Check Sheet

Question 1

Blood pressure

Answer 1

• start with palpatory method
• measures arm for cuff size
• arm at heart’s level
• stethoscope over brachial aa
• measure BP bilaterally
• takes ortho’s if on BP meds, lightheaded, syncope, or dehydrated

Question 2

Pulse

Answer 2

• determine rate and rhythm
• listen for 15 seconds and time by 4
• listen for full 60 seconds if irregular
• auscultates to determine rate if irregular

Question 3

respirations

Answer 3

• comments on assessing while patient is unaware

- notes: rate, effort, depth, rhythm

Question 4

temperature

Answer 4

• bladder or rectum measures would be most accurate
• axillary least accurate
• take temperature orally

Question 5

Jugular vein pressure estimation

Answer 5

• raise patients head 30 degrees
• use oblique lighting
• inspect both jugular vein pulsations
• measure from apex of pulsation to sternal angle (at 90 degree angle)
• check hepatojugular reflex if

Question 6

Carotid arteries

Answer 6

• palpate both carotids independently
• note: amplitude, contour, and thrills
• palpate aa while auscultating to determine S1
• ask patient to hold breath and auscultate both aa
• use bell to assess bruits
• listen with diaphragm for high pitches

Question 7

Inspect pericordum

Answer 7

• use tangential lighting

- comments on if PMI is visible

Question 8

Palpates pericordium

Answer 8

• aortic area
• pulmonic area
• right ventricle
• left ventricle
• palpates in LLD position
• comments on heaves and thrills
• determines PMI

Question 9

Determines PMI

Answer 9

• uses palm to generally assess
• uses fingers to localize
• comments on: duration, diameter, amplitude, and location
• positions pt in LLD if unpalpable supine

Question 10

Auscultation of patient supine

Answer 10

• determine rate and rhythm of heart while pt is supine
• listen with diaphragm to:
• listens to 2nd right intercostal space
• listens to 2nd left intercostal space
• listenings to LLSB intercostal spaces 3-5
• listens to apex
• notes findings on aortic and mitral regurgitation, or frictions rubs
• listens with bell to:
• apex
• LLSB
• notes: aortic or mitral stenosis, S3 or S4

Question 11

Auscultations of pt in LLD position

Answer 11

• listens with bell over apex

- notes: mitral stenosis, S3 or S4

Question 12

Auscultation of pt leaning forward

Answer 12

• asks pt to exhale fully and hold breath
• listens with diaphragm to:
• LLSB
• apex
• notes: aortic regurgitation and friction rub
• listens with bell to:
• LLSB
• notes right sided S3 or S4
• inch stethoscope over auscultatory areas taking time to listen
• if murmur present notes: timing, location of maximal intensity, radiation, intensity, pitch, quality

Question 13

inspects arms

Answer 13

• inspects arms bilaterally

- notes: symmetry, swelling, vascular pattern, nail color, skin color, and skin texture

Question 14

Palpates of arms

Answer 14

• assess radial aa bilaterally
• assess capillary refill of fingers
• correctly performs allen test
• palpates epitrochlear lymph nodes

Question 15

leg inspection

Answer 15

• inspects legs bilaterally
• notes: size, swelling, symmetry, venous patter, nail color, skin color, skin texture, venous enlargement, pigmentation, rashes, scars, ulcers
• assess hair distribution on legs, feet, toes
• assess color of legs dangling
• check for postural changes if indicated
• stand pt and check for varicosities bilaterally

Question 16

palpate lymph nodes in LE

Answer 16

• superficial inguinal lymph nodes

- comment on size, consistency, and tenderness

Question 17

palpates arteries in LE

Answer 17

• femoral aa bilaterally
• popliteal aa bilaterally
• posterior tibialis aa bilaterally
• dorsalis pedis aa bilaterally

Question 18

checks LE for edema

Answer 18

• dorsum
• medial malleolus
• over shins
• measure if present

Question 19

checks for DVTs

Answer 19

• homan’s sign

- squeeze calf

Question 20

Assesses temperature of LE

Answer 20

• with back of hand

Question 21

Auscultation of LE and abdomen

Answer 21

Listen with diaphragm to:

• femoral aa
• abdominal aa

Question 22

Beginning of assessment

Answer 22

• introduce self as student
• confirm reason for appointment
• ask if any questions before starting
• inform patient that they should feel free to ask questions throughout the exam

Question 23

During assessment

Answer 23

• explain what your doing

- drape pt appropriately

Question 24

End of assessment

Answer 24

• thank patient for coming in
• ask them if they have any questions
• inform pt you are going to step out to talk to preceptor
• explain you will be back to explain exam findings

Question 25

Presentation of case

Answer 25

• introduction sentence
• general observation
• vital signs
• discuss:
• JVP
• carotid aa
• pericordium
• auscultations of pericordium
• legs inspection
• leg palpation
• auscultation of LE