(CPA) cardiovascular exam Flashcards
how is the cardiovascular examination started?
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’
which two questions must you ask before proceeding with the examination?
‘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)
what must you do as part of your introduction?
must confirm the patient’s name and date of birth
what position is required for the cardiovascular examination?
must be laying on the bed at a 45-degree angle
what exposure is required for the cardiovascular examination?
exposed from the waist up
women do not need to take their bra off
how are the different parts of the cardiovascular exam split up into sections?
(PIPPA)
position and exposure inspection palpation percussion auscultation
what is WIPERQQ?
Wash hands Introduction Permission Exposure Reposition Q: Are you comfortable? Q: Are you in any pain?
what is PIPPA?
Position and Exposure Inspection Palpation Percussion Auscultation
what does palpation involve in the cardiovascular exam?
pulses
- radial artery
- ulnar artery
- brachial artery
- common carotid artery
chest palpation
- apex beat
- heaves
- thrills
where is the radial pulse measured?
between the tendon of the flexor carpi radialis and the tendon of the brachioradialis
what is assessed when palpating the radial, ulnar and brachial pulses?
rhythm and rate
what is heart rhythm?
regularity of the beat
what is heart rate?
number of beats in 1 minute
which arm is palpated for the radial, ulnar and brachial pulse normally?
normally done on the right arm as you are approaching the patient from the right
how is the rhythm and rate of the peripheral and central pulses determined?
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)
what does a heart rate of less than 60bpm indicate?
bradycardia
what does a heart rate of more than 100bpm indicate?
tachycardia
where is the ulnar pulse measured?
lies between the flexor digitorum superficialis and flexor carpi ulnaris.
where is the brachial pulse measured?
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
what must you ensure when palpating the brachial pulse?
keep the elbow fully extended (!!)
= makes palpation easier
what are the peripheral pulses?
radial, ulnar and brachial pulses
i.e. not common carotid artery pulse
what is the limitation of palpating the peripheral pulses and how is this overcome?
cannot comment on character and volume using the peripheral pulses
= so use the common carotid artery pulse instead
where is the common carotid pulse measured?
palpated in the neck
= medial to the sternocleidomastoid muscle and lateral to the thyroid cartilage
what must you ensure when palpating the common carotid pulse?
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
which pulse must you palpate when wanting to determine character and volume?
common carotid pulse
which fingers should be used when palpating pulse?
use the index and middle finger
cannot use the thumb as it has a pulse of its own!
summarise the palpation of pulses in the cardiovascular exam
pic
where is the apex beat palpated?
left fifth intercostal space, mid-clavicular line
what causes the apex beat?
caused by the apex of the left ventricle of the heart against the anterior chest wall during contraction
explain the technique of apex beat palpation
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
what can you do when the apex beat is harder to palpate?
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
