Physical Exam of the Cardiovascular
System17
Four steps for the Cardiovascular (CV) Physical Exam (PE) of the neck - ANSWERS1. correctly
position patient
- supine with head 30-45 degrees and legs supported
2. Inspect jugular veins
- look for evidence of JVD or abnormal waves
3. Palpate carotid pulse bilaterally
- describe the amplitude
4. auscultate carotid arteries bilaterally (bruit vs. murmur)
- remind patient to refrain from breathing/talking for a few seconds
- remove nasal O2 briefly
Fours steps for the CV exam of the precordium (the front of the heart) - ANSWERS1. state
inspection for apical impulse
2. properly palpates for apical impulse
3. properly palpates and names all 4 valve areas
4. properly auscultates all 4 valve areas
Where do you palpate and auscultate the following areas?
1. Aortic Area
2. Pulmonic Area
3. Erbs point
4. Tricuspid Area
,5. Mitral Area - ANSWERS1. Aortic Area: 2nd ICS, right sternal border
2. Pulmonic Area: 2nd ICS, left sternal border
3. Erbs point: 3rd ICS, left sternal border
4. Tricuspid Area: 4th ICS, left sternal border
5. Mitral Area: 5th ICS, midclavicular line
Where should the PE exam be done? - ANSWERSin a quiet room with tangible lighting if
possible
How should the patient be positioned for a CV PE? - ANSWERSlying supine with the head/upper
body elevated at 30-45 degrees
- legs should be supported
"General" order of a CV PE (3) - ANSWERS1. inspection - seeing
2. palpation - feeling
3. auscultation - listening
*percussion is no longer used on CV exams*
An arrhythmia is suggested by an _________________ pulse. - ANSWERSirregular
What pulse will give you the most accurate heart rate? - ANSWERSapical pulse
What is the Heart Rate (HR) for someone who is tachycardic or bradycardic? - ANSWERStachy
>100
brady <60
, *normal = 60 - 100 beats per min*
What are the Respiration Rates (RR) for someone who is tachypnea or bradypnea? -
ANSWERStachy = RR >20
brady = RR <12
*normal RR = 12-20 breaths per min*
Cheyne-stokes respiration - ANSWERSalternating near apnea with hyperventilation
(hyperpnea --> apnea --> hyperpnea --> apnea)
Respiratory arrest - ANSWERScomplete cessation of breathing
What might a patient with respiratory difficulty present with? - ANSWERS1. cyanosis
- blueish coloration of nails, lips, nose, and fingers
*ALL due to hypoxia*
Why should you check the BP in both arms? - ANSWERSif you do not you will never know if the
patient has unequal pressures
- you need to treat a patient for hypertension dependent upon the highest value, so you could
miss hypertension in one arm
When taking a blood pressure what is the problem with having a cuff that is too big or too
small? - ANSWERStoo small = falsely high pressures
too big = falsely low pressures
System17
Four steps for the Cardiovascular (CV) Physical Exam (PE) of the neck - ANSWERS1. correctly
position patient
- supine with head 30-45 degrees and legs supported
2. Inspect jugular veins
- look for evidence of JVD or abnormal waves
3. Palpate carotid pulse bilaterally
- describe the amplitude
4. auscultate carotid arteries bilaterally (bruit vs. murmur)
- remind patient to refrain from breathing/talking for a few seconds
- remove nasal O2 briefly
Fours steps for the CV exam of the precordium (the front of the heart) - ANSWERS1. state
inspection for apical impulse
2. properly palpates for apical impulse
3. properly palpates and names all 4 valve areas
4. properly auscultates all 4 valve areas
Where do you palpate and auscultate the following areas?
1. Aortic Area
2. Pulmonic Area
3. Erbs point
4. Tricuspid Area
,5. Mitral Area - ANSWERS1. Aortic Area: 2nd ICS, right sternal border
2. Pulmonic Area: 2nd ICS, left sternal border
3. Erbs point: 3rd ICS, left sternal border
4. Tricuspid Area: 4th ICS, left sternal border
5. Mitral Area: 5th ICS, midclavicular line
Where should the PE exam be done? - ANSWERSin a quiet room with tangible lighting if
possible
How should the patient be positioned for a CV PE? - ANSWERSlying supine with the head/upper
body elevated at 30-45 degrees
- legs should be supported
"General" order of a CV PE (3) - ANSWERS1. inspection - seeing
2. palpation - feeling
3. auscultation - listening
*percussion is no longer used on CV exams*
An arrhythmia is suggested by an _________________ pulse. - ANSWERSirregular
What pulse will give you the most accurate heart rate? - ANSWERSapical pulse
What is the Heart Rate (HR) for someone who is tachycardic or bradycardic? - ANSWERStachy
>100
brady <60
, *normal = 60 - 100 beats per min*
What are the Respiration Rates (RR) for someone who is tachypnea or bradypnea? -
ANSWERStachy = RR >20
brady = RR <12
*normal RR = 12-20 breaths per min*
Cheyne-stokes respiration - ANSWERSalternating near apnea with hyperventilation
(hyperpnea --> apnea --> hyperpnea --> apnea)
Respiratory arrest - ANSWERScomplete cessation of breathing
What might a patient with respiratory difficulty present with? - ANSWERS1. cyanosis
- blueish coloration of nails, lips, nose, and fingers
*ALL due to hypoxia*
Why should you check the BP in both arms? - ANSWERSif you do not you will never know if the
patient has unequal pressures
- you need to treat a patient for hypertension dependent upon the highest value, so you could
miss hypertension in one arm
When taking a blood pressure what is the problem with having a cuff that is too big or too
small? - ANSWERStoo small = falsely high pressures
too big = falsely low pressures
