PHYSICAL EXAMINATION OF THE CARDIOVASCULAR SYSTEM

Compiled to fulfill the assignment of English courses

Lecturers: Dina

Compiled by:

Debbyana Radithya 181128

Elis Mega B. 181132

Larasati Ayu C. 181144

Niken Maziyatul I. 181150

Rahayu Lili S. 181156

Ulfia Nur A. 181175

D3 NURSING STUDY PROGRAM

INSTITUTE OF TECHNOLOGY, SCIENCE, AND HEALTHRS DR. SOEPRAOEN

MALANG
 PREFACE

We offer thanks to the presence of Allah SWT, who gives a lot of pleasure, grace and gifts so
that the author can complete a paper entitled "PHYSICAL EXAMINATION OF THE
CARDIOVASCULAR SYSTEM"

Author realizes that this paper there are still many shortcomings, for that suggestions and
constructive criticism for improvement are always awaited. Finally, I hope that with all its
simplicity it can be useful for writers in particular and readers in general.

Malang, 14 October 2020

 Author

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 TABLE OF CONTENTS

PREFACE......................................................................................................i

CONTENTS...................................................................................................ii

CHAPTER I INTRODUCTION

1.1Background...............................................................................................5

1.2 Problem Formulation...............................................................................6

1.3 Objectives................................................................................................6

CHAPTER II THEORY REVIEW

2.1 Functional Anatomy of the Heart............................................................7

2.2 Physical examination of the cardiovascular system.................................9

1. General condition...............................................................................9

2. Check blood pressure.........................................................................9

3. Pulse check.........................................................................................10

4. Hands.................................................................................................11

5. Jugular Vein Examination..................................................................12

6. Heart examination..............................................................................13

7. Lungs..................................................................................................17

8. Abdomen............................................................................................18

9. Feet and Legs.....................................................................................18

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CHAPTER III

3.1 The patient case with diagnosis congestive heart failure.........................19

3.2 Prosedure for physical examination of the cardiovaskuler system..........21

CHAPTER IV CLOSING

4.1 Conclusion...............................................................................................24

REFERENCES.............................................................................................25

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 CHAPTER I

INTRODUCTION

1.1 Background

Cardiovascularconsists of two syllables, namely cardiac and vascular. Cardiac which

means heart and vascular which means blood vessels. In this case includes the blood
circulation system which consists of the heart and blood components of blood vessels. This
circulatory center or blood circulation begins in the heart, which is a muscular pump that
pulsates rhythmically and repeats 60-100x / minute. Each beat causes blood to flow from the
heart, throughout the body in a closed network consisting of arteries, arterioles, and
capillaries and then back to the heart through the venules and veins.

In the mechanism of maintaining the internal environment, blood circulation is used as a

transport system for oxygen, carbon dioxide, food, and hormones and drugs throughout the
tissues in accordance with the metabolic needs of each cell in the body. In this case, changes
in the volume of body fluids and hormones can affect the cardiovascular system either
directly or indirectly.

In understanding the cardiac circulatory system, we need to understand the physiological

anatomy of the heart so that we are able to understand various problems related to the
cardivascular system without any mistakes that make us neglicent(negligence). Therefore, it
is very important to understand cardiovascular physiological anatomy, which directly
functions in circulating drugs and oxygenation in the body in the process of life.

In carrying out the assessment properly, understanding, practice and skills are needed to
recognize the signs and symptoms displayed by the patient. This process is carried out
through the interaction of care from the client, observation, and measurement. Examination
in nursing uses the same approach as the physical medical assessment, namely the inspection,
palpation, auscultation and percussion approach.Medical physical assessment is carried out to
establish a diagnosis in the form of certainty about the client's illness. In principle, the

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 physical assessment of nursing is developed based on a nursing model that is more focused
on the responses caused by the health problems experienced. Nursing physical assessment
must reflect a physical diagnosis that nurses can generally plan actions to overcome. To
obtain accurate data before the physical examination, a medical history, psychosocial, socio-
economic history, and others are carried out. This allows a focused assessment and does not
create bias in drawing conclusions about the problems found.

Physical examination is an examination of the body to determine the presence of

abnormalities in a system or an organ of a body part by seeing (inspection), feeling
(palpation), tapping (percussion) and listening (auscultation). Generally, this examination is
carried out sequentially (inspection, palpation) , percussion and auscultation).

