Cardiovascular Assessment and Skills

Question 1

general considerations of cardiac assessment (patient and general surroundings)

Answer 1

• patient must be properly dressed in a gown
• good lighting to see pulsations and slight movements
• quiet environment
• warm stethoscope and room

Question 2

sequence of cardiac exam`

Answer 2

-inspection
-palpation
-auscultation
(percussion not routinely performed)

Question 3

where are the different point of ausculation?

Answer 3

• aortic area: pt right side 2 ICS space
• pulmonic area: pt left side 2 ICS space
• erbs points: pt left side 3 ICS space
• tricupid: pt left side 4 ICS spance
• mitral/apical: pt left side 5th ICS midcalvicular line

Question 4

inspection of the precordium

Answer 4

• apical impulse (may not be seen due to breast, obesity, muscle)
• apical impulse may be visible in children and adults with thin chest wall
• abnormal: strong pulsation like heaves/lifts in adult

Question 5

inspection of the neck: carotid arteries

Answer 5

• medical to sternocleidomastoid muscle
• at 45 degree angle pulsation can be visible bilaterally and equal
• normal: mild pulsations at carotid

Question 6

inspection of the neck: jugular vein

Answer 6

-distention reflects right sided heart failure
-normal: not visible at 30-25 degree angle
-if visible documentL degree, height: sign of worsening CHF
-located above clavicle and next to SCM
-

Question 7

technique for heart palpation

-what to document

Answer 7

• postion at 30 degress, use 4 fingers
• note: locations, size of pulsations, quality of pulsation(sustained vs brief), at the apical pulse
• note: thrills, heaves, lifts at the aortic, pulmonic, tricuspid, erbs)

Question 8

what can make palpating the apical pulse easier?

Answer 8

turning the patient to the left lateral position: this must the heart closer to the chest wall

Question 9

palpation of the carotid arteries

Answer 9

• only do 1 at a time

- note quality

Question 10

what to auscultate

Answer 10

• heart rate and rhythm
• sounds
• listen for 1 minute to determine pulse rate and regularity

Question 11

what to listen for when ausclautign the heart?

Answer 11

-rate
-rhythm: regular/irregular
-S1: lub (mitral and tricuspid valve close)
-S2: dub (pulmonic and aortic valves close)
- S3 and S4 are abnormal
extra heart sounds

Question 12

what is the diaphragm used for

Answer 12

-high pitch sounds

S1 and S2

Question 13

what is the bell used for

Answer 13

Lowe pitched sounds

S3 and S4

Question 14

heart murmurs

Answer 14

• caused by disruption of flow through the heart

- sound depends on: functions fo the valve, size of the valve opening, rate of blood flow

Question 15

palpating the peripheral pulses

what to look for?

Answer 15

• assess for amplitude and symmetry

- capillary refill: less than 3 seconds