Midterm Practical: Heart exam Flashcards
Patient/Table Position
Supine
Table Elevated 30 degrees
Gown Open Anteriorly
Dr. Stands on Pt’s Right Side
Blood Pressure Cuff Application
Arm supported @ Heart level
Artery marker over brachial artery
2.5cm Superior to Cubital Fossa
Snug w/ room for 2 fingers
Palpating for the Target Systolic Pressure
Find Radial pulse
Pump cuff until pulse is lost
Add 30 to estimate systolic
Taking Blood Pressure
Stethoscope on brachial artery (medial to bicep tendon)
Deflate cuff @ 3mmHg per second
Report within +/-5 mmHg
Upper Extremity Pulses (Name, Location, Time)
[Brachial]
Medial to Bicep Tendon
Palpate for 3-5 Seconds
[Radial]
Anterior Distal Radius
Palpate for 3-5 Seconds
Inspecting the Upper Extremities
1) Color, Temperature (use back of hand), Edema
2) Digital Clubbing (bulbous swelling of nail base)
3) Skin Turgur (decreased stays elevated for several seconds
4) Capillary Refill
Cause of Decreased Turgur
Dehydration
Capillary refill (time to hold) (normal refill time)
Hold for 5 seconds
Normal Refill: approximately 2 Seconds
Lower Extremity Pulses (Name, Location, Time)
[Posterior Tibial]
Posterior to the Medial Malleolus
Palpate for 3-5 seconds
[Dorsalis Pedis]
Dorsum of Foot
Palpate for 3-5 seconds
Lower Extremity Inspection
1) Color, Temperature (use back of hand), Absence of Hair
2) Pitting Edema: “if pit remains after I release, this is pitting edema”
3) Capillary refill
Cause and Location of checking Pitting Edema
DVT
Shin, Dorsum of foot & posterior to medial malleolus
Capillary Refill (hold time) (normal refill time)
Hold for 5 seconds
Normal Refill: approximately 2 seconds
Observe Jugular Venous Pulsation (JVP)
Use Tangenital Lighting
“Right internal jugular vein used to locate JVP”
“Internal Jugular vein located lateral and deep to sternal insertion of SCM”
JVP indicative of “venous pressure”
Normal Height of JVP
From Sternal Angle of Louis: less than or equal to 3cm
Cause of JVP
Right Sided Heart Failure
Observe Precordium for Visible Pulsations
Visualize apical pulse using tangenital lighting
State normal location of apical pulse
State what the apical pulse represents
Normal Location of Apical Pulse
Left 5th Intercostal @ Mid-Clavicular Line
Apical pulse Represents what?
Left Lateral Border of the Heart
Attempt to visualize any other visible pulsations
Using tangenital Lighting
Pathology in an Abnormal Visible Pulsation
Enlarged Ventricles
Palpate Carotid Artery (Fingers, Time, Normal Heart Rate)
Use 2 fingers @ Cricoid Cartilage Level
(Medial to SCM)
Hold Palpations for 3-5 seconds
Normal HR: 60-100 bpm
Palpate Apical Pulse/PMI
Shield Breats
Start with pads of hands over the Mitral Area
Isolate Pulse with a single finger
Lateral PMI ->
“PMI that is lateral to the mid Clavicular line may represent cardiomegaly”
Palpate for Heave and Lifts
Shield breats
Place Finger Pads flat against chest in Intercostal Spaces
“Heaves & Lifts are sustained pulses that rhythmically lift my fingers”
Pathology resulting in a Lift or Heave
Enlarged ventricles
Palpate for Thrills
Shield Breasts
Place ball of hand firmly on chest
“Thrill is a buzzing sensation caused by Underlying Turbulent Blood Flow”
Pathology that could cause a Thrill
Valvular Stenosis
Percussion
State “percussion is used to estimate size of heart if PMI cant be located during observation or Palpation”
Explain Auscultation To Patient
Patient breathes normally
All Patients Sheild Breasts
State Location of all 6 Listening Spots & What Valve is heard best at them
2nd Right ICS: Aortic
2nd Left ICS: Pulmonic
3rd Left ICS: Aortic & Pulmonic [Erb’s Point]
4th and 5th Left ICS: Tricuspid
5th Left ICS @ Mid-Clavicular line: Mitral
Auscultate 6 Listening Spots (with Diaphragm)
3-5 seconds each with diaphragm
Say “diaphragm used for high-pitched” sounds
Name a high-pitched heart sound: S1
Auscultate 6 Listening Spots (with Bell)
3-5 seconds each
Say “Bell is used for low-pitched sounds”
Name a low-pitched heart sound: S3
Palpate Carotid Artery during Auscultation of 6 Spots
With BOTH Bell and Diaphragm
Say “carotid upstroke facilitates identification of systole and diastole (S1 & S2)”
Say “S1 falls just before Carotid upstroke and S2 follows the Carotid Upstroke
Name 2 Abnormal Heart Sounds & Their Causes
Rub: Pericarditis
Murmur: Stenosis or Regurgitation
Exam Sequence of the Heart Exam
Upper Extremity
Lower Extremity
Chest Inspection
Palpation
Percussion???
Auscultation
