lOMoARcPSD|28964921
6512 Final Review Feb2020
Advanced Health Assessment (Walden University)
Studocu is not sponsored or endorsed by any college or university
Downloaded by john gatheca ()
, lOMoARcPSD|28964921
NURS 6512 Final Exam Review (Week 7-11)
Heart, Lungs, and Peripheral Vascular
Examination techniques of the Heart, Lungs, and PV systems
Examination techniques of the Heart:
Inspection - use tangential lighting; stand to the patient’s right, patient should sit erect
and lean forward, lye supine, and left lateral recumbent position; apical pulse
midclavicular line 5th left intercostal space; check the skin for cyanosis, venous
distention, nail bed for cyanosis and capillary refill time
Palpation - patient supine, palpate the precordium, use proximal halves of the 4 fingers
or whole hand; being at apex, move inferior to left sternal border, then up the sternum
to the base and down the right sternal border in the epigastrium or axillae; apical pulse
seen at point of maximal impulse; feel for a thrill – fine, palpable, rushing, vibration, a
palpable murmur, over the base of the heart; locate each sensation in terms of its
intercostal space and relationship to the midsternal, midclavicular, or axillary lines; when
palpating the precordium, use your other hand to palpate the carotid artery
Percussion - limited value by defining the borders of the heart or determining its size
because the shape of the chest is rigid; a chest radiograph useful in defining the heart
border; begin tapping at the anterior axillary line, moving medially along the intercostal
spaces toward the sternal border; resonant to dull marks the border;
Auscultation - listen to all 5 of the cardiac areas using the diaphragm first then the bell;
use firm pressure with the diaphragm and light pressure with the bell; 5 cardiac areas –
aortic valve, pulmonic valve, second pulmonic, tricuspid, mitral; assess rate and rhythm,
have patient breath normally then hold the breath in expiration, listen for S1 while
palpating the carotid pulse; have the patient inhale deeply, listen closely for S2 during
inspiration; basic heart sounds pitch, intensity, duration, and timing in the cardiac cycle;
4 basic heart sounds S1, S2, S3, S4
Examination techniques of the lungs:
Chest/Lungs – Inspect the chest, front, back, noting thoracic landmarks of and shape of
anteroposterior (AP) diameter compared with the lateral diameter, symmetry, color,
superficial venous patterns, prominence of ribs Inspection; patient sit upright,
unclothed, using tangential light
Retractions and deformity e.g. minimal pectus excavatum are difficult to detect; pigeon
chest, funnel chest, barrel chest seen with chronic condition
AP diameter less than lateral diameter; if they equal each other, chronic condition
present – e.g. barrel chest related to chronic asthma, emphysema
Evaluate respirations for rate and rhythm – respiratory rate is 12-20 per minute;
respirations to heartbeats is a 1:4 ratio;
Downloaded by john gatheca ()
, lOMoARcPSD|28964921
Rhythm – breathe easily, regularly, with no apparent distress; variations – to shallow or
to deep; tachypnea – rapid breathing, Kussmal – deep and rapid, Cheyene-Stokes –
regular periods of breathing with intervals of apnea followed by a
crescendo/decrescendo sequence of respiration
Inspect chest movement with breathing for symmetry and use of accessory muscles;
retractions are seen when the chest wall seems to cave in at the sternum
Palpate the chest for thoracic expansion, sensations such as crepitus (palpated and
heard) - gently bubbling feeling, grating vibrations,
Tactile fremitus (palpable vibration of the chest wall that occurs from speech), best felt
posteriorly, use phrase “99” or “Mickey Mouse”, palpate both sides simultaneously and
symmetrically; increased fremitus fluid or solid mass is present, decreased is excess air in
the lungs
Thoracic expansion evaluation – stand behind patient, place thumbs along spinal process
of the tenth rib with palms lightly in contact with posterolateral surfaces, thumbs will
diverge during quiet and deep breathing
Palpate for pulsations, tenderness, bulges, depressions, masses, and unusual movement
Pleural friction rub – grating, coarse vibration, on inspiration, e.g. leather rubbing on
leather
Perform direct or indirect percussion of the chest, comparing both sides for
