NURS 6512 Final Exam Review

 Examination techniques of the Heart, Lungs, and PV systems 1. Examination techniques of the Heart:  Inspection - use tangential lighting; stand to the patient’s right, patient should sit erect and lean forward, ly ...

 Examination techniques of the Heart, Lungs, and PV systems 1. Examination techniques of the Heart:  Inspection - use tangential lighting; stand to the patient’s right, patient should sit erect and lean forward, lye supine, and left lateral recumbent position; apical pulse midclavicular line 5th left intercostal space; check the skin for cyanosis, venous distention, nail bed for cyanosis and capillary refill time  Palpation - patient supine, palpate the precordium, use proximal halves of the 4 fingers or whole hand; being at apex, move inferior to left sternal border, then up the sternum to the base and down the right sternal border in the epigastrium or axillae; apical pulse seen at point of maximal impulse; feel for a thrill – fine, palpable, rushing, vibration, a palpable murmur, over the base of the heart; locate each sensation in terms of its intercostal space and relationship to the midsternal, midclavicular, or axillary lines; when palpating the precordium, use your other hand to palpate the carotid artery  Percussion - limited value by defining the borders of the heart or determining its size because the shape of the chest is rigid; a chest radiograph useful in defining the heart border; begin tapping at the anterior axillary line, moving medially along the intercostal spaces toward the sternal border; resonant to dull marks the border;  Auscultation - listen to all 5 of the cardiac areas using the diaphragm first then the bell; use firm pressure with the diaphragm and light pressure with the bell; 5 cardiac areas – aortic valve, pulmonic valve, second pulmonic, tricuspid, mitral; assess rate and rhythm, have patient breath normally then hold the breath in expiration, listen for S1 while palpating the carotid pulse; have the patient inhale deeply, listen closely for S2 during inspiration; basic heart sounds pitch, intensity, duration, and timing in the cardiac cycle; 4 basic heart sounds S1, S2, S3, S4 1. Examination techniques of the lungs:  Chest/Lungs – Inspect the chest, front, back, noting thoracic landmarks of and shape of anteroposterior (AP) diameter compared with the lateral diameter, symmetry, color, superficial venous patterns, prominence of ribs Inspection; patient sit upright, unclothed, using tangential light  Retractions and deformity e.g. minimal pectus excavatum are difficult to detect; pigeon chest, funnel chest, barrel chest seen with chronic condition  AP diameter less than lateral diameter; if they equal each other, chronic condition present – e.g. barrel chest related to chronic asthma, emphysema  Evaluate respirations for rate and rhythm – respiratory rate is 12-20 per minute; respirations to heartbeats is a 1:4 ratio;  Rhythm – breathe easily, regularly, with no apparent distress; variations – to shallow or to deep; tachypnea – rapid breathing, Kussmal – deep and rapid, Cheyene-Stokes – regular periods of breathing with intervals of apnea followed by a crescendo/decrescendo sequence of respiration  Inspect chest movement with breathing for symmetry and use of accessory muscles; retractions are seen when the chest wall seems to cave in at the sternum  Palpate the chest for thoracic expansion, sensations such as crepitus (palpated and heard) - gently bubbling feeling, grating vibrations,  Tactile fremitus (palpable vibration of the chest wall that occurs from speech), best felt posteriorly, use phrase “99” or “Mickey Mouse”, palpate both sides simultaneously and symmetrically; increased fremitus fluid or solid mass is present, decreased is excess air in the lungs  Thoracic expansion evaluation – stand behind patient, place thumbs along spinal process of the tenth rib with palms lightly in contact with posterolateral surfaces, thumbs will diverge during quiet and deep breathing