H & P check off

Question 1

Categories for Heart and Vascular Dz Checkoff

Answer 1

1. general
2. skin
3. heart
4. blood vessels
5. special tests

Question 2

General (6)

Answer 2

Introduce self

verify name

state wash hands

explain the purpose of visit

vital (Ht, wt, T, P, R, BP)

general appearance

Question 3

skin (6)

Answer 3

finger nails for clubbing

capillary refill in toes and fingers

observe lips for cyanosis

inspect UE and LE (symmeptry, color, hair)

Palpate temperature of UE & LE

Palpae for LE edema (dorsum, malleolus, anteiror tibia)

Question 4

Heart (GENERAL) (inspect, palpate, auscultate)

Answer 4

1. heat of bed at 30 degrees

Inspect: lifts/heaves (light)

Palpates: impulses, fingers, thrills (heel of hand)

auscultate: diaphragm, bell, augment

Question 5

inspect lifts and heaves where

Answer 5

aortic
pulmonic
L 3rd interspace
Apex (PMI)

Question 6

Palpates impulses …

Answer 6

aortic
pulmonic
Apex

Question 7

Palpates for thrills

Answer 7

L sternal border (4th/5th interspace)

Apex

Question 8

Auscultate diaphragm

Answer 8

aortic (2 ICS on R sternal border)

Pulmonic (2 ICS on L sternal border)

3 let ICS

4th L ICS

5th L ICS (tricuspid)

Apex (mitral)

Question 9

Auscultate Bell

Answer 9

4th L ICS

5th L ICS

Apex (mitral)

Question 10

Auscultate augmentation

Answer 10

mitral valve with L LATERAL decubitis (Bell)

auscultate 3 or 4 ICS along L sternal border (diaphragm) = LEAN FORWARD EXHALE - aortic regurgitation

Question 11

Blood vessels (observe, palpate, auscultate)

Answer 11

observe neck veins for distention - tangential light (bilateral)

JVP (R side only, from sternal angle HOB 30)

Bilateral Palpate bilateral auscultate

Question 12

vessels palpated (BILATERAL) (10)

Answer 12

Temporal

Carotid

Brachial

Radial

Ulnar

Aorta

Femoral

Popliteal

Dorsalis pedis

Posterior tibialis

Question 13

BV auscultated BELL

Answer 13

temporal

carotid

aorta

renal

iliac

femoral

Question 14

special tests (7)

Answer 14

1. Allen’s test
2. measure calf circumference (BILATERAL )
3. measure thigh circumference
4. palpate for thighs tenderness
5. Homan’s sign
6. stemmers sign
7. LE arterial insufficiency

Question 15

Allen’s test

Answer 15

patient hand in fist

compress radial and ulnar

open fist

let go one at a time

repeat ea. artery and ea. side

Question 16

Homan’s sign

Answer 16

Bilateral

dorsiflex foot and squeeze calf

“Do you feel any pain?”

Question 17

Stemmer’s sign

Answer 17

pinch and lift skin fold at base of 2nd toe

Question 18

LE arterial insufficiency

Answer 18

elevate both legs 60 degrees

verbalize would do this for 30 seconds

look for vascular return after legs are dropped down