Lab Competency 1

Question 1

What is the pulse grading scale?

Answer 1

0 = no palpable pulse
1+ faint, but detectable
2+ more diminished pulse than normal
3+ normal pulse
4+: bounding pulse

Question 2

what are the heart rate norms for adults, children, toddlers, and newborns?

Answer 2

Average is 72 BPM
Adults: 60-100 BPM
Children: 70-120 BPM
Toddlers: 90-150 BPM
Newborns: 120-160 BPM

Question 3

What is the difference between a regular, irregular, and intermittent pulse

Answer 3

Regular: the time between beats is the same, and the beats are of the same strength

Irregular: the rhythm does not have an even pattern; the time between beats may change, or the strength of the beats may change or the pulse may vary in both time between beats and strength

Intermittent: the strength does not vary greatly, but a beat is skipped, either at regular or irregular intervals, but if the missing beats in an intermittent pulse were present, then the pulse rhythm would be normal

Question 4

Aortic area landmark for heart auscultation

Answer 4

2nd IC space to the R of sternum
best to hear S2

Question 5

Pulmonary area landmark for heart auscultation

Answer 5

2nd IC space to the L of sternum

Question 6

Erb’s Point/Murmers landmark for heart auscultation

Answer 6

3rd IC space to the L of sternum

Question 7

Tricuspid area for ausculation

Answer 7

4th/5th IC space (lower L sternal border)

tricuspid valve = R AV valve

Question 8

Apex landmark for heart auscultation (also called the mitral)

Answer 8

5th IC space (medial to midclavicular line)

Can hear S1 here well too

Question 9

How do you perform the ABI?

Answer 9

take the R arm, L arm blood pressure (take the highest reading)

take the R ankle (dorsal pedal, and posterior tibial) take the higher BP for the R ABI overall reading

take the L ankle (dorsal pedal and posterior tibial) take the higher BP for the L ABI overall reading

Take the LOWEST ABI reading of left or right to determine ABI

Question 10

interpret ABI findings

Answer 10

above 0.9 = normal

0. 71-0.90 = mild obstruction
1. 41-0.70 = moderate obstruction
2. 00-.40 = severe obstruction

• *0.5-0.9** = claudication and pain in calf with ambulation
• *0.2-0.5**= critical limb ischemia with atrophic changes, rest pain, and wounds
• *<0.2** = severe ischemia and gangrene/severe necrosis

Question 11

what are the general indications of an abnormal ABI?

Answer 11

PAD (diabetes mellitus)
DVT

Question 12

How do you perform the Rubor of Dependency?

Answer 12

1) observe color of both feet in supine or sitting
2) in supine, elevate one leg for 60 sec to 35-45 deg
3) observe foot color in supine (light pink is normal, chalky white or painful means arterial insufficiency)
4) lower the leg to dependent position (ie. sit them up)
5) time the color return to the color of the non-elevated foot

Question 13

What are abnormal findings for rubor of dependency?

Answer 13

light pink with foot elevated in supine
>20-30 seconds + bright red arterial color

abnormal result indication = arterial compromise

Question 14

where should you measure edema?

Answer 14

malleolus
[x] inches/cm from malleolus
[x] inches/cm from malleolus (second distance)

Question 15

what is the procedure for measuring edema?

Answer 15

examine circumferential measurements at 3 locations
document the distance from the bony landmark and the circumferential measurement

Question 16

What is the procedure for measuring pitting edema?

Answer 16

palpate the ankle and medial aspect of the tibia to detect

Question 17

what is the pitting edema scale?

Answer 17

0 = normal 
1+ = barely perceptible 
2+ = rebounds in \<15 sec 
3+ = rebounds in 15-30 sec 
4+ = rebounds in \> 30 sec 

edema is associated with CHF