lOMoARcPSD|22015503
Heart and Vessel
Assessment
Health Assessment (Liberty
University)
lOMoARcPSD|22015503
Heart and Vessel Assessment
- Upon inspections I don’t see any pulsations, thrusts, lifts, or heaves
present. Also no bulges or masses noted. Now I am going to
palpate for precordium pulsations. (Base, lateral border, & apex).
•There are no thrills, thrusts, lifts, heaves, bulges or
masses present.
- Check for PMI (Point of maximal impulse) is at the 5th ICS-MCL
(right under nipple), diameter is 1-2cm, amplitude is a +2, and
duration is short lasting only for the first half of systole.
-There is no jugular vein distention present on either side of the neck.
-Auscultate the following areas: use diaphragm (regular sounds)
and bell (murmurs)
1. Aortic (RSB, 2ND ICS): S2- diastole
2. Pulmonic (LSB, 2ND ICS): S2- diastole
3. Erb’s Point (LSB, 3RD ICS): S1 and S2 heard equally here.
4. Tricuspid (LSB, 4TH ICS): S1- systole
5. Mitral (MCL, 5TH ICS) : S1- systole
-Also contains the apical pulse and PMI
-Rate is 60-100 bpm, regular rhythm, intensity is normal with no
splitting. S1 sounds were heard near the mitral and tricuspid valves
(near apex) during systole. S2 sounds were heard near the
pulmonic and aortic valves (near base) during diastole. The
following sounds were not heard:
1. S3: Ken-tuc-key during systole (ventricular gallop)
2. S4: Tenn-es-see during diastole (atrial gallop)
lOMoARcPSD|22015503
3. Murmurs: indicates turbulent blood flow, use bell
- Inspect and palpate bilaterally the following: no edema, signs
of thrombus such as redness or swelling. Any pain?
1. Carotid(one at a time) 5. Popliteal 9.Temporal
2. Brachial 6. Posterior Tibial
3. Radial 7. Dorsalis Pedis
4. Femoral (verbalize) 8. Apical
•Normal pulse is 60-100, strong and regular, the amplitude
of each of these are a +2.
•There is no distention, dilation, or swelling in the legs so
no varicosities present.
-Homan’s sign: pt. bends knee at 90 degrees, you dorsiflex the foot
(toes to nose), ask if any pain and verbalize that you check both
legs.
•Pain is a (+) Homan’s sign
-Blood pressure: normal 120/80
•Auscultatory Gap- palpate brachial pulse, inflate cuff until
pulse disappears, then deflate cuff. Palpated systolic bp is
122mmHg, now inflate cuff 20-30mmHg above the palpated
122mmHg so 142 mmHg. Pulse did not return so there is no
auscultatory gap present. Wait 30 sec (check pulse here) then
inflate bp to 142
mmHg, note first and last beat heard. 122/90 mmHg which
is WNL.
•Pulse pressure: systolic-diastolic=pulse pressure (30mmHg-
50mmHg).
•Bp should be the same when lying, sitting, and standing, so I
would check you bp in each of these positions. With orthostatic
patients their bp drops when changing positions (20mmHg
systolic & 10mmHg diastolic ). To compensate for this, their
pulse increases (20bpm). Dehydration or syncope can indicate
this.
lOMoARcPSD|22015503
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lOMoARcPSD|22015503
•I could take your bp on both arms to be sure there is no
discrepancy, I would not take bp on the side that
mastectomy contains a central line, or a dialysis graft.
•Leg bp is also greater than bp in the arm, right arm is more
accurate b/c it is closer to the heart.
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