SAS 13

• AL Strategy: Turn and talk (Students turn to talk partner/s to – find out, summarize, clarify, share ideas, point of view or opinions)
• The patient should be comfortable and calm during the examination as anxiety may elevate the blood pressure or change the heart rate or rhythm.
• The examination gown has an opening in the front, which enables the nurse to open the gown only as necessary during the examination.
• The patient should be assisted onto the examination table and immediately draped with a sheet.
• The examination should be performed from the patient’s right side.
• The components of the cardiovascular examination include inspecting the face, looking for signs of anxiety, inspecting the great vessels of the neck, and discussing risk factors for coronary heart disease.
• The carotid pulse provides valuable information about cardiac function and is especially useful for detecting stenosis or insufficiency of the aortic valve.
• To assess the amplitude and contour of the carotid pulse, the patient should be lying down with the head of the bed elevated to about 30°.
• First inspect the neck for carotid pulsations, which may be visible just medial to the sternocleidomastoid muscles.
• Place your index and middle fingers on the right carotid artery in the lower third of the neck, press posteriorly, and feel for pulsations.
• A tortuous and kinked carotid artery may produce a unilateral pulsatile bulge.
• Causes of decreased pulsations include decreased stroke volume and local factors in the artery such as atherosclerotic narrowing or occlusion.
• Press just inside the medial border of a well-relaxed sternocleidomastoid muscle, roughly at the level of the cricoid cartilage.
• Avoid pressing on the carotid sinus, which lies at the level of the top of the thyroid cartilage.
• For the left carotid artery, use your right fingers.
• Never press both carotids at the same time as this may decrease blood flow to the brain and induce syncope.
• Slowly increase pressure until the maximal pulsation is felt, and then slowly decrease pressure until you best sense the arterial pressure and contour.
• The amplitude of the pulse correlates reasonably well with the pulse pressure.
• Use the bell at the apex, and then move medially along the lower sternum border.
• The bell is more sensitive to the low-pitched sounds of S3 and S4 and the murmur of mitral stenosis.
• The right ventricle of the heart can be palpated at the right 2nd intercostal space.
• The characteristic of the pulse of a patient who is suffering from aortic insufficiency is a slow, weak, and thready pulse.
• The diaphragm is better for picking up the relatively high-pitched sounds of S1 and S2, the murmurs of aortic and mitral regurgitation, and pericardial friction rubs.
• X-rays, ECG, and echocardiography provide accurate measurement.
• Palpation of the apical impulse can provide a rough size estimate.
• When assessing for any palpable thrills over the heart of the patient, Nurse Ikumi must use her index and the middle finger.
• Percussion is rarely used today to estimate cardiac size.
• When detecting the point of maximal impulse on the patient, the nurse must stand at the right side of the patient.
• Listen throughout the precordium with the diaphragm, pressing it firmly against the chest.
• Apply the bell lightly, with just enough pressure to produce an air seal with its full rim.
• Dextrocardia is a condition where the internal organs from the thoracic and abdominal cavity are found on the opposite sides from what is normal.
• Conditions that can exhibit thrills in a patient include aortic stenosis, patent ductus arteriosus, and ventricular septal defect.
• Resting the heel of your hand on the chest like a fulcrum may help you to maintain light pressure.
• The hepatojugular reflux is elicited by applying pressure on the patient’s abdomen in the right upper quadrant.
• When assessing the amplitude and contour of the patient’s carotid pulse, Nurse Sakura must place the patient in a supine position.
• When assessing the point of maximal impulse in a female patient, the nurse should instruct the patient to displace her left breast upward and laterally.
• If the nurse has accidentally pressed both carotid arteries at the same time while assessing the patient’s neck, it can lead to hypertension.
• The timing of the carotid upstroke in relation to S1 and S2 is crucial in correctly identifying S1 and S2, especially when the heart rate is increased and the duration of diastole, normally shorter than systole, is shortened and approaches the duration of systole.
• Press deeply in and upward and hold the pressure for 30 seconds.
• For much of the cardiac examination, the patient should be supine, with the upper body raised by elevating the head of the bed or table to about 30°.