Lab 1: CVP Examination and Evaluation Flashcards
What does a 0 mean on the pulse scale?
Absent
Pulse is Palpable, but thready and weak; easily obliterated. What is its rating
1+
Pulse is normal, easily identified; not easily obliterated. Whats its rating
2+
Increased pulse; moderate pressure for obliteration. Whats its rating
3+
Pulse is full, bounding; cannot obliterate. Whats its rating
4+
Tasked w/ locating carotid, brachial, radial, femoral, popliteral, dorsalis pedis, and posterior tibial pulse in this lab.
Explain how to palpate the carotid artery pulse
The common carotid artery is palpated on the neck below the jaw and latearl to the larynx/trachea (i.e., mid-point between your earlobe and chin) using the middle and index fingers.
How is the Brachial artery pulse found
The brachial artery is palpated on the anterior aspect of the elbow by gently pressing the artery againt the underlying bone with the middle and index fingers. The brachial artery pulse is commonly used to measure blood pressure with a stethoscope and sphygomanometer
Explain how to palpate the radial artery pulse
The radial pulse is palpated immediately above the wrist joint near the base of the thumb, or the anatomical snuff box, by gently pressing the radial artery against the underlying bone w/ the middle and index fingers
Explain how to palpate the femoral pulse
Palpated over the ventral thigh between the pubic symphysis and anterior superior iliac spine w/ the middle and index fingers
Explain how to find the popliteral pulse
The popliteal pulse is palpated on the posterior knee with the middle and index fingers; this pulse is more difficult to palpate as compared to other pulse sites
Explain how to palpate the posterior tibial pulse
The posterior tibial pulse is palpated posterior and inferior to the medial malleolus by gently pressing the tibial artery against the underlying bone with the middle and index fingers
Explain how to find the dorsalis pedis pulse
The dorsalis pedis pulse is palpated in the groove between the first and second toes slightly medial on the dorsum of the foot (i.e., dorsal latearl to the extensor hallucis longus tendon and distal to the dorsal prominence of the navicular bone) with the middle and/or index fingers
What position is the pt in when listening to the heart?
Supine
Can the pt keep their shirt on while listening to the heart?
No
Where is the aortic area located?
near the second intercostal space just to the right of the sternum
Where is the pulmonic area located>
Second intercostal space to the let of the sternum
where is the tricuspid area located?
lower left sternal border around the fourth or fifth intercostal space
Where is the mitral area located?
Apex of the heart, usually in the firth left intercostal space, medial to the midclavicular line
Lungs:
* pt should be in a quiet room in a sitting position with bare skin exposed and should breathe deeply but slowly through an open mouth
* Using the diaphragm of the stethoscope, systematically listen to the entire lung space (anterior and then posterior and latearl, or vice versa) with at least one breath per bronchopulmonary segment, alternating between similar location on the right and left sides and comparing intensity, pitch, and quality, while moving from the upper to lower chest.
Precaustions:
* pts who are weak or have poor balance or orthostatic intolerance should be offered additional support in the sitting position to prevent falling
* The therapist should move slowly from one pulmonary segment to the next in order to avoid patient dizziness as a result of hyperventilation from deep breaths being performed too rapidly
* Appropriate draping should be maintained during ausculation
Common erros when listening to lungs: listening to breath sounds through the patients gown (the stethoscope should be placed directly against the pts chest wall)
Auscultation of BP:
BP cuff:
1) The relaxed subject sits on a char with back supported and feed uncrossed
2) The cuff of the sphygmomanometer is wrapped firmly around the left arm above the elbow (1 inch above antecubital fossa, the bend of the elbow)
3) The arm should be resting on a table top or bench or supported by therapist at approximately the level of the heart. There is a slight bend to elbow
4) Palpate brachial artery and align arrow of BP cuff with artery
Set up stethoscope
1) Palpate brahcial pulse, medial to bicep tendon and palce diaphragm
2) make sure diaphgram is activated by tapping diaphragm and you should hear tapping. if not, twist so diaphragm and not bell is activated
3) Note no sound should be heard when diaphragm is palced on brachial artery
close valve on inflating bulb to clockwise to close
inflate cuff to between 200-250mmHg
The valve on the inflating bulb is opened slightly by turning it in the counterclockwise direction, allowing the pressure to drop slowly by about 2-3 mm Hg/sec
When the first knocking sound is heard, this point marks the systolic pressure
As the pressure is lowered further, the charcter of the sounds change, When the sound disappear, this point marks the diastolic pressure
No more than 3 BP’s consectively. BEtween BP wait at least 1 minute. After 3 BP’s wait at least 3 minutes
The bell (smaller allows low frequency sounds, which permits hearing gallops and rumbles. The diaohragm is for high frequency sounds and used for taking BP
BP
Sternal precuations:
* healing the sternum usually takes 6 to 8 weeks. The amount of restriction and the time period vary widely from surgeon to surgeon but normally fall in the range of not more than 10 to 20 pounds for 6 to 12 weeks
* No lifting more than 5-10 pounds
* No reaching behind the back; and
* No pushing or pulling through the arms
Patients are also restricted from doing pushups and other strenuous resistive exercises involving the pectoralis muscles for 3 to 4 months or more. Furthermore, most physicians require modifications to assisted transfers and ambulation with a walker or crutches to minimize sternal stress
