Cardiovascular Physical Exam Lab
Below are the elements of the physical exam that we will be performing today.
Please also refer to Bates (10th edition) ch 9: The Cardiovascular System (p348) & ch 12: The Peripheral Vascular System (p476).
General
Opening the Encounter
1. Introduction: Explain encounter, wash hands
The examiner introduces self to patient, explains what is about to happen, washes hands.
Vital Signs
1. Measurement: Pulse rate (radial)
Radial pulse is palpated (or heart is auscultated) while monitoring the time.
2. Measurement: Respiratory rate
Respirations are counted by observation, palpation, or auscultation over time.
3. Measurement: Blood pressure
Correctly sized cuff is applied & brachial pulse is palpated, then blood pressure is measured appropriately.
Cardiovascular Exam
Heart
1. Inspection and Palpation: Heaves, thrills, and PMI.
The total precordial area is inspected & palpated for heaves & thrills. The exact location of the PMI is palpated, in left lateral recumbent position if necessary.
2. Auscultation: 4 areas for heart sounds. Note apical pulse.
Auscultate for transmitted cardiac sounds in four areas (Aortic, Pulmonic, Tricuspid, Mitral), using the diaphragm & bell, while the patient is seated & supine. Note the apical pulse (S1) & correlate with the peripheral (radial) pulse.
3. Inspection: Neck vein distention and pulsations at 45 degrees
The neck veins are observed for distention or pulsations with the patient lying at a 45° angle.
4. Auscultation: Carotids, (using bell)
The carotids are auscultated using the bell while the patient pauses in breathing.
Extremities
5. Inspection: Extremities.
Inspect skin & hair distribution on extremities (observing skin for rashes, swelling, & color).
Fingernails are examined for clubbing, & capillary refill. Hands are examined (observing size, symmetry, swelling, and color).
6. Palpation: Differences in skin temperature. Assess edema.
Deliberately palpate the skin on extremities, using dorsum of the hand to note discrepancies of skin temperature. Edema should be assessed in the lower extremities or dependent regions.
7. Palpation: Peripheral Pulses Bilaterally
Palpate the radial, brachial, femoral, popliteal, posterior tibial, & dorsalis pedis pulses. Compare bilaterally.
Special Maneuver: Valsalva strain,
Listening to murmur while standing/squatting
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