diaphragmatic excursion, percussion tone intensity, pitch, duration, and quality - tap
sharply and consistently from the wrist; examine back of patient while sitting with the
head bent forward and arms folded in front, then have patient raise arms overhead
while percussing the later and anterior chest
Resonance heard over all areas of the lungs, hyperreasonance heard with hyperinflation
(emphysema, asthma), dullness or flatness suggests pneumonia or atelectasis
Diaphragmatic excursion – the movement of the thoracic diaphragm during inhalation
and exhalation; pg. 274 Dains – pt. Take breath, hold it, percuss scapular line locating
lower border, mark the point where resonance changes to dullness, mark with a marking
pen, allow the patient to breathe, then repeat the procedure on the other side, have the
patient take several breaths to exhale as much as possible and then to hold; percuss up
from the marked point and make a mark at the change from dullness to resonance,
have the patient start to breathe and then repeat on the other side; measure and record
the distance in cm between the marks on each side, distance is usually 3-5 cm
Auscultate the chest with the stethoscope diaphragm, from apex to base, comparing
both sides for intensity, pitch, duration, quality of breath sounds, unexpected breath
sounds (crackles, rhonchi, wheezes, friction rubs) and vocal resonance; have pt. Sit up
and breathe slowly and deeply through the mouth; have the patient sit the same way as
for percussion; also have the patient sit erect with shoulder back for auscultation of the
anterior chest
Breath sounds – vesicular, bronchovesicular and bronchial pg. 276; adventitious breath
sounds – crackles (formerly rales), rhonchi, wheezes, friction rub
Vocal resonance – spoken voice transmits through the lung fields that may be heard with
the stethoscope, have patient recited numbers, names and other words
Downloaded by john gatheca ()
, lOMoARcPSD|28964921
Examination techniques of the peripheral vascular system:
Peripheral Arteries – palpation occurs best over the arteries, close to the surface, that lie
over bones; when palpating the carotid, never palpate both sides simultaneously;
palpate at least one pulse point in each extremity, usually at the most distal point;
perform the Allen test (pg. 340) to ensure ulnar artery patency prior to radial artery
puncture; the thumb can be used to fix the brachial or femoral pulse; palpate the arterial
pulses to assess heart rate, rhythm, pulse control, amplitude, symmetry, and
occasionally sometimes obstructions to blood flow
Carotid, brachial, radial, femoral, popliteal, dorsalis pedis, and posterior tibial arteries
Observe for signs of cyanosis, lip pursing, finger clubbing, alae nasi for flaring – any signs
of this suggest cardiac or respiratory difficulty
Alae nasi flaring – sign of air hunger
Clubbing – enlargement of the terminal phalanges of the fingers/and or toes; seen
with emphysema, lung cancer, cystic fibrosis, congenital heart disease
Auscultation – use the bell of the stethoscope over the artery, auscultate for a bruit over
the carotid, subclavian, abdominal aorta, renal, iliac, and femoral arteries; when
listening to the carotid, have the patient suspend their breathing for a few seconds;
assess the degree of peripheral artery degree – patient lie supine, elevate extremity,
note degree of blanching, have patient sit on edge of bed to lower the extremity, note
time for return of color to extremity; assess capillary refill; jugular venous pressure –
pg.342. Assess Homan sign, edema, and varicose veins
Examination findings of arterial blood flow in infants
Examination findings of arterial blood flow in infants - arterial blood flow in infants; after the
umbilical chord is cut, blood flows to the lungs at a higher pace, pulmonary arteries expand and
relax which decreases the resistance of systemic circulation; the decrease leads to closure of the
foramen ovale shortly after birth, increased oxygen tension in the arterial blood usually
stimulates contraction and closure of the ductus arteriosus
Examination findings of the heart and lungs in a patient with illegal
drug use
Examination findings of the heart and lungs in a patient with illegal drug use - severe chest pain
associated with cocaine use, tachycardia, hypertension, coronary arterial spasm and
pneumothorax with acute chest pain are symptoms
Downloaded by john gatheca ()
