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1.
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Simultaneously inspect and palpate the precordium for the presence of abnormal pulsations, lifts, or heaves.
• Inspect and palpate the aortic and pulmonic areas, observing them at an angle and to the side, to note the presence or absence of pulsations.
• Inspect and palpate the tricuspid area for pulsations and heaves or lifts.
• Inspect and palpate the apical area for pulsation, noting its specific location (it may be displaced laterally or lower) and diameter. If displaced laterally, record the distance between the apex and the MCL in centimeters.
• Inspect and palpate the epigastric area at the base of the sternum for abdominal aortic pulsations.
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No pulsations
No pulsations
No lifts No heaves
Pulsations visible in 50% of adults and palpable in most PMI in the 5th LICS or to MCL
Diameter of 1 to 2 cm
Aortic ulsations
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Pulsations
Pulsations
Diffuse lifts or heaves
PMI displaced laterally or lower
Diameter over 2 cm
Bounding abdominal pulsations
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2.
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Auscultate the heart in all four anatomic sites: aortic, pulmonic, tricuspid, and apical (mitral).
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S1: Usually heard at all sites
S2: Usually heard at all sites (usually louder at the base)
S3: In children & young adults
S4: in many older adults
S1- closure of mitral/tricuspid valves
S2- closure of aortic and pulmonic valves
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Increased or decreased intensity
Varying intensity with different beats
Increased intensity at the aortic area.
Increased intensity at the pulmonic area
Sharp-sounding ejection clicks
S3 in older adults
S4 maybe a sign of HPN
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3.
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Palpate the carotid artery.
(Use extreme caution.)
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Symmetric pulse volumes;
Full pulsations, thrusting quality;
Quality remains same when client breathes, turns head, and changes from sitting to supine position;
Elastic arterial wall
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Assymetric volumes;
Decreased pulsations;
Increased pulsations;
Thickening, hard, rigid, beaded, inelastic walls
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4.
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Auscultate the carotid artery.
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No sound heard on auscultation
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Presence of bruit in one or both arteries
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5.
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Inspect the jugular veins for distention.
• The client is placed in a semi-Fowler’s position, with head supported on a small pillow.
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Veins not visible (indicating right side of heart is functioning normally)
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Veins visibly distended
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