1.2 Problem Formulation

1. What is the anatomy of the cardiac system?
2. How is the blood circulation of the heart?
3. What is the pathophysiology of the cardiovascular system?
4. What are some physical examinations performed on the cardiovascular system?
5. What are the diagnostic tests of the cardiovascular system?
1.3 Objectives
1. Knowing about the anatomy of the heart system.
2. Knowing the heart blood circulation.
3. Knowing the pathophysiology of the cardiovascular system.
4. Knowing the physical examination performed on the cardiovascular system.
5. Knowing the diagnostic tests on the cardiovascular system.

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 CHAPTER II

REVIEW OF THEORY

2.1 Functional Anatomy of the Heart

The cardiovascular system consists of the heart and the vascular system including the
heart muscle, atria, ventricles, valves, coronary arteries, cardiac veins, electrical conduction
structures and cardiac breathing. While the blood vessel system (vascular) is formed by the
body's blood vessels including arteries, arterioles, veins, venules, and capillaries. The main
function of the cardiovascular system is the transportation of nutrients and oxygen to the
body, removal of waste and carbon dioxide, and maintain adequate perfusion of organs and
tissues. The heart is a muscle formed by four separate cavities, namely two atria and two
ventricles. The walls of the atria are thin, have low pressure and serve more as a place for
blood supply to each ventricle in the pumping function of the heart
The ventricles are made up of thicker muscles compared to the atria. On the inside of the
ventricles in the apex area there is a lump of palpilaris muscle, in the base area and around the
atrioventricular valve hole there is a thick muscle that functions to reduce the size of the
ventricular circle when there is ejection of blood. The heart has four separate valves that drain
blood in one direction and prevent it from flowing back. There are two types of valves,
namely the atrioventricular valve (AV valve) and the semilunar valve. The atrioventricular
valve, which is located in the right atrium and right ventricle, consists of three cusps (tricuspid
valve) while between the left atrium and the left ventricle it consists of two valves (bicuspid
valve).
The increase in ventricular pressure will cause the AV valve cover slightly convex
toward the atria. The seminular valve is present between the left ventricle and the aorta and
between the right ventricle and the pulmonary artery. Closing the valve will cause a heart
sound when auscultated.
Closure of the atrioventricular valve causes a single heart sound (S1). The sound of heart
one; dull, low tone, longer than sound two (S2), the sound is heard "lub". Closure of the
seminular valve causes two heart sounds. Two heart sounds; high pitch, sharp, sound sounds
"dub". The time between S1 and S2 is ventricular systole and the time between S2 and S1 is
ventricular diastole.

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 The other heart sounds are the triple heart sound (S3) and the heart sound four (S4).
Three heart sounds can be heard in children and young adults, this condition is still said to be
normal in early diastole after S2 sound. The sound is heard “lub-dub-dee” (S1-S2-S3). Four
heart sounds (S4) can be heard in the elderly, this condition is said to be normal in late
diastole. The sound is heard dee-lub-dub (S4-S1-S2). The heart is supplied by the coronary
arteries which function to transport blood, nutrients, and oxygen to the mycocardium. The
cardiac venous system is formed by large veins, obligate veins, small veins, medium veins,
minimalist cord veins, and posterior veins. The heart has a conduction system that initiates
electrical activity and transmits it through the fibers of the heart muscle to the myocardial
tissue. The main conduction system structure consists of the sinoatrial node (SA Node), the
atrioventricular node (AV Node). Decorative bundles, bundles of right, left branches and
purkinye fibers. The heart gets innervation from the sympathetic nervous system and the
parasympathetic nerves that work reciprocally. The sympathetic nerves stimulate the heart,
increase the heart rate and the capacity of the heart to build, whereas the parasympathetic
nerves work against it.

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2.2 Physical Examination of the Cardiovascular System
Physical examination is an examination of the body to determine the presence of
abnormalities in a system or an organ of a body part by seeing (inspection), feeling
(palpation), tapping (percussion) and listening (auscultation). The sequence of examinations
runs logically from head to toe, and once trained can be done in as little as 10 minutes:
1. general condition,
2. blood pressure,
3. pulse,
4. hand,
5. head and neck,
6. heart,
7. lungs,
8. abdomen and legs and feet.