6512 Final Review Feb2020
Advanced Health Assessment (Walden University)
Studocu is not sponsored or endorsed by any college or university
Downloaded by john gatheca ()
, lOMoARcPSD|28964921
NURS 6512 Final Exam Review (Week 7-11)
Heart, Lungs, and Peripheral Vascular
Examination techniques of the Heart, Lungs, and PV systems
Examination techniques of the Heart:
Inspection - use tangential lighting; stand to the patient’s right, patient should sit erect
and lean forward, lye supine, and left lateral recumbent position; apical pulse
midclavicular line 5th left intercostal space; check the skin for cyanosis, venous
distention, nail bed for cyanosis and capillary refill time
Palpation - patient supine, palpate the precordium, use proximal halves of the 4 fingers
or whole hand; being at apex, move inferior to left sternal border, then up the sternum
to the base and down the right sternal border in the epigastrium or axillae; apical pulse
seen at point of maximal impulse; feel for a thrill – fine, palpable, rushing, vibration, a
palpable murmur, over the base of the heart; locate each sensation in terms of its
intercostal space and relationship to the midsternal, midclavicular, or axillary lines; when
palpating the precordium, use your other hand to palpate the carotid artery
Percussion - limited value by defining the borders of the heart or determining its size
because the shape of the chest is rigid; a chest radiograph useful in defining the heart
border; begin tapping at the anterior axillary line, moving medially along the intercostal
spaces toward the sternal border; resonant to dull marks the border;
Auscultation - listen to all 5 of the cardiac areas using the diaphragm first then the bell;
use firm pressure with the diaphragm and light pressure with the bell; 5 cardiac areas –
aortic valve, pulmonic valve, second pulmonic, tricuspid, mitral; assess rate and rhythm,
have patient breath normally then hold the breath in expiration, listen for S1 while
palpating the carotid pulse; have the patient inhale deeply, listen closely for S2 during
inspiration; basic heart sounds pitch, intensity, duration, and timing in the cardiac cycle;
4 basic heart sounds S1, S2, S3, S4
Examination techniques of the lungs:
Chest/Lungs – Inspect the chest, front, back, noting thoracic landmarks of and shape of
anteroposterior (AP) diameter compared with the lateral diameter, symmetry, color,
superficial venous patterns, prominence of ribs Inspection; patient sit upright,
unclothed, using tangential light
Retractions and deformity e.g. minimal pectus excavatum are difficult to detect; pigeon
chest, funnel chest, barrel chest seen with chronic condition
AP diameter less than lateral diameter; if they equal each other, chronic condition
present – e.g. barrel chest related to chronic asthma, emphysema
Evaluate respirations for rate and rhythm – respiratory rate is 12-20 per minute;
respirations to heartbeats is a 1:4 ratio;
Downloaded by john gatheca ()
, lOMoARcPSD|28964921
Rhythm – breathe easily, regularly, with no apparent distress; variations – to shallow or
to deep; tachypnea – rapid breathing, Kussmal – deep and rapid, Cheyene-Stokes –
regular periods of breathing with intervals of apnea followed by a
crescendo/decrescendo sequence of respiration
Inspect chest movement with breathing for symmetry and use of accessory muscles;
retractions are seen when the chest wall seems to cave in at the sternum
Palpate the chest for thoracic expansion, sensations such as crepitus (palpated and
heard) - gently bubbling feeling, grating vibrations,
Tactile fremitus (palpable vibration of the chest wall that occurs from speech), best felt
posteriorly, use phrase “99” or “Mickey Mouse”, palpate both sides simultaneously and
symmetrically; increased fremitus fluid or solid mass is present, decreased is excess air in
the lungs
Thoracic expansion evaluation – stand behind patient, place thumbs along spinal process
of the tenth rib with palms lightly in contact with posterolateral surfaces, thumbs will
diverge during quiet and deep breathing
Palpate for pulsations, tenderness, bulges, depressions, masses, and unusual movement
Pleural friction rub – grating, coarse vibration, on inspiration, e.g. leather rubbing on
leather
Perform direct or indirect percussion of the chest, comparing both sides for
