(CPA) cardiovascular exam

Question 1

how is the cardiovascular examination started?

Answer 1

W - wash your hands

I - introduce yourself and what you will be doing and confirm the patient’s NAME and DATE OF BIRTH

P - permission (introduce what you are going to do and ask them if they are happy with that)

E - exposure (make sure they are exposed from the waist up for this examination)

R - reposition (make sure they are lying on the bed at a 45-degree angle depending on if the bed needs to be readjusted)

Q - question: “Are you comfortable?”; ‘let me know if you have any questions’

Q - question: “Are you in pain?’; ‘let me know if at any point you feel pain and we can stop then’

Question 2

which two questions must you ask before proceeding with the examination?

Answer 2

‘are you comfortable?”

‘are you in any pain?’

(let me know if you have any questions or if you are ever in any pain and we can stop)

Question 3

what must you do as part of your introduction?

Answer 3

must confirm the patient’s name and date of birth

Question 4

what position is required for the cardiovascular examination?

Answer 4

must be laying on the bed at a 45-degree angle

Question 5

what exposure is required for the cardiovascular examination?

Answer 5

exposed from the waist up

women do not need to take their bra off

Question 6

how are the different parts of the cardiovascular exam split up into sections?

Answer 6

(PIPPA)

position and exposure
inspection
palpation
percussion
auscultation

Question 7

what is WIPERQQ?

Answer 7

Wash hands 
Introduction
Permission
Exposure
Reposition
Q: Are you comfortable? 
Q: Are you in any pain?

Question 8

what is PIPPA?

Answer 8

Position and Exposure 
Inspection
Palpation
Percussion 
Auscultation

Question 9

what does palpation involve in the cardiovascular exam?

Answer 9

pulses

• radial artery
• ulnar artery
• brachial artery
• common carotid artery

chest palpation

• apex beat
• heaves
• thrills

Question 10

where is the radial pulse measured?

Answer 10

between the tendon of the flexor carpi radialis and the tendon of the brachioradialis

Question 11

what is assessed when palpating the radial, ulnar and brachial pulses?

Answer 11

rhythm and rate

Question 12

what is heart rhythm?

Answer 12

regularity of the beat

Question 13

what is heart rate?

Answer 13

number of beats in 1 minute

Question 14

which arm is palpated for the radial, ulnar and brachial pulse normally?

Answer 14

normally done on the right arm as you are approaching the patient from the right

Question 15

how is the rhythm and rate of the peripheral and central pulses determined?

Answer 15

count the pulses within 15 seconds and then multiply the result by 4

(state if you had time you would do it for longer i.e. 30/60 seconds)

Question 16

what does a heart rate of less than 60bpm indicate?

Answer 16

bradycardia

Question 17

what does a heart rate of more than 100bpm indicate?

Answer 17

tachycardia

Question 18

where is the ulnar pulse measured?

Answer 18

lies between the flexor digitorum superficialis and flexor carpi ulnaris.

Question 19

where is the brachial pulse measured?

Answer 19

in the cubital fossa

= medial side of the tendon of biceps brachii and keep the elbow fully extended (!!)

OR

middle third of the humerus in the medial bicipital groove

Question 20

what must you ensure when palpating the brachial pulse?

Answer 20

keep the elbow fully extended (!!)

= makes palpation easier

Question 21

what are the peripheral pulses?

Answer 21

radial, ulnar and brachial pulses

i.e. not common carotid artery pulse

Question 22

what is the limitation of palpating the peripheral pulses and how is this overcome?

Answer 22

cannot comment on character and volume using the peripheral pulses

= so use the common carotid artery pulse instead

Question 23

where is the common carotid pulse measured?

Answer 23

palpated in the neck

= medial to the sternocleidomastoid muscle and lateral to the thyroid cartilage

Question 24

what must you ensure when palpating the common carotid pulse?

Answer 24

make sure the patient’s head is straight (!!)

= if the neck is twisted to the left, you will not be able to palpate the right common carotid pulse as it will be covered by the SCM muscle

Question 25

which pulse must you palpate when wanting to determine character and volume?

Answer 25

common carotid pulse

Question 26

which fingers should be used when palpating pulse?

Answer 26

use the index and middle finger

cannot use the thumb as it has a pulse of its own!

Question 27

summarise the palpation of pulses in the cardiovascular exam

Answer 27

pic

Question 28

where is the apex beat palpated?

Answer 28

left fifth intercostal space, mid-clavicular line

Question 29

what causes the apex beat?

Answer 29

caused by the apex of the left ventricle of the heart against the anterior chest wall during contraction

Question 30

explain the technique of apex beat palpation

Answer 30

first, locate the 2nd rib by finding the sternal angle as they are on the same level

count down to the 5th intercostal space on the left and move laterally to the mid-clavicular line

feel for the apex beat laterally and move more medially in case the apex beat is displaced

Question 31

what can you do when the apex beat is harder to palpate?

Answer 31

1) patient to lean towards their left side, which may help you to feel it
2) get the patient to jog on the spot for 1 minute to increase their heart rate