[05.02] Demo PE of the CVS V2.2.pdf

Establish rapport

What must one always establish for any patient encounter?

Greet the patient and companion, Introduce self, Use appropriate questions/language, Allow the patient to respond, Listen to patient, Use appropriate non-verbal cues, Talk in an appropriate tone, Ask about other conditions, Ask for the reason for consultation, Always ask for consent

What are the components of establishing rapport/communication skills?

"Magandang araw/Good morning, ako po si

name

, isang YL6 student. Ano po ang pangalan ninyo?”

What is the suggested self-introduction phrase for a YL6 student?

Ask permission and explain the steps to the patient prior to performing them

What specific action is required regarding procedures to demonstrate professionalism?

Offer a female companion present

What must a male clinician ensure if the patient is female and they are of opposite sexes?

Patients with cardiogenic shock

What example patient is given who might present with distress, not awake, or with decreased sensorium?

Observe and note if the patient is awake or with decreased sensorium

What is the first step in the General Survey regarding the patient's consciousness?

Tripod position, Nasal flaring, Pursed lips, Use of accessory muscles, Presence of intercostal muscle retractions, Speaks in words, Tachypneic

What are the signs of shortness of breath (SOB)?

Patient is still okay

What does it indicate if a patient with SOB is able to respond to a question like "Mukha po kayong hinihingal, sir. Nahihirapan po ba kayo huminga?"

Examine the patient further, and administer oxygen if needed

What should be done if the patient with SOB is unable to respond?

Compress the radial artery until a maximal pulsation is detected

What is the technique for assessing the Heart Rate (HR)?

bpm

What unit is used when reporting Heart Rate (HR)?

cpm

What unit is used when reporting Respiratory Rate (RR)?

Rise and fall of the chest

What physical observation determines the Respiratory Rate (RR)?

Irregular heartbeats and atrial fibrillation

In which two conditions is the pulse oximeter not recommended for measuring heart rate?

Full 60-second period

For an irregular heart rate, over what period should beats be counted manually?

6-second period, multiplied by 10

For a regular heart rate, what duration of counting is used to estimate beats per minute?

Brachial artery at the heart level

How should the arm be positioned when taking blood pressure (BP)?

2.5 cm (1 inch) above the antecubital crease

Where should the lower border of the BP cuff be positioned?

Palpation

What initial technique is used to estimate Systolic Blood Pressure (SBP)?

Feel the radial artery

What step is performed while inflating the cuff to estimate SBP by palpation?

Add 30 mmHg

What step follows noting the pressure at which the radial pulse disappears during SBP estimation by palpation?

To be able to catch hypertension and emergencies

Why is adding 30 mmHg important in SBP estimation?

BELL

What part of the stethoscope is used to hear the Korotkoff sounds?

"Blood pressure of the patient is ___mmHg."

How should the blood pressure findings be reported?

The patient's brachial artery should be at heart level

What positioning ensures an accurate BP reading besides cuff placement?

Radial artery

What artery pulse is felt at the wrist when estimating SBP by palpation?

160 mmHg

If the radial pulse disappears at 130 mmHg, what is the target inflation pressure?

Supine position with head elevated to 30-45°

What is the ideal patient position for assessing Jugular Venous Pressure (JVP)?

Reflects the pressure in the right atrium (RA)

What pressure does the Internal Jugular Vein (IJV) pulsation reflect?

Turn the patient’s head to the left and examine the right side of their neck

What positioning helps visualize the IJV?

Between the clavicular and sternal heads of the sternocleidomastoid

Where can the Internal Jugular Vein (IJV) be found?

Light pressure on the vein above the clavicle

How can internal jugular pulsations be eliminated, differentiating them from carotid pulsations?

Oscillation point of pulsation

What is the highest point at which the IJV pulsation is visible in the neck called?

Above the sternal angle

What measurement is needed from the oscillation point of pulsation to determine JVP?

Ruler and a card (or tape measure)

What tools are used to measure the height of the IJV pulsation?

Sternal Angle as a Reference Point

What is the Lewis Method for JVP measurement that uses the sternal angle as the reference?

Less than 4 cm above the sternal angle

What is the normal value for JVP using the Sternal Angle as a Reference Point?

Add 5 cm to the measurement

What adjustment is made to the sternal angle measurement if the reference point is the Right Atrium (RA)?

5 cm below the sternal angle

Where is the Right Atrium (RA) located in relation to the sternal angle for JVP calculation?

The IJV pulsation is easily palpable

What statement about IJV is incorrect according to the source material's note?

"The JVP is ab/normal at _ cm above the sternal angle."

How should the JVP findings be reported?

Relatively constant

How does the height of the JVP change no matter the angle of supineness?

Inspect for carotid pulsations without palpating

What is the first step when assessing carotid pulsation?

Right carotid in the lower ⅓ of the neck

Where should the left index and middle fingers be placed to palpate the right carotid artery?

