Module 5 Heart & Peripheral Vascular System

Question 1

Heart assessment

Answer 1

Neck vessels
Inspect precordium
Auscultate precordium (area of chest wall over the heart)
Diaphragm
Bell

Question 2

PVS assessment

Answer 2

Inspect & palpate arms
Inspect & palpate legs

Question 3

Neck vessels:
Cardiovascular assessment includes

Answer 3

survey of vascular structures in neck
• Carotid artery
• Jugular veins
• These vessels reflect efficiency of cardiac
function

Question 4

Neck vessels:
Palpate carotid arteries

Answer 4

• Palpate each carotid artery
medial to sternomastoid
muscle in lower half of
neck; palpate gently
• Palpate only one carotid
artery at a time
• Assess amplitude of pulse
• Findings should be same
bilaterally

Question 5

Neck vessels
Auscultate carotid arteries

Answer 5

• For persons middle-aged or older, or who
show symptoms or signs of cardiovascular
disease, auscultate each carotid artery for
presence of a bruit

A bruit is a blowing, swishing sound indicating
blood flow turbulence; normally none is
present

Question 6

Neck vessels
Jugular Venous Pressure

Answer 6

Indication of heart’s efficiency as a pump and
intravascular volume status, or Central
Venous Pressure (CVP)

Question 7

Heart Inspection
Precordium

Answer 7

During contraction, apex beats against chest
wall, producing an apical impulse
• May be visible in 4th or 5th ICS @ or medial to
L) MCL
• Abnormal pulsations, such as a heave or lift
may be visible

Question 8

Heart - Auscultation

Answer 8

Auscultate with the diaphragm of the
stethoscope to assess heart rate,
rhythm & sounds

Question 9

Pneumonic for heart auscultation
All People Enjoy Time Magazine

Answer 9

1. All- Aortic Area (2nd intercostal space)
2. Ppl- Pulmonic area (2nd intercostal space)
3. Enjoy- Erbs Point (3rd intercostal space)
4. Time- tricuspid area (4th or 5th intercostal space)
5. Magazine- mitral area/ apex (5th intercostal space)

Question 10

Heart Sounds: S1

Answer 10

S1- Closure of mitral & tricuspid valves
Louder at apex
Onset of systole
Synchronous with carotid pulse
High pitched
“Lubb”

Question 11

Heart Sounds: S2

Answer 11

• S2- Closure of aortic & pulmonic valves
Louder at base
Onset of diastole
High pitched
“Dubb”

Question 12

Heart sounds: S3

Answer 12

S3- Ventricular filling in early diastole
Heard at apex or L) lower sternal
border
Lower pitched
Rhythm of sound resembles
rhythm of Ken-TUCK-y
Signifies decreased ventricular
compliance; early sign of heart
failure

Question 13

Heart sounds: S4

Answer 13

S4- Ventricular filling in late diastole
due to atrial contraction
Heard at apex
Lower pitched
Rhythm of sound resembles
rhythm of TEN-nes-see
Signifies increased resistance to
filling due to loss of ventricular
wall compliance

Question 14

When do you use the bell for auscultating?

Answer 14

Use the bell to listen to the 5 precordial
areas, in reverse order, for lower
pitched sounds, such as S3, S4 and
murmurs
• Murmurs are prolonged extra sounds
during systole or diastole, due to
turbulent blood flow in the heart or great
vessels
• Helpful to also auscultate with client in
L) lateral position & sitting up & leaning
forward

Question 15

PVS: upper extremities

Answer 15

• Inspect, then turn person’s hands over,
  noting color of skin and nailbeds;
  temperature, and the presence of any
  edema or clubbing
  • Assess peripheral perfusion and
  cardiac output by checking capillary
  refill

Question 16

PVS: upper extremities

Answer 16

Palpate radial, ulnar & brachial pulses
for rate, rhythm and amplitude
• Grade amplitude from 0-3+

Question 17

PVS: lower extremities

Answer 17

• inspect both legs together, noting skin
  color, hair distribution, venous pattern,
  size (swelling or atrophy), and any skin
  lesions or ulcers
  • Palpate skin temperature
  • Palpate calf for tenderness

Question 18

PVS:lower extremities

Answer 18

Palpate pulses:
Femoral
Popliteal
Posterior Tibial
Dorsalis Pedis
• Grade amplitude

Question 19

PVS: lower extremities

Answer 19

• Palpate for peripheral edema over tibia or
medial malleolus
• Determine if edema is unilateral or bilateral
• Determine if edema is pitting or non-pitting
• Grade degree of pitting:
1+ Mild pitting, slight indentation, no perceptible swelling
2+ Moderate pitting, indentation subsides rapidly
3+ Deep pitting, indentation remains, leg looks swollen
4+ Very deep pitting, indentation lasts long time, leg very swollen

Question 20

Inspect saphenous system

Answer 20

Varicosities – dilated,
tortuous veins d/t
incompetent valves or
vessel wall weakness

Question 21

If you can’t palpate dorsal pedis pulse,

Answer 21

Use Doppler

Question 22

Vascular amplitude scale

Answer 22

0: absent
1+ weak
2+ normal
3+ full/bounding