Physical Exam (1) - Cardio Flashcards
parts of a physical examination
observation and inspection
palpation
auscultation
capillary refill time
edema
blood pressure
self care eval
what does the observation and inspection include
analysis of the MS and NM systems
analysis of MS and NM system –> O&I
posture
gait
muscle strength and tone
skin color and tone
facial expression
what is observed about the chest wall
shape and symmetry
observed from the front, back and sides
A-P diameter of the chest wall
should be less than the transverse diameter (medial to lateral)
what should we inspect –> O&I
skin
nails
lips
noting whether cyanosis or pallor is present
what are thoracic landmarks
imaginary lines on the surface
will help localize findings on physical exam
thoracic landmarks
midsternal line
right and left midclavicular lines
right and left anterior axillary lines
right and left midaxillary lines
right and left posterior axillary lines
vertebral line
right and left scapular lines
midsternal line
vertically down the middle of the sternum
midclavicular lines
parallel to the midsternal line
beginning at mid clavicle
R&L
anterior axillary lines
parallel to the midsternal line
beginning at the anterior axillary folds
R&L
midaxillary lines
parallel to the midsternal line
beginning at the mid axilla
R&L
posterior axillary lines
parallel to the midsternal line
beginning at the posterior axillary folds
R&L
posterior axillary lines
parallel to the midsternal line
beginning at the posterior axillary folds
R&L
vertebral line
vertically down the spinous process
scapular lines
parallel to the vertebral line
through the inferior angle of the scap when the pt is standing erect
R&L
what do thoracic landmarks do
help document our findings
what do we palpate
thorax and chest wall
pulses
what does palpation of the thorax and chest wall include
trachea
suprasternal notch
clavicles
manubrium
angle of loius
sternum
ribs
intercostal spaces
xiphoid processes of thoracic spine
how do we palpate
systematic way
what do we have to do prior to palpation
let the pt know what you are doing
pulses
carotid
brachial
radial
femoral
popliteal
dorsalis pedis
posterior tibialis
what do we want to know about pulses
rate
rhythm
what do we use for auscultation
stethoscope
to listen to the pt’s chest
where do we do ausculation
quiet setting
pt must be disrobed
any clothing will impede exam
technique of auscultation
do not rush
avoid lifting the stethoscope
what do we do instead of lifting the stethescope
“inch” it
from one site to another
where should auscultation be done on the body
5 areas of auscultation
not limited to these areas
5 areas of auscultation
aortic valve area
pulmonic valve area
second pulmonic area
tricuspid area
mitral area
aortic valve area
2nd intercostal space on the right of the sternal border
landmark for aortic valve area
angle of louie
angle of louie
go to the jugular notch then the manubrium then the angle of louie
move over to the right to the aortic valve area
pulmonic valve area
2nd left intercostal space at the left sternal border
second pulmonic area
third intercostal space on the left of the sternal border
tricuspid area
4th intercostal space on the left at the sternal border
what is the mitral area also called
apical
mitral area
at apex of the heart
5th intercostal space at the midclavicular line
cardiac cycle
heart contracts and relaxes rhythmically to ensure proper circulation
basic heart sounds
S1 and S2
S1 and S2
most distinct heart sounds
S1
result of the closure of the AV valves
mitral and tricuspid valves
what does S1 indicate
beginning of systole
where is S1 best heard
toward the apex of the heart
S1 sounds like
lubb
S2
result of closure of the semilunar valves
aortic and pulmonary
what does S2 indicate
end of systole
where is S2 best heard
aortic and pulmonic areas
