NURS 6512 Final Exam Review From Week 7 to Week 11 Understanding the Heart, Lungs, and Peripheral Vascular • ExaminationtechniquesoftheHeart, Lungs,and PV systems

NURS 6512 Final Exam Review From Week 7 to Week 11 Understanding the Heart, Lungs, and Peripheral Vascular • ExaminationtechniquesoftheHeart, 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 sternumto the base and down the right sternal border in the epigastrium or axillae; apical pulseseen 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