine) - contrast nephrotoxicity risk
• NPO status 6-8 hours as ordered
• Document baseline vital signs
• Mark peripheral pulses distal to insertion site
• Patient education on expected sensations (warm, flushing, fluttering)

Relationship To Central

Essential preparation to ensure patient safety and successful procedure execution

Concept

Post-Procedure Nursing Care for Cardiac Catheterization

Sub Concepts

• Monitor insertion site for bleeding and hematoma - priority assessment
• Check distal pulses, color, temperature, sensation frequently
• Maintain bed rest with affected extremity straight (femoral access)
• Apply pressure or compression device as ordered
• Encourage fluids to flush contrast and protect kidneys
• Monitor urine output
• Monitor for chest pain, dysrhythmias, retroperitoneal bleeding signs
• Assess for contrast-induced nephropathy

Relationship To Central

Critical monitoring and interventions to prevent complications and promote safe recovery

Concept

Potential Complications and Patient Education

Sub Concepts

• Bleeding and hematoma at insertion site
• Contrast-induced nephropathy
• Allergic reactions to contrast
• Dysrhythmias
• Arterial dissection
• Stroke risk
• Patient teaching - report bleeding, swelling, numbness, coldness
• Site care - keep clean and dry
• Fluid intake recommendations
• Gradual activity resumption
• Cardiovascular risk factor modification (DOH PhilPEN alignment)

Relationship To Central

Risk awareness and patient empowerment for safe post-procedure monitoring and recovery

To

Cardiac Output Calculation

From

Cardiac Physiology

Strength

strong

Relationship

Cardiac output is the fundamental measurement derived from understanding how heart rate and stroke volume interact in the cardiac cycle

To

Stroke Volume Determinants

From

Cardiac Output Calculation

Strength

strong

Relationship

Stroke volume is directly affected by preload, afterload, and contractility, which together determine cardiac output capacity

To

ECG Interpretation

From

Electrical Conduction System

Strength

strong

Relationship

ECG records the electrical impulses traveling through the conduction system, with each wave representing specific conduction phases

To

Cardiovascular Risk Factors

From

Health History Assessment

Strength

strong

Relationship

Identifying risk factors during history-taking helps predict MI and heart failure risk, guiding diagnostic test ordering

To

Heart Sounds Auscultation

From

Physical Examination

Strength

strong

Relationship

Auscultation is a key component of the comprehensive physical examination revealing valvular and ventricular dysfunction

To

Nursing Diagnosis

From

Heart Sounds

Strength

moderate

Relationship

Abnormal heart sounds support nursing diagnoses like decreased cardiac output and ineffective tissue perfusion

To

Cardiac Biomarkers

From

ECG Interpretation

Strength

strong

Relationship

ST elevation on ECG (STEMI) indicates need for immediate troponin measurement and intervention

To

Myocardial Infarction Diagnosis

From

Cardiac Biomarkers

Strength

strong

Relationship

Troponin elevation is the gold standard for confirming myocardial infarction diagnosis

To

Stroke Volume Determinants

From

Hemodynamic Monitoring

Strength

strong

Relationship

CVP and PAWP measurements directly assess preload, one of the three determinants of stroke volume

To

Tissue Perfusion

From

Mean Arterial Pressure

Strength

strong

Relationship

MAP must be maintained above 65 mmHg to ensure adequate perfusion of vital organs

To

Coronary Artery Disease Diagnosis

From

Cardiac Catheterization

Strength

strong

Relationship

Coronary angiography is the gold standard for visualizing and diagnosing coronary artery disease

To

Allergy and Renal Function

From

Pre-Procedure Assessment

Strength

strong

Relationship

Identifying iodine allergy and compromised renal function prevents contrast-induced complications

To

Insertion Site Assessment

From

Post-Procedure Monitoring

Strength

strong

Relationship

Regular assessment of bleeding and hematoma is the priority intervention to prevent hemorrhagic complications

To

Vascular Patency

From

Distal Pulse Checks

Strength

strong

Relationship

Presence of distal pulses confirms arterial patency and adequate tissue perfusion distal to catheter insertion

To

Contrast Clearance

From

Fluid Encouragement

Strength

moderate

Relationship

Increased fluid intake helps flush contrast dye and reduces risk of contrast-induced nephropathy

To

Risk Factor Modification

From

Patient Education

Strength

moderate

Relationship

Teaching cardiovascular risk factor modification aligned with DOH PhilPEN supports secondary prevention

To

Cardiac Electrical Stability

From

Normal Sinus Rhythm

Strength

strong

Relationship

NSR indicates normal conduction through entire system with appropriate rate and regular rhythm

To

Heart Failure Indication

From

S3 Heart Sound

Strength

strong

Relationship

S3 in adults over age 30 is a classic indicator of heart failure and volume overload

To

AV Conduction Block

From

PR Interval Prolongation

Strength

strong

Relationship

PR interval exceeding 0.20 seconds indicates delayed conduction through the AV node

To

STEMI Emergency

From

ST Elevation

Strength

strong

Relationship

ST segment elevation indicates acute myocardial injury requiring emergency reperfusion therapy

To

Heart Failure Diagnosis

From

BNP Measurement

Strength

strong

Relationship

BNP levels below 100 pg/mL effectively rule out heart failure; elevated levels confirm diagnosis

To

MI Confirmation and Timing

From

Troponin Serial Measurements

Strength

strong

Relationship

Serial troponin draws spaced 3-4 hours apart show rising pattern confirming acute MI vs. chronic elevation

To

Accurate Hemodynamic Readings

From

Phlebostatic Axis

Strength

strong

Relationship

Proper transducer leveling at 4th intercostal space midaxillary line ensures valid pressure measurements

To

Organ Perfusion

From

MAP Greater Than 65 mmHg

Strength

strong

Relationship

Minimum MAP of 65 mmHg is required to maintain adequate diastolic pressure for coronary and cerebral perfusion

To

Early MI Detection

From

Myoglobin Elevation

Strength

moderate

Relationship

Myoglobin rises earliest (1-3 hours) but lacks cardiac specificity, useful for early rule-out

To

Reinfarction Detection

From

CK-MB Measurement

Strength

moderate

Relationship

CK-MB clears faster than troponin (2-3 days), making it useful for detecting reinfarction after initial MI

To

Renal Function Monitoring

From

Contrast-Induced Nephropathy

Strength

strong

Relationship

Pre-existing renal dysfunction increases risk; post-procedure monitoring includes creatinine and urine output

To

Insertion Site Hemostasis

From

Bed Rest Post-Catheterization

Strength

strong

Relationship

Maintaining extremity immobility prevents disruption of femoral puncture site hemostasis

To

Peripheral Perfusion Assessment

From

Capillary Refill Time

Strength

moderate

Relationship

Refill time under 3 seconds indicates normal arterial perfusion; prolonged suggests reduced perfusion

To

Right Heart Function

From

JVD Assessment

Strength

moderate

Relationship

Elevated JVD suggests right atrial pressure elevation from right heart failure or fluid overload