3- physical exam of CVS

“low volume” pulse is also called

“tready” or “weak” pulse

“high volume” pulse is also called

“bounding” or “strong” pulse

during an emergency, pulse volume dictates patient _____

positioning

what position should the pt be in if they have a tready pulse

horizontal/head-down/Trendelenburg position → brings blood back to heart

what position should the pt be in if they have a bounding pulse

semi-sitting position → slows return of blood to heart

which fingers should you use to feel pulse

index + middle finger

how many fingers do you use to feel pulse on older pts

prevent slipping + stabilize the artery w/ 2-4 fingers

how do you take radial pulse

using 2 or more fingers

T/F: you must count pulse after the pt is relaxed

true

how long do you count pulse for

1 minute

how do you take carotid pulse

1. have pt flex neck to relax platysma

2. locate anterior border of SCM

3. place 2 fingers along border in middle of neck

4. press down firmly towards midline

why should you never take carotid pulse at angle of the mandible

this can massage the carotid sinus → slowing the pulse

T/F: never take carotid pulse on both sides at the same time

true, can be dangerous esp in older pts

carotid pulse is most frequently used during

medical emergencies

T/F: you should feel each carotid separately

true

what do you do if the HR is not the same on both sides of the carotid

auscultate (listen) for carotid bruit

how do you listen for carotid bruit

1. have pt hold their breath

2. place stethoscope over carotid w/ lesser pulse in middle of the neck

3. listen for “swooshing sound” caused by turbulence of the blood flow through a narrowed or partially obstructed arterial lumen

if there’s a carotid bruit, you should assess for what 2 things

1. transient ischemic attacks (TIAs)

2. cerebrovascular accidents/strokes (CVAs)

how do you take brachial pulse

1. position pt’s arm w/ palm facing ceiling

2. go upwards on medial side on arm, above elbow

3. support pt’s arm w/ your hand + feel pulse w/ 2 fingers

brachial pulse is taken on what pts

children during medical emergencies

using a stethoscope over the brachial artery monitors what

Korotkoff sounds

what happens if you use a BP cuff that’s too small

overestimation of BP

what happens if you use a BP cuff that’s too big

underestimation of BP

where should the arm be when taking BP

brachial artery must be at cardiac level

what happens if the arm is above heart level when taking BP

underestimation of BP

what happens if the arm is below heart level when taking BP

overestimation of BP

how many BP do you take at the pt’s 1st visit

2

what do you do if the pt has elevated readings at their 1st visit

take 2 more readings at the end of the visit

how many reading are needed for diagnosis of HTN

2-4 readings

what’s the auscultatory gap

absence of Korotkoff sounds between SBP + DBP readings, occurs in some HTN pts

failure to recognize the auscultatory gap can lead to

• serious underestimation of the SBP

• serious overestimation of the DBP

you must inflate the BP cuff to ___ mmHg in all patients

200 mmHg

what’s pulse pressure

difference between SBP + DBP

high pulse pressure is associated w/ what

uncontrolled hyperthyroidism

low pulse pressure is associated w/ what

uncontrolled hypothyroidism

what’s the BP readings for stage 1 HTN

• SBP: 130-139

• DBP: 80-89

what’s the BP readings for stage 2 HTN

• SBP: >140

• DBP: >90

when should you estimate SBP via palpation

during an emergency before BP cuff use

what's the estimate SBP if only carotid pulse is palpable

60-70 mmHg

what's the estimate SBP if carotid + femoral pulse are palpable

70-80 mmHg

what's the estimate SBP if carotid + femoral + radial pulse are palpable

>80 mmHg

clubbing or convexity of the nails may indicate

heart & lung diseases causing chronic hypoxia

spooning or koilonychia of the nails may indicate

iron deficiency anemia

splinter hemorrhage of the nails may indicate

jagged lines seen in subacute bacterial endocarditis

fingers, toes, lips turning blue may indicate

cyanosis associated w/ congenital heart defects

how do you check for ankle edema

• press firmly w/ thumb on top of foot near ankle for a few sec + remove thumb

• “dent” = edema = congestive heart failure

purpose of palpating chest

detection of parasternal heaves + apex beat

what’s a heave

palpable impulse that noticeably lifts the palpating hand

how do you palpate for a parasternal heave

• put R palm against L parasternal region

• R ventricular hypertrophy = L parasternal heave

what’s an apex beat

lowest & lateral most point where cardiac impulse can be palpated

displaced apex beat would indicate

L ventricular hypertrophy

how do you percuss a pt’s chest

• L hand placed over chest while R hand taps L hand

• go lateral → medial, over ICS 2-5

what percussion sound indicates the heart vs. lungs

• heart: dull

• lungs: resonant

audible S₃ in older patients indicates what

congestive heart failure

audible S₃ is normal in which pts

young pts + athletes

audible S4 indicates

HTN or aortic stenosis → severely thick + stiff L ventricular wall → vibration of ventricular wall during atrial contraction