Cardiovascular, Pulmonary, Vessels Rubric

Question 1

Cardiovascular: Inspect

Answer 1

Note HR and BP.
Observe for surgical scars and physical characteristics
Apical Pulse
Pulsations
Heaves or lifts

Question 2

Cardiovascular: Palpation

Answer 2

Verbalize: Locate and measure PMI
Note that normal is 5th ICS midclavicular line
Note looking for lifts, heaves, thrills

Question 3

Cardiovascular: percuss

Answer 3

Verbalize: percuss heart size if concerned for CHF

Question 4

Cardiovascular: Auscultate

Answer 4

Diaphragm first: Name and listen at aortic, pulmonary, 1, pulmonary 2, tricuspid, and mitral areas
Listen for rate and rhythm, S1 and S2, splitting, S3 or S4
Extra heart sounds, Murmurs, clicks, gallops, rubs, snaps
Left lateral decubitus over apex for mitral stenosis
Murmurs: listening for timing, pitch, intensity, location, radiation

Question 5

Pulmonary: Inspect

Answer 5

Note RR, pulse ox
Size/shape, AP diameter, symmetry, physical characteristics
Note use of accessory muscles, audible wheezing, DOE

Question 6

Pulmonary: palpation

Answer 6

Palpate for thoracic expansion with inspiration, tenderness, and tactile fremitus (99)

Question 7

Pulmonary: percussion

Answer 7

ant/post/lat fields for dullness, hyper resonance

Question 8

Pulmonary: Auscultation

Answer 8

With diaphragm: ant/post/lat fields
Comment listening for rales, rhonchi, crackles, wheezes
ehophany (E) and pectorioquy (99)

Question 9

Vessels: Inspection

Answer 9

Inspect extremities for color, hair distribution, CCE, varicose veins

Question 10

Vessels: Palpation

Answer 10

Palpate for pitting edema.
Pulses - comment feeling for rate, rhythm, and amplitude. Palpate carotid, brachial, radial and descending aorta. Verbalize femoral, popliteal, dorsalis pedis, and posterior tibialis.

Question 11

Vessels: Auscultation

Answer 11

Using bell, listen for bruits: carotid, aortic, renal, iliac, verbalize femoral

Question 12

Special tests

Answer 12

Measure JVP with bed at 45 degrees with tangential light

Homans sign for DVT (knee flexed, dorsiflex foot)