In the next examination of the heart, in addition to finding normal results, we can also
find abnormalities in the results physical examination which includes, among others: a
widened heart border, various abnormal variations in heart sounds and additional sounds in
the form of a noise (murmur).

1. General Condition
Observe the patient's distress level. The level of consciousness must be noted and
explained. Evaluation of the patient's ability to think logically is very important because it
is a way to determine whether oxygen is able to reach the brain (brain perfusion). Client
awareness needs to be assessed in general, namely compos mentis, apathy, somnolence,
sopor, soporocomatous, or coma.
2. Blood Pressure Check
Blood pressure is the pressure exerted on the artery walls. This pressure is influenced by
several factors such as cardiac output, arterial tension, and blood volume, rate and
viscosity (viscosity). Blood pressure is usually described as the ratio of systolic pressure
to diastolic pressure, with normal adult values ranging from 100/60 to 140/90. Blood
pressure measurement techniques include:

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 The spignomanometer cuff is tied to the upper arm, the stethoscope is placed in the
brachial artery on the ventral surface of the elbow slightly below the
spigmomanometer cuff.
The pressure in the spigmomanometer is increased by pumping air into the cuff until
the radial and brachial pulses have disappeared. The cuff is extended again by 20 to 30
mmHg above the point of loss of the radial pulse then the pressure inside the
spigmomanometer is gradually lowered.
When the pulse starts to sound again, read the pressure listed on the spigmomanometer
scale, this pressure is systolic pressure.
The sound of the next pulse is a bit loud and still sounds that loud until one day the
pulse weakens or disappears completely. The last pulsating sound is the diastolic
pressure.
3. Pulse Check
Palpation
Palpation assessment includes frequency, rhythm, quality, wave configuration, and the
state of blood vessels. Normal heart rate

Age Heart rate (beats / minute)

Baby 120-160/mnt

Todler 90-140/mnt

Preschool 80-110/mnt

School age 75-100/mnt

Youth 60-90/mnt

Adult 60-100/mnt

a. Rhythm
Normally the rhythm is the regular interval that occurs between each pulse or
heart. If the pulse is irregular, then the heart rate should be calculated by auscultating

10
 the apical pulse for one full minute while feeling the pulse. Any difference between
audible contractions and palpable pulse should be noted. Rhythmic disturbances
(dysrhythmias) often result in pulse deficits, a difference between the apex frequency
(the frequency of the heart heard at the apex of the heart) and the pulse rate. Pulse
deficits usually occur with atrial fibrillation, atrial flutter, premature ventricular
contractions and varying degrees of heart block.
b. Pulse strength
The strength or amplitude of the pulse indicates the volume of blood injected into
the artery wall with each contraction of the heart and the state of the arterial system
leading to the pulse. Normally, the pulse strength remains the same with each heart
beat.
0 does not exist, cannot be palpable
1+ pulse missing, very difficult to palpate, easy to lose
2+ easy to palpate, normal pulse
3+ full pulse, increasing
4+ strong, pulse bouncing, immovable
4. Hands
In cardiac patients, the following are the most important findings to pay attention to when
examining the upper limb:
Peripheral cyanosis, where the skin appears bluish, indicates a decreased rate of
blood flow to the periphery, so it takes longer for hemoglobin to desaturate. Normal
occurs with peripheral vasoconstriction due to cold air, or in pathological decreased
blood flow, for example, cardiac shock
Pale, can indicate anemia or increased systemic vascular resistance
Capillary refill time (CRT = Capillary Refill Time), is the basis for estimating
peripheral blood flow velocity. To test capillary refill, press firmly on the tip of your
finger and then release quickly. Normally, reperfusion occurs almost immediately
with the return of color to the fingers. Slow reperfusion indicates a slower rate of
peripheral blood flow, as occurs in heart failure
Temperature and humidity of the hands are controlled by the autonomic nervous
system. Normally hands feel warm and dry. In a state of stress, it will feel cold and

