CARDIOVASCULAR SYSTEM

MATERIALS
a. Stethoscope
b. Sphygmomanometer
c. Rulers
d. Marker
PRCEDURE
I. Neck
1. Locates carotid and jugular pulsations and differentiate
a. Describe and point the location of carotid artery
b. Describe and point the location of jugular vein
2. Measure JVP
a. Position the patient with head of bed at 30-45 degrees
b. Place ruler vertically, perpendicular to angle of Louis
c. Identify and point the highest level of jugular vein pulsation; or the highest level of jugular vein distension
d. Place another ruler horizontally at the highest level of pulsation/distension
e. Measure the distance correctly up from the chest wall
3. Palpate carotid arteries
a. Use light palpation
b. Palpate each carotid separately
4. Palpate jugular vein
a. Occlude jugular vein under the jaw
b. Observe for flattening of jugular vein
c. Occlude jugular vein above the clavicle
d. Observe for distension of jugular vein
5. Tests abdominojugular reflux
a. Position patient at 45-degree angle
b. Place partially inflated BP cuff over patient’s abdomen
c. Apply 20-30 mmHg pressure over the abdomen
d. Apply pressure for 15-30 seconds
e. Note distention of jugular vein while applying pressure
f. Release pressure
g. Note for return of jugular vein to normal after release of pressure
6. Auscultate neck vessels
a. Use bell of stethoscope
b. Ask the client to hold breath during auscultation
c. Auscultate carotid arteries
d. Auscultate jugular veins
II. Precordium
1. Inspect apex for pulsations and movement
2. Identify point of maximal impulse
3. Palpate for lifts, heaves, thrusts, thrills
a. Palpate apex correctly at fifth intercostal space midclavicular line
b. Palpate tricuspid area correctly at 4th to 5th intercostals space left sternal border
c. Palpate pulmonic area correctly at 2nd intercostals space left sternal border
d. Palpate aortic are at 2nd intercostals space right sternal border
e. Palpate epigastric area below xyphoid process
4. Percuss for cardiac dullness
a. Use indirect or mediate percussion
b. Identify location of cardiac borders
5. Auscultate four auscultatory sites and differentiate
a. Use both bell and diaphragm of the stethoscope
b. Note rate, rhythm, extra sounds, or murmurs
 c. Auscultate apex correctly
d. Auscultate tricuspid area correctly
e. Auscultate Erb’s point correctly
f. Auscultate Aortic area correctly
g. Auscultate Pulmonic area correctly
h. Check heart rate and rhythm
III. Peripheral-Vascular
1. Inspect upper extremities
a. Color
b. Lesions
c. Edema
2. Check capillary refill
a. Presses nails until blanching
b. Release nails and note time for color return
3. Inspect abdomen
a. Position patient in supine position
b. Expose client’s abdomen while maintaining privacy
c. Inspect arterial pulsation over abdominal aorta
d. Note abdominal venous pattern
4. Inspect lower extremities
a. Note and verbalizes color of the skin
b. Check for lesions
c. Check for edema and grade
d. Check hair distribution
e. Check condition of nails
5. Peripheral pulses
a. Palpate pulses noting rhythm, equality of amplitude and symmetry
b. Palpate Temporal pulse
c. Palpate Carotid pulse
d. Palpate Brachial pulse
e. Palpate Radial pulse
f. Palpate Ulnar pulse
g. Palpate Femoral pulse
h. Palpate Popliteal pulse
i. Palpate Dorsalis Pedis pulse
j. Palpate Posterior Tibialis pulse
6. Lymph nodes
a. Palpate lymph nodes bilaterally
b. Palpate cervical lymph nodes
c. Palpate clavicular lymph nodes
d. Palpate axillary lymph nodes
e. Palpate epitrochlear lymph nodes
f. Palpate inguinal lymph nodes
7. Skin temperature
a. Use light palpation
b. Use dorsum of the hands
c. Palpate bilaterally for skin temperature
8. Calf circumference
a. Use tape measure
b. Measure forefoot circumference
c. Measure ankle circumference
d. Measure calf circumference
e. Measure midthigh circumference
f. Compare measurement bilaterally
9. Calf pain
a. Support patient’s leg
b. Dorsiflexe foot while supporting leg
c. Ask client for pain during dorsiflexion
d. Repeat procedure on other leg
10. Auscultation
a. Use bell of stethoscope
b. Auscultate temporal arteries
c. Auscultate abdominal aorta over epigstric area
11. Check blood pressure
a. Use appropriate equipment
b. Place BP cuff snugly around limb
c. Check palpatory systolic BP
d. Allows 1-2 minutes rest after checking palpatory SBP
e. Check systolic and diastolic pressure
f. Inform patient of BP result