Cardiac Exam Flashcards
Jugular Vein Distension
Sign of R sided heart failure
Bed elevated to 45 degrees (seated or recumbent position)
Veins distend above levels of clavicles = jugular vein distension is present
Pitting Edema Scale
Skin rebound time
1+ = barely perceptible depression/pit
2+ = w/in 15 sec
3+ = w/in 15-30 sec
4+ = greater than 30 sec
S1 heart sound
“lub”
= Closing of the tricuspid & mitral valves (onset of ventricular diastole)
Auscultate at the 4th and 5th IC space
S2 heart sound
“dub”
= Closing of the Aortic and Pulmonic valves (start of ventricular diastole)
Auscultate at 2nd IC space @ sternal border
- R (aortic)
- L (pulmonic)
S3 heart sound =
“lub dub dub” (abnormal)
= Possible CHF of ventricular dysfunction (early diastole)
*Heard w/ healthy kids = physiologic 3rd heart sound
Auscultate w/ BELL at apex of heart (5th IC space)
“Kentucky”
S4 heart sound
“la lub dub” (abnormal)
= INC resistance to ventricular filling (LATE diastole before S1)
Auscultate at the Apex of the heart w/ the BELL
*Hypertensive cardiac disease, CAD/pulmonary disease, MI, CABG
“Tennessee”
Evaluate the Mediastinum for Tracheal shift:
Palpate the trachea - pointer and ring on either side of where SCM heads attach and middle follows trachea down to see if it shifts
What does a tracheal shift indicate?
Indicates collapsed lung, disproportionate intrathoracic pressures/lung volumes
Contents shift to:
- Affected side when intrathoracic pressure on that side is DEC (lobectomy, atectasis)
- Unaffected side when INC pressure present (pleural effusion, tumor)
Assess chest wall motion/evaluate for symmetry and posture:
Assess segmentally - upper, middle, and lower lobes while patient quietly breaths
Eval for symmtry, posture, and timing of movement
Upper lobes
palm of hands = ANT chest wall from 4th rib up
Fingers = stretched over traps
thumbs = over middle of chest
Middle lobe / L Lingula =
Fingers LAT over POST axillary folds
Palms over chest wall (under breast tissue)
Lower chest wall =
POST back:
Wrap fingers along anterior axillary folds, thumbs around base of scapulae
Fremitus
*Pt says “99” , looking for symmtery side to side (nomal/INC/DEC), check upper/middle/lower regions
- Vibration that is produced by the voice or by the presence of secretions in the airways
- Transmitted to the chest wall and palpated by the hand
Normal= uniform vibration throughout the entire chest
INC fremitus =
Presence of secretions
DEC fremitus =
Presence of AIR
Assess diaphragm involvement
Palpate ANT chest wall
thumbs = over costal margins/xyphoid process
Ask patient to breathe in - thumbs should move 2-3 inches apart
Evaluate Mediate Percussion
Used to assess diaphragmatic excursion - Performed to evaluate any abnormal findings, especially changes in lung density
Start at T7-12 Use middle finger of non-dom hand and place over posterior back, use dominant hand to ext wrist and hit middle finger of non-dominant hand and note sound (normal/dull/tympanic)
Do this once after asking pt to inhale and hold till you hit a dull sound and mark, and again breathing normally and mark again
When performing mediate percussion for diaphragmatic excursion, what direction and how far should diaphragm move?
Diaphragm should move up w/ exhalation (rest) 3-5 cm
(Inhalation diaphragm contracts/moves down)
Normal mediate percussion sound =
Resonate (normal lung tissue)
Dull mediate percussion sound =
Over the liver or solid organ, more dense tissue, sounds like a “thud” (practice on bare thigh)
May indicate consolidation or a tumor
Tympanic mediate percussion sound =
Loud, long and hollow
Can be heard over an empty stomach or hyperinflated chest (emphyzema)