11
 damp. In cardiac shock, the hands are very cold and wet due to stimulation of the
sympathetic nervous system and result in vasoconstriction.
Edema stretches the skin and makes it difficult to fold.
Decreased skin turgor occurs with dehydration and aging.
Clubbing of the fingers and toes indicates chronic desaturation of hemoglobin, as in
congenital heart disease.
5. Jugular Vein Examination
An estimate of right heart function can be made by observing the pulsation of the
jugular vein in the neck. This is a way of estimating central venous pressure, which
reflects the end-diastolic pressure of the right atrium or right ventricle (the pressure just
before right ventricular contraction). The jugular vein is inspected to measure venous
pressure which is affected by blood volume, the capacity of the right atrium to receive
blood and deliver it to the right ventricle, and the ability of the right ventricle to contract
and push blood into the pulmonary artery. Technique
 Have the client lie on his back with his head elevated 30 to 45 degrees (semi-Fowler
position)
 Ensure that the neck and upper thorax are exposed. Use a pillow to straighten your
head.
 Avoid hyperextension or neck flexion to ensure that veins are not stretched or curled.
 Usually the pulse is not seen when the client is seated. When the client returns to the
supine position slowly, the venous pulse height begins to increase above the
manubrium height, which is 1 or 2 cm when the client reaches a 45 degree angle.
Measure venous pressure by measuring the vertical distance between the Louis angle
and the highest level of visible internal jugular vein pulsation point.
 Use two rulers. Draw a line from the bottom edge of the regular ruler with the end of
the pulsating area of the jugular vein. Then take a centimeter ruler and make it
perpendicular to the first ruler at the level of the corner of the sternum. Measure in
centimeters the distance between the second ruler and the sternal angle.
 Repeat the same measurement on the other side. Bilateral pressure greater than 2.5
cm is considered to be elevated and is a sign of right heart failure. Increased pressure
on one side can be caused by obstruction.

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6. Heart examination

Inspection
a. Thorax / chest
The patient lies on a flat base. In the form of the chest "Veussure Cardiac" there is
a wide local protrusion in the precordium, between the sternum and apex codis.
Sometimes shows a heart pulsation. The presence of Voussure Cardiaque, indicates
the presence of organic heart defects, heart defects that have been long / occurring
before complete retention, hypertrophy or ventricular dilatation. This lump can be
confirmed by touch.
b. Ictus Cordis
In normal adults who are somewhat thin, there is often a visible pulsation called
ictus cordis in the V intercostal, left medioclavicularis line. This pulse is located in
accordance with the apex of the heart. The pulsation diameter is approximately 2 cm,
with the maximum punctum in the middle of the area. Pulses occur at the time of the
ventricular system. If the ictus kordis is shifted to the left and widens, there may be
left ventricular enlargement. In adhesive pericarditis, ictus out occurs during diastolis,

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 and at the time of systemic retraction occurs. This situation is called negative ictus
kordis. The strong pulse in the left third rib is caused by dilation of the pulmonary
artery. The supra sternal pulse may be the result of a strong aortic pulse. In right
ventricular hypertrophy, pulsations appear in the IV ribs in the sternal line or
epigastric region. Look for visible intercostal artery pulses on the back. This situation
is found in mitral stenosis. Pulses in the lower neck near the scapula are found at the
coarctatio aorta.
Palpation
Apical impulses can also sometimes be palpated. Normally felt as a light
pulsation, 1 to 2 cm in diameter. The palms were first used to determine their size and
quality. When the apical impulse is wide and strong, it is called the heave or lift of the
left ventricle. It is so named because it seems to "lift" the hand off the chest wall during
palpation. PMI is abnormal. If the PMI is located below the intercostal space V or lateral
to the medioclavicular line, the cause is left ventricular enlargement due to left heart
failure. Normally, PMI is only felt in one intercostal space. If the PMI is palpable in two
separate areas and the pulsation is paradoxical (not concurrent), a ventricular aneurysm
should be suspected. In addition to the pulsation, pay attention to the vibration of "thrill"
that is felt in the palms, due to abnormal heart valves. These vibrations correspond to a
strong heart sound (murmur) on auscultation so that they can be palpated. Thrill can also
be palpated over the blood vessel if there is significant obstruction of blood flow, and will
occur over the carotid artery if there is narrowing (stenosis) of the aortic valve.
Determine at what phase the vibration is felt, as well as its location.
Percussion
The use of percussion is to define the boundaries of the heart. In patients with
pulmonary emphysema there is difficulty percussion of the boundaries of the heart. In
addition to percussion of the boundaries of the heart, large blood vessels in the basal part
of the heart must also be percussed. In normal circumstances between the left and right
sternal lines in the manubrium sterni there is a deaf which is the aortic area. If this area is
widened, possibly due to aortic aneurysm. To determine the left border of the heart
perform percussion from the lateral to the medial direction. The left heart border extends

