Hello, my name is Leslie Jones-Larsen, and today we'll be talking about the cardiovascular patient assessment, vitals, and intake. We'll be focusing on patient intake and developing skills to ensure that we have an effective patient assessment, vitals, intake that includes the medication reconciliation, and that our patients actually understand what we're intaking, and through that method we're going to call that the teach-back method. For the cardiac patient assessment, we'll start with the patient interview. It's really important that you introduce yourself and make eye contact, that you sit or stand at the patient level while maintaining the ability to look up or across the patient, and avoid looking down. Don't forget to acknowledge and introduce yourself to other persons accompanying the patient and try to understand the relationship to them. Ask clear and concise questions while maintaining your eye contact. Ask clarifying questions when needed to make sure the details are accurate to the story you're starting to create. And remember to thank the patient for their time and information. Specifically with cardiology, you'll need to drill down into cardiovascular diseases. You've seen these names and information in previous modules, and the patients may or may not know what you're talking about, but you can use your probing questions about the heart to get enough information to allow for further investigation during the visit. As you move to the vitals, you can have two options for blood pressure management. The auscultative, which is using the brachial artery to detect the appearance and the muffling sounds for both the systolic and diastolic blood pressures, or the oscillometric. This is where you're using software within the device to detect the waveforms as the blood pressure cuff is deflated to provide both the systolic and diastolic blood pressures. It doesn't depend on which method you choose or which offering your clinic really prefers, but it is imperative that the proper technique is used. First you want to remember to properly prepare the patient. Use proper technique for the measurement, take proper measurements, properly document the blood pressure, average the readings, and provide the blood pressure to the patient. We'll go into more details specifically on each of these steps. For step one, really ask yourself, is the patient prepared? Does any clothing need to be removed for proper cuff placement? Has the patient been sitting in the chair for three to five minutes with flat feet on the floor and a back supported? Has the patient avoided caffeine, exercise, and smoking at least 30 minutes before? Does the patient need to go to the restroom to empty his or her bladder? Ideally, there is no talking to the patient or the observer during this rest period and measurement period. Proper technique for that measurement is don't be in a rush. Support the patient's arm and position the middle of the cuff on the patient's upper arm at the level of the right atrium. Make sure you've selected the correct cuff size. Make sure that the blood pressure measurement device has been validated and calibrated periodically in your clinic. And use the stethoscope, diaphragm, or the bell for austere readings. If it's the first visit within the cardiology clinic, record the blood pressures in both arms and use the arm that gives the highest reading for subsequent visits and readings. Separate out the repeated measurements by one to two minutes. Depending on the type of readings and the equipment you have in your clinic, review the specific determinations and readings. You want to make sure that you average those multiple readings and document within the record as well as provide to the patient and their family. Also, always remember to document when the most recent blood pressure medication was taken before the measurements. For additional cardiac intake requirements, we'll also need to gather the patient's heart rate and respiratory rates. We'll need the height and weight to determine the patient's BMI. And altogether, these measurements will really ensure that we understand the risk factors that are possible to predict cardiovascular diseases and can help us consider possible therapies. Medication reconciliation is usually the last part of the patient intake. The Centers for Medicare and Medicaid ask that this type of component is completed at every ambulatory visit. It's best practice to take the extra time after hospitalization to ensure that the hospital discharge reconciliation and the clinic reconciliation match, and if there's discrepancies that they're dealt with at the ambulatory visit. This is all to be completed within 30 days of the hospital discharge. It's really important that you include all of the above pieces of the puzzle, those prescription medications, the herbs, vitamins, nutritional supplements, and over-the-counter drugs. Furthermore, clarifying the doses and asking clarifying questions regarding the accuracy of which medication is really important. Reconcile and document any changes for the provider to review and sign off. Last, remember that you're using the teach-back method when working with the patient and their family. Asking a patient or family member to explain in their own words what they need to know or do in a very caring way. Remember to check for understanding, and if they need something re-explained, check again. This really is proven to improve the patient provider communication and the patient health outcomes in the ambulatory setting. Remind yourself to use your caring voice and attitude, display comfortable body language, use plain language for the patient and their family to understand, ask the patient to explain back using their own words, and use open-ended questions, and avoid questions that can just be yes or no. Emphasize that you do have the responsibility to explain clearly, and it's not a problem if you need to repeat anything. Remember to document the patient response for the use of this teach-back method. If you have any questions, go to your preceptor first, but you can always reach out to the MedAxiom Academy.

cardiovascular patient assessment

teach-back method

blood pressure management

medication reconciliation

MedAxiom Academy