Do not press on both carotid arteries at the same time

What is the crucial safety instruction when palpating carotid arteries?

The patient might pass out

What is the risk of pressing both carotid arteries simultaneously?

At least one carotid artery

How many carotid arteries should be auscultated for a bruit?

Turbulent or non-laminar blood flow

What is the physiological cause of a carotid bruit?

Stenosis or pagkipot sa ugat

What condition does a carotid bruit signify?

Underlying arterial occlusive pathology that can lead to stroke

What underlying condition might a carotid bruit point to?

Diaphragm or bell

What two parts of the stethoscope can be used to auscultate for a carotid bruit?

"Brisk, smooth, and rapid carotid upstroke with a gradual downstroke. No carotid bruit."

How should the normal findings of the carotid pulsation be reported?

Look to their left

What instruction facilitates easy palpation of the right carotid artery?

Supine position with the head elevated to 30°

What position should the patient be in for chest inspection and palpation?

Heaves or Lifts and Thrills

What two physical signs are inspected on the anterior chest wall?

Movement of heart/ribs going to your fingers/hand

What is the sensation of a Heave or Lift?

Vibratory sensation on skin from turbulent flow through abnormal valve

What is the sensation of a Thrill?

Thrills and Heaves or Lifts

What two things are palpated at the right and left 2nd intercostal space, left parasternal border, and apex?

Fingerpads or base of fingers

What part of the hand is used to palpate for thrills?

Ball of the hand

What part of the hand is used to palpate for heaves or lifts?

Palmar surface of several fingers, then localize to one finger

What parts of the hand are used to palpate the apical impulse?

Location, Diameter, Amplitude

What three characteristics of the apical impulse must be noted?

4th to 5th left ICS midclavicular line

What is the normal location of the apical impulse?

1 interspace

What is the normal diameter of the apical impulse?

Small, feels brisk, and tapping

What is the normal amplitude of the apical impulse?

Enlargement (cardiomegaly)

What does a displaced apical impulse signify?

Left 5th intercostal space

What is the normal location of the apical impulse?

Fingerpads and the ball of palm

What two parts must be in contact with the chest at the A, P, T, M points during palpation?

Avoid touching the breast

What specific precaution must be taken when palpating a female patient's chest at the 4th or 5th intercostal space?

"Adynamic precordium. No heaves, lifts, or thrills. Point of maximal impulse is at the 5th left ICS midclavicular line."

How should the normal findings of the chest be reported?

If a murmur is heard, listen longer and palpate the radial pulse

What two actions should be taken if a murmur is heard during auscultation?

Determine if it is systolic or diastolic and assess the severity

What is the purpose of listening longer and palpating the radial pulse when a murmur is heard?

Aortic Regurgitation, Mitral Stenosis

What two diastolic valve lesions are included in the ARMS mnemonic?

Posterior chest, bi-basal area

What area should be checked for a decrease in breath sounds?

Fluid accumulation, pleural effusion, congestion

What three conditions does a decrease in breath sounds pertain to?

Staircase auscultation

What is the technique for auscultating the four main valve areas?

Supine position

What position should the patient be in for staircase auscultation?

Diaphragm

What part of the stethoscope is used to auscultate the four valve areas for S1 and S2?

Right 2nd ICS, right PSB

Where is the Aortic area located?

Left 2nd ICS, left PSB

Where is the Pulmonary area located?

Left 4th ICS, PSB

Where is the Tricuspid area located?

Left 5th ICS, PSB

Where is the Mitral area located?

Always Pray To Mary

What mnemonic helps recall the auscultatory areas?

Tricuspid and Mitral areas

Where should the bell of the stethoscope be used to check for S3 and S4?

Rales, wheezes, crackles, and decreased breath sounds

What four lung sounds are included in a focused PE of the cardiovascular system?

Congestive heart failure

Rales are noted in patients with what condition?

Pleural effusion, together with heart failure

Decreased breath sounds are noted in patients with what two conditions?

1 complete cycle

For auscultation, how long should the clinician stay in one area if the sound is normal?

Deep inhale and exhale

What instruction should be given to the patient during auscultation?

Inspiratory and expiratory phases

If sounds aren't clear, what two phases must the sounds be listened to again?

Base of the lungs

What specific area of the posterior chest should be auscultated?

"Good S1 and S2. S2 is loudest at the base, S1 is loudest at the apex. No murmurs, S3, S4."

How should the normal heart findings be reported?

"Clear and equal breath sounds, no rales or wheezes."

How should the normal lung findings be reported?

S2

Which heart sound should be loudest at the base?

S1

Which heart sound should be loudest at the apex?

Diaphragm

What part of the stethoscope did Dr. Chiu state she only uses to check S1 and S2?

Bell

What part of the stethoscope can also be used to check for S3 and S4?

30-40 degrees

At what angle should the patient's head be elevated for the Hepatojugular Reflux (HJR) test?