3rd Intercoastal Space, Left Sternal Border

• a decrease in the color of the skin • caused by lack of oxyhemoglobin. • It is a result of anemia or decreased arterial perfusion. • It is best observed around the fingernails, lips, and oral mucosa. • In patients with dark skin, the nurse observes the palms of the hands and soles of the feet.

• a bluish tinge, most often of the nails and skin of the nose, lips, earlobes, and extremities • suggests decreased flow rate of blood to a particular area, which allows more time for the hemoglobin molecule to become desaturated • may occur normally in peripheral vasoconstriction associated with a cold environment, in patients with anxiety, or in disease states such as HF

• a bluish tinge observed in the tongue and buccal mucosa • denotes serious cardiac disorders (pulmonary edema and congenital heart disease) in which venous blood passes through the pulmonary circulation without being oxygenated.

• yellowish, slightly raised plaques in the skinmay be observed along the nasal portion of one or both eyelids and may indicate elevated cholesterol levels (hypercholesterolemia).

• a purplish-blue color fading to green, yellow, or brown over time • is associated with blood out-side of the blood vessels and is usually caused by trauma. • Patients who are receiving anticoagulant therapy should be carefully observed for unexplained _____

NORMAL

PULSATION OVER THE SKIN

JUGULAR VENOUS PRESSURE • Position the patient supine with the head of the table elevated __ degrees.

JUGULAR VENOUS PRESSURE • This measurement should be less than __ cm in a normal healthy adult.

INTERNAL JUGULAR PULSATION

CAROTID PULSATION

PRECORDIAL MOVEMENT • Position the patient supine with the head of the table slightly elevated. • Always examine from the patient's right side. • Inspect for precordial movement. Tangential lighting will make movements more visible. • Palpate for precordial activity in general. • You may feel "extras" such as thrills or exaggerated ventricular impulses. • Palpate for the point of maximal impulse (PMI or apical pulse). • It is normally located in the ___ or ___ intercostal space just medial to the midclavicular line and is less than the size of a quarter. • Note the location, size, and quality of the impulse.

The entire precordium is palpated methodically using the palms and the fingers, beginning at the ____, moving to the _______, and then to the base of the ____.

Having the client seated and learning forward s best suited for

The left lateral recumbent position is best suited for

Auscultation of the Heart - Right 2nd ICS sternal border.

Auscultation of the Heart Left 2nd ICS sternal border

Auscultation of the Heart Left 4th ICS sternal border

Auscultation of the Heart - Left 5th ICS midclavicular line

S1 AND S2 HEART SOUND s1 s2

S1 -

S2 -

S3 HEART SOUND

S3 HEART SOUND s1 s2 s3

S4 HEART SOUND s4 s1 s2

S1 - CLOSURE OF THE _____

S2 - CLOSURE OF THE _____

S1 SOUND IS BEST HEARD OVER THE

S2 SOUND IS BEST HEARD OVER THE

CARDIAC RATE RANGES FROM _____ bpm