diaphragmatic excursion, percussion tone intensity, pitch, duration, and quality - tap
sharply and consistently from the wrist; examine back of patient while sitting with the
head bent forward and arms folded in front, then have patient raise arms overhead
while percussing the later and anterior chest
Resonance heard over all areas of the lungs, hyperreasonance heard with hyperinflation
(emphysema, asthma), dullness or flatness suggests pneumonia or atelectasis
Diaphragmatic excursion – the movement of the thoracic diaphragm during inhalation
and exhalation; pg. 274 Dains – pt. Take breath, hold it, percuss scapular line locating
lower border, mark the point where resonance changes to dullness, mark with a marking
pen, allow the patient to breathe, then repeat the procedure on the other side, have the
patient take several breaths to exhale as much as possible and then to hold; percuss up
from the marked point and make a mark at the change from dullness to resonance,
have the patient start to breathe and then repeat on the other side; measure and record
the distance in cm between the marks on each side, distance is usually 3-5 cm
Auscultate the chest with the stethoscope diaphragm, from apex to base, comparing
both sides for intensity, pitch, duration, quality of breath sounds, unexpected breath
sounds (crackles, rhonchi, wheezes, friction rubs) and vocal resonance; have pt. Sit up
and breathe slowly and deeply through the mouth; have the patient sit the same way as
for percussion; also have the patient sit erect with shoulder back for auscultation of the
anterior chest
Breath sounds – vesicular, bronchovesicular and bronchial pg. 276; adventitious breath
sounds – crackles (formerly rales), rhonchi, wheezes, friction rub
Vocal resonance – spoken voice transmits through the lung fields that may be heard with
the stethoscope, have patient recited numbers, names and other words
Downloaded by john gatheca ()
, lOMoARcPSD|28964921
Examination techniques of the peripheral vascular system:
Peripheral Arteries – palpation occurs best over the arteries, close to the surface, that lie
over bones; when palpating the carotid, never palpate both sides simultaneously;
palpate at least one pulse point in each extremity, usually at the most distal point;
perform the Allen test (pg. 340) to ensure ulnar artery patency prior to radial artery
puncture; the thumb can be used to fix the brachial or femoral pulse; palpate the arterial
pulses to assess heart rate, rhythm, pulse control, amplitude, symmetry, and
occasionally sometimes obstructions to blood flow
Carotid, brachial, radial, femoral, popliteal, dorsalis pedis, and posterior tibial arteries
Observe for signs of cyanosis, lip pursing, finger clubbing, alae nasi for flaring – any signs
of this suggest cardiac or respiratory difficulty
Alae nasi flaring – sign of air hunger
Clubbing – enlargement of the terminal phalanges of the fingers/and or toes; seen
with emphysema, lung cancer, cystic fibrosis, congenital heart disease
Auscultation – use the bell of the stethoscope over the artery, auscultate for a bruit over
the carotid, subclavian, abdominal aorta, renal, iliac, and femoral arteries; when
listening to the carotid, have the patient suspend their breathing for a few seconds;
assess the degree of peripheral artery degree – patient lie supine, elevate extremity,
note degree of blanching, have patient sit on edge of bed to lower the extremity, note
time for return of color to extremity; assess capillary refill; jugular venous pressure –
pg.342. Assess Homan sign, edema, and varicose veins
Examination findings of arterial blood flow in infants
Examination findings of arterial blood flow in infants - arterial blood flow in infants; after the
umbilical chord is cut, blood flows to the lungs at a higher pace, pulmonary arteries expand and
relax which decreases the resistance of systemic circulation; the decrease leads to closure of the
foramen ovale shortly after birth, increased oxygen tension in the arterial blood usually
stimulates contraction and closure of the ductus arteriosus
Examination findings of the heart and lungs in a patient with illegal
drug use
Examination findings of the heart and lungs in a patient with illegal drug use - severe chest pain
associated with cocaine use, tachycardia, hypertension, coronary arterial spasm and
pneumothorax with acute chest pain are symptoms
Downloaded by john gatheca ()
