ing for heart sound
TRANSCRIPT
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.y Begin auscultation over the aortic area, placing
the stethoscope over the second intercostal space,along the right sternal border
y Then move to the pulmonic area, located at the
left n over the sternal border.y Next assess the triscupid area,which lies over
the fourt and fifth intercostal space, along the left
sternal bordery Finally, listen mitral area, located at the fifth
intercostal space, near the midclavicular line.
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Heart Sounds
y Systole the period of ventricular contraction
yS1 - first heart sound
yS2
- second heart sound
yAlways identify S11
and S2, then listen for
adventitious sounds, such as third and fourth
heart sounds. Also listen for murmurs,whichsound like vibrating, blowing, or rumbling
sounds.
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Hearing Pericardial Friction Rubs
y Have the patient lean forward . If the patient cant
tolerate leaning forward, position him sitting
upright.
y Ask the patient to exhale, hen listen with the
diaphragm stethoscope over the third intercostal
space on the left side of the chest.
y If you suspect a rub but have trouble hearing one,ask the patient to hold his breath.
y A friction rub may be heard during atrial systole,
ventricular systole, or ventricular diastole.
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y To differentiate a pericardial friction rub form a
pleural friction rub, ask the patient to hold his
breath.
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Assessing the vascular system
y Inspection
yStart by making general observations. Are arms
equal in size? Are legs symmetrical?Then note
skin color, body hair distribution, and lesions,
scars, clubbing, and edema of the extremities. If
the patient is confined to bed, check the sacrum
for swelling. Examine the finger nails andtoenails for abnormalities.
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y Palpation
yFirst, asses skin temperature, texture, and
turgor.Then assess capillary refill in the nail
beds on the finger and toes. Refill time should
be no more than 3 seconds, or long enough to
say capillary refill. Palpate the patients arms
and legs for temperature and edema.Thenpalpate the arterial pulses.
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PalpatingArterial Pulses
y Carotid pulse
y Lightly place your fingers just lateral to the trachea and below
the jaw angle. Never palpate both carotid at the same time
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y Brachial pulse
y Position your fingers medial to the biceps and tendons
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y Femoral pulse
y Press relatively hard at the point inferior to the inguinal ligament.
For an obese patient, palpate in the crease of the groin, halfwaybetween the pubic bone and the tip bone.
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y Popliteal pulse
y Press firmly in the popliteal fossa at the back of the knee.
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y Posterior tibial pulse
y apply pressure behind and slightly below the malleous of the ankle.
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y Dorsalis pedis pulse
y Place your fingers on the medial dorsum of the foot while the
patient points his toes dow
n.T
he pulse is difficult to palpate hereand may seem to be absent in healthy patients.