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from the medioclavicular line in the intercostal spaces III to V. The change between
sonor sounds from the lungs to the relative dimness is defined as the left heart border.
The right border lies below the right border of the sternum and cannot be
detected. An enlarged heart either to the left or to the right will usually be seen. In some
people whose chest is very thick or obese or has emphysema, the heart is so far below the
surface of the chest that even the left border is not clear unless it is enlarged.
Heart Auscultation
Cardiac auscultation studies include examination of heart sounds, heart sounds
and pericardial scraping.
c. Heart Sounds
To hear heart sounds, pay attention to the localization and origin of heart sounds,
determine S1 and S2 heart sounds, sound intensity and quality, the presence or
absence of S3 heart sounds and S4 heart sounds, heart sound rhythm and frequency,
and other accompanying heart sounds.
Localization and origin of heart sounds
Auscultation of heart sounds is carried out in the following places:

• Ictus cordis to hear heart sounds coming from the mitral valve

• Left intercostal II to hear heart sounds coming from the pulmonary valve.

• Right intercostal III to hear heart sounds coming from the aorta

• Intercostal IV and V on the right and left edges of the sternum or end of the sternum to
hear heart sounds coming from the tricuspidal valve.

The auscultation sites above are incompatible with the anatomical location and
location of the valves in question. This is due to the delivery of heart sounds to the chest
wall.

Determine heart sounds I and II

In a healthy person, two kinds of heart sounds can be heard:

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 Heart sound I (S1), caused by closing the mitral and tricuspidal valves. This
sound is a sign of the start of the ventricular systole phase. The I heart sound is heard to
coincide with the palpation of the pulse in the carotid artery.
Heart sound II (S2), caused by closure of the aortic and pulmonary valves and
signs the start of the ventricular diastolic phase.
Sound Intensity and Quality
The intensity of the heart sound is greatly influenced by the thickness of the chest
wall and the presence of fluid in the pericardial cavity.
The intensity of the heart sound must be determined according to how slow or
loud the sound is heard. The heart sound I is generally louder than the second heart sound
at the apex of the heart, while the basal sound of the II heart sound is greater than the I
heart sound.
Also pay attention to the quality of the heart sound
In a state of splitting (sound of a broken heart), namely the sound of the heart I
burst due to closing the mitral and tricuspid valves not simultaneously. This may be
found under normal circumstances. A second heart sound that is broken, is normally
found at the time of inspiration where P 2 is slower than A 2. In a situation where the
splitting of the heart sound does not disappear in respiration (fixed splitting), this
condition is usually pathological and is found in ASD and Right Bundle branch Block
(RBBB).
The presence or absence of heart sounds III and heart sounds IV
A low-intensity 3rd heart sound is occasionally heard at the end of the ventricular
rapid filling, low-pitched, most clearly at the apex of the heart. Under normal
circumstances found in children and young adults. In pathological conditions found in
severe heart defects such as heart trouble and myocarditis. Heart sounds 1, 2 and 3 give a
sound like galloping horses, known as protodiastolic gallops.
The 4th heart sound occurs due to forced ventricular distension due to atrial
contraction, most clearly heard at the apex cordis, normal in children and in adults found
in pathological conditions, namely with A - V block and systemic hypertension. The
rhythm that occurs by the 4th heart is called the presystolic gallop.
The rhythm and frequency of heart sounds

