Auscultation of the Heart Left 2nd ICS sternal border

CARDIAC RATE RANGES FROM _____ bpm

CAROTID PULSATION

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

PULSATION OVER THE SKIN

NORMAL

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

• 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.

S1 - CLOSURE OF THE _____

• 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

S1 AND S2 HEART SOUND s1 s2

• 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 _____

S1 SOUND IS BEST HEARD OVER THE

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 ____.

S1 -

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.

• 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.

S3 HEART SOUND s1 s2 s3

S3 HEART SOUND

S2 -

S2 SOUND IS BEST HEARD OVER THE

Auscultation of the Heart - Left 5th ICS midclavicular line

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

Auscultation of the Heart Left 4th ICS sternal border

The left lateral recumbent position is best suited for

S4 HEART SOUND s4 s1 s2

3rd Intercoastal Space, Left Sternal Border

Having the client seated and learning forward s best suited for

INTERNAL JUGULAR PULSATION

S2 - CLOSURE OF THE _____