FROM PREP TO PERFECTION! YOUR NUR 507 EXAM 2 A+
BLUEPRINT.
Cardiovascular assessment includes:
1. Cardiac vascular system
2. Peripheral vascular system
Cardia is performed with a __ exam.
pulmonary exam
Peripheral vascular is done when ____.
Examining the extremities.
Chest Pain requires you to use...
OPQRSTU pain scale
Cardiac Assessment (7)
1. Chest pain (at rest, with exertion)
2. Dyspnea (at rest, with exertion)
3. Orthopnea (SOB when lying down)
4. Paroxysmal noctural dyspnea (PND)
5. Peripheral edema
6. Past cardiac history
7. Cardiac risk factors
Cardiac risk factors
diabetes (#1 risk factor for CAD and sudden cardiac death)
family history
smoking
obesity
First step: Inspect (4 steps)
a. Lie px at 30 degrees
b. Look for pulsation (apical impulse b/t fourth and fifth rib) this is most easily seen in
children or thinner adults
c. Observe for a "heave" or a lift"
,d. Inspect vessels of the neck
Never palpate __ carotid arteries at ___.
Never palpate both carotid arteries at the same time.
Second Step: Palpate (feel) (7 steps)
a. palpate carotid arteries one at a time
b. apical impulse (point of maximal impulse)
c. heaves/lifts
d. thrills
e. left lateral decubitus position may be useful
f. should occupy only one interspace (4th or 5th) midclavical line of just medial
g. may not be palpable in various circumstances
Cardiac Ascultation mnemonic
"All Patients Eagerly Take Meds"
"All physicians enjoy taking money"
A-Aortic area
P- pulmonic area
E- Erb's point
T- tricuspid area
M- mitral apex
How many heart tones are there?
Five heart tones
Aortic area
second intercostal space along right sternal border
Pulmonic area
second intercostals space at left sternal border
Erb's point
third intercostal space at left sternal border
Tricuspid area
fifth intercostal space along the left sternal border
, mitral area
fifth intercostal space, midclavical line. This is where the PMI is found. Known as th
point of maximal impulse.
note: with enlarged hearts mitral area may present at anterior axillary line
Auscultation of Heart (2 types)
1. S1 and S2 heart sounds (use diaphragm at areas of A, P, E, T, M) and listen for "lub"
"dub" or S1, S2 sound
2. Apical pulse (left of sternum, b/t 4th and 6th ICS at MCL. 30 sec if regular, 60 sec if
irregular)
S1
closure of mitral, tricuspid valves.
beginning of systole
"LUB" (greater at apex)
S2
closure of aortic, pulmonic valves,
beginning of diastole
"DUB" (greater at base)
Cardiac Ascultation (4 things to know)
1. cardiac cycle
2. pulse deficit
3. extra heart sounds (split S1/S2, S3/S4 "gallop", murmurs/clicks/rubs)
BLUEPRINT.
Cardiovascular assessment includes:
1. Cardiac vascular system
2. Peripheral vascular system
Cardia is performed with a __ exam.
pulmonary exam
Peripheral vascular is done when ____.
Examining the extremities.
Chest Pain requires you to use...
OPQRSTU pain scale
Cardiac Assessment (7)
1. Chest pain (at rest, with exertion)
2. Dyspnea (at rest, with exertion)
3. Orthopnea (SOB when lying down)
4. Paroxysmal noctural dyspnea (PND)
5. Peripheral edema
6. Past cardiac history
7. Cardiac risk factors
Cardiac risk factors
diabetes (#1 risk factor for CAD and sudden cardiac death)
family history
smoking
obesity
First step: Inspect (4 steps)
a. Lie px at 30 degrees
b. Look for pulsation (apical impulse b/t fourth and fifth rib) this is most easily seen in
children or thinner adults
c. Observe for a "heave" or a lift"
,d. Inspect vessels of the neck
Never palpate __ carotid arteries at ___.
Never palpate both carotid arteries at the same time.
Second Step: Palpate (feel) (7 steps)
a. palpate carotid arteries one at a time
b. apical impulse (point of maximal impulse)
c. heaves/lifts
d. thrills
e. left lateral decubitus position may be useful
f. should occupy only one interspace (4th or 5th) midclavical line of just medial
g. may not be palpable in various circumstances
Cardiac Ascultation mnemonic
"All Patients Eagerly Take Meds"
"All physicians enjoy taking money"
A-Aortic area
P- pulmonic area
E- Erb's point
T- tricuspid area
M- mitral apex
How many heart tones are there?
Five heart tones
Aortic area
second intercostal space along right sternal border
Pulmonic area
second intercostals space at left sternal border
Erb's point
third intercostal space at left sternal border
Tricuspid area
fifth intercostal space along the left sternal border
, mitral area
fifth intercostal space, midclavical line. This is where the PMI is found. Known as th
point of maximal impulse.
note: with enlarged hearts mitral area may present at anterior axillary line
Auscultation of Heart (2 types)
1. S1 and S2 heart sounds (use diaphragm at areas of A, P, E, T, M) and listen for "lub"
"dub" or S1, S2 sound
2. Apical pulse (left of sternum, b/t 4th and 6th ICS at MCL. 30 sec if regular, 60 sec if
irregular)
S1
closure of mitral, tricuspid valves.
beginning of systole
"LUB" (greater at apex)
S2
closure of aortic, pulmonic valves,
beginning of diastole
"DUB" (greater at base)
Cardiac Ascultation (4 things to know)
1. cardiac cycle
2. pulse deficit
3. extra heart sounds (split S1/S2, S3/S4 "gallop", murmurs/clicks/rubs)