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 The rhythm and frequency of the heart sound must be compared with the pulse rate.
The normal rhythm of the heart is regular and when it is irregular it is called an
arrhythmia cordis.
The frequency of the heart sounds should be determined in minutes, then compared
with the pulse rate. If the pulse rate and heart sound are more than 100 beats per minute
each, it is called tachycardi and if the frequency is less than 60 beats per minute it is
called bradycardia.
Sometimes the heart rhythm changes according to respiration. When expiration is
slower, this condition is called sinus arrhythmia. This is due to changes in stimulation of
the autonomic nervous system at the S - A node as a pacemaker. If the heart rhythm is
completely irregular it is called fibrillation. Sometimes a normal heart rhythm is
occasionally punctuated by a faster heart rate called extrasystole, which is followed by a
longer diastolic phase (compensatory pause). Opening snap, caused by the opening of the
mitral valve in the aortic stenosa, or pulmonary stenosa.
7. Lungs
Findings that are often found in heart patients include:
 Tachypnea. Rapid, shallow breathing can be seen in patients who have heart failure
or are in pain, or who are very anxious.
 Chyne-stokes respiration. Patients with severe left ventricular failure may exhibit
chyne-stokes breathing, which is characterized by rapid breathing alternating with
periods of apnea.
 Hemoptitis. Pink frothy sputum indicates acute pulmonary edema.
 Cough. Dry and deep cough due to minor airway irritation is common in patients
with pulmonary congestion due to heart failure.
 Krekels. Heart failure or atelectasis associated with bed rest, splinting due to
ischemic pain, or the effects of painkillers and sedatives often result in cramps.
 Wheezing. Compression of the small airways due to edema of the pulmonary
interstitial tissue can result in wheezing.

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8. Abdomen
In cardiac patients, there are two common components for abdominal examinations
 Hepatojugular reflux. Swelling of the liver results from decreased venous return
caused by right ventricular failure. The liver becomes large, hard, non-tender, and
smooth. Hepatojugular reflux can be checked by pressing firmly on the liver for 30 to
60 seconds and a 1 cm increase in jugular venous pressure will be seen. This
elevation indicates the inability of the right side of the heart to respond to increased
volume.
 Bladder distension. Urine output is an important indicator of heart function. Hence a
decrease in urine output is a significant finding that should be investigated to
determine whether the decrease is due to decreased urine output (which occurs when
renal perfusion is decreased) or due to the patient's inability to urinate.
9. Feet and Legs
Most patients with heart disease also develop peripheral vascular disease, or peripheral
edema due to right ventricular failure. Therefore, in all cardiac patients it is important to
assess the peripheral arterial circulation and venous return.

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 CHAPTER III

A. THE PATIENTS CASE WITH A DIAGNOSIS CONGESTIVE HEART FAILURE IN

MAWAR ROOM

Pra interaction :

1. Read nursing records

2. Prepare medical equipment and privacy of the room
3. Ask for patient consent
4. Position the patient
5. Washing hands

Orientation :

Nurse : good afternoon

Patient : good afternoon nurse

Nurse : what is your name ?

Patient : my name is siti nurse

Nurse : what is your last education ?

Patient : I am last education in junior high school nurse

Nurse : how are you today ? what do you feel ?

Patient :I am still sick, I was congested for 4 days, it was difficult to pee for 3 days, my legs
were swollen nurse

Nurse : is there a history of high blood pressure ?

Patient : yes my blood pressure usually exceeds 130

Nurse : do you often take hypertension drugs ?

Patient : yes nurse right

Nurse : I will do a physical examination. with the aim of knowing your condition . are you
willing?

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Patient : yes nurse

Nurse : is there chest pain ?

Patient : yes nurse

Work stage :

Nurse : your general state is weak, composmentis awareness and inspection there is skin
turgor for more than two seconds and there is swelling of the right leg. does the leg hurt if i
press it ?

Patient : no it does’nt, and my feet are swollen for about 5 days

Nurse : I will do tension to measure your blood pressure. what was your blood pressure last
time control ?

Patient : emmmm last I control 150mmhg

Nurse : now the height is still 160/100 mmhg, and pulse 108, normal temperature 36C. after
that I will check your chest to find out the state of the heart . excuse me mam

10 minutes after examination ...

Nurse : inspection ictus cordis invisible, palpation ictus cordis palpable in ics mid clavicula
line sinistra, percusion deafening voice and auscultation no aditional sound. there is swelling
of your heart mam

And than normal chest shape, using the breathing auxiliary muscles, nostril breathing +,
palpation no tenderness, no additional sound and symmetrical abdomen, no tenderness,
tympani throughout the abdomen, lower limb muscle strength 4 4

Patient : is that what caused my leg to be swollen for too long, why did it happen nurse ?

Nurse : because the heart is enlarged fluid is difficult to pass and it is difficult to urinate and
the legs become swollen. there are abnormal examination results in the heart to see the
swelling we schedule a heart ultrasound

Patient : ok nurse thank you . what therapy will I get for my healing ?

Nurse : I'll report your condition to the doctor in charge later. This is the therapy that I give
furosemide injection to help clear urine and reduce swelling in the legs . and don't drink too
much

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 Patient : ok nurse thank you

Termination :

Nurse : how did you feel after i checked ?

Patient : I feel more comfortable and know my condition

Nurse : ok I will go back to the nurse's room, if I need to call in the room. I'll be back in 2
hours to check your condition

Patient : ok nurse thank you

B. PROCEDURE FOR PHYSICAL EXAMINATION OF THE CARDIOVASCULAR

SYSTEM

ASSESS THE CLIENT'S CONDITION

 General Conditions
 Breathing depth
 Comfortable position

TOOL PREPARATION

 Non sterile handscoon

 Stethoscope
 Tensimeter
 2 elbow ruler or straight ruler

A. PRE INTERACTION STAGE

1. Read the client's nursing and medical records
2. Prepare tools and room privacy
3. Ensure that the client has signed the concent information
4. Arrange the position according to the client's convenience
5. Wash hands 

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B. ORIENTATION STAGE
1. Give greetings, call the client by his name
2. Explain the procedure and purpose of action to the client or family
C. WORKING STAGE
1. Inspection
 The general state of the patient, whether there is weakness and shortness of breath
with or without activity
 Inspect for edema, extremities, ascites.
 Normal CRT identification <2 seconds
 Identify chest pain radiating to the neck and right arm
 Identify the location of the apical impulses on MCS ICS 4-5, Amplitude
 Inspection for bleeding
 Inspection of blood pressure, SPO2 and hourly catheter urine production
2. Palpation
 Feel the pulse at the apical heart, feel the vibration, regularity
 Feel for pulse radial artery, carotid note frequency, rhythm, vibration or thrill and
its contour
 Akral feel on the fingers and toes
 Palpation of limb edema, ascites and hepatomegaly
3. Percussion
 Knowing the limits of the heart from the changes in the sound of chest cavity
vibrations starting from ICS 2-5 left and right, then compare and note the start of a
change in sound from sonor to deaf
4. Auscultation
a. Auscultation of heart sounds
 Take the stethoscope, and attach the stethoscope {bell} to:
ICS 2,3,4,5 MCS ICS 6 Identify S1 S2 Single or the presence of S3, S4
(EXTRA DIASTOLE), systolic or diastolic nut, gallop sound.
b. Measure jugular vein pressure
 Instruct client to lie on his back with the upper bed tilt 30-40 degrees

22
  Position the client's head slightly tilted in the opposite direction to the position of
the nurse
 Identification of the jugular vein pulsation and its highest point on the client's
neck
 Find the vertex of the base of the sternum
 Install one ruler vertically at the base of the sternum
 Install the other ruler horizontally parallel to the highest point of venous jugular
pulsation
 Determine the vertical distance between this highest point and the angle of the
sternum, normally less than 3cm
5. Tidy up the tools and tidy up the client
6. Document Actions record the client's response to the Action
D. Termination Stage
 Evaluation of the client's feelings
 Summarize the results of the activity
 Perform a contract for the next activity
 End the activity
 Washing hands

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 CHAPTER IV

CLOSING

A. Conclusion

The cardiovascular system consists of the heart and the vascular system including the
heart muscle, atria, ventricles, valves, coronary arteries, cardiac veins, electrical conduction
structures and cardiac breathing. While the blood vessel system (vascular) is formed by the
body's blood vessels including arteries, arterioles, veins, venules, and capillaries. The main
function of the cardiovascular system is the transportation of nutrients and oxygen to the body,
removal of waste and carbon dioxide, and maintain adequate perfusion of organs and tissues.

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 REFERENCES

Brunner dan Suddarth.2002.Buku Ajar Keperawatan Medikal Bedah Volume 2 Edisi

8.Jakarta:Buku Kedokteran EGC

Setiawati, Santun.2007.Panduan Praktis Pengkajian Fisik Keperawatan Edisi 3.Jakarta:Trans

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