‘tympanic: drurmike ‘gastric bubble high-pitched, loud resonant hollow healthy lun lowpitched, loud ee ot dullmuted bone: high-pitched, soft ut thud ike Tver rmediumpitched, sft Eerie The primary purpose ofthe cardiovascular system ie to move nuient, gazes and ‘noses fo and fom call ft encompasses the neck vessels, heart ond Deripheral vacular ystor Blood Pressure (BP) BP recorded at two nomber The higher number whichis the ayrtolle pressure, isthe maximal contraction otthe bear = Thelower umber hich the date pressr, sh esting presi wart ventricles he ference between the syatole and castle presse, called the pulse pressure, represents the force hat the hear generates each time contacts « Troe io hetural “normal value for BP rather there range of valves, which upon increasing, are associated th greater Ves Nock Vessel Assessment ‘Aesesiment of neck vein provides Wformation about @ cient’ wolume and ‘reas mn the carchovasulr system. Inspection ‘The right terol jugular von i typlealy the best neck vein to inspect. Postion the chant ta degre angle ard turn head aight aay {Using tangental ight, cbaerve the piycal appearance nd the venous pulsation ‘ofthe entorna jugular ven, where pases over the strnomastetd muscle Fsipation Paipate the carotid arteries low inthe neck to avoid the carotid sinus. Do one Side ot time to prevent compromising blood few to the head. Locate te intr! jug pulsston an mark the highest pont of pulsation {Fndthe "angie of Lous and use we sralgh insta mark ha intercon snd Imoseute tre datance above the sternal angle (2 em o less broad Auscultation ‘Ausctate the carotid arteries using the bel of the stethoscope. stent angle of jaw, midsoreal ores and base of neck then ask the cient to held the breath miomertaniy + Carotid ruta are a blowing or rushing sound over the corte otery: ually the osu of atenosia ofthe caro tery Heart & Pericardium Assessment This involves assessing the “pump and surrounding se. inspection Ina supine poston, inspect the chest wall and epigastrum, looking for ulations, heaves or hi. Peusatons othe apical impulse, maybe visible inthe th o Sth CS (intercostal Space at the lh melanie town as ve PA oie of mana impulse) Palpation Methodically palpate the pericardium using the paims and fingers. Begin atthe pot and move tothe lo stoma border aia then to the base ofthe hear ‘Apia pulsation (Mi canbe ft on pation Mi Erormaly 2 cm n diameter 1 a'lago, ately isplaced or difuse PMI may indicate some form of ‘cardiomega ‘No palpable pulsations over the some, pulmonic and mil valves Thats Boul Benepe hones: he apex 1 polpobe mur that feels srnlarto 9 ext puing ps ofthe fogers may [Seimce sonte to hs vistors are always aasocated with murmurs + Reaves upward coplocement ofthe chew aganst tre hand heaves are best {St wnth ‘he heel 6! he hand at she rernl border heaves have various sesociations Percussion Although Used to determine cardi borders, percussion io imted usefulness In sscosamont ofthe hears Auseultation ‘hiss the systemic lrtening to cardiac atvityspeciicaly blood flow the candace structures ied Right 2nd ICS storm border sortie valve {UR'2nd CS somal border ~ pulmonic valve [oft Sth Cs sterol borcer—scupid valve Cah Sth C3 melee ine = mira valve Ith sounds are fit or undetectabe, have the cient lean forward or ay on thee side to bring the heart closer to the surface ofthe anterior chest wal + ian for on of he AV ativan ves aod 58 othe semluner values) eounds 2°Gh i bostheard over the mitral valve + 52's pesthesrd over the arte valve « sing te dlaphragm of stethoscope, note the folowing at each aren Ginga stethoscope. : sounds produced by the body + Sound must be isleted for proper identfication and evaluation *Haatnare provider outline ng ea anti to lust the hecuency intensity duration, number and quay of sounds + Performed forthe purposes of examining the crcuatery system, respiratory — ‘System ora gosvantesinal (system tot + rate and shythm ss + Stands2 SI's the "tub" sound: 82 isthe “dub” sound 51 ie louder than 52 at the apex: 52 is louder than S1 at the bare Sh coinees with earcid pulsation + era heart sounds or murmurs "53s ound by creamed blgod volume within he venice ands best heard with the bell ofthe stetroscope; known as a ventricular gallop = S419 caused by blood bing forced into «perro vei: kxown ‘an atrial gallop murmurs ae turbulence, oF 2 geile lowing or sucoshirg sound, cased by: S*Fchange:n the elo oftlood fw > b stuctural defect in te vaes 2 apunvntl opening rhe ar aes Repeat the auscultation process, using the bel ofthe sethosco Grading of Murmurs a 1 Pare audible Cleary audible, but fant IM moderatly loud: easy to hear with stethoscope I~ loud: sesocated with’ trl palpable onthe chest wall \Vvery loud: heard with stethoscope paral ited of the chest wal W-Toddesthoord with entire stttoacope ited of he chest wal Peripheral Vascular Systom 2 system of intertwining veins and erteres, which cory blood to and from te | heart an lunge ‘Artery Assessment ‘Arteries assessed in caphalocausal positon Carotid (See Neck Vessel Assesment) Upper Extremity - Radial & Brachial Pulses + Papate both radial pulzassimuitancousiy {note the rate, hydhm, character acl amplitude; compare both pues 1 feelsho pales with ane finger + fe i chet forearm anc feel for abounding pub by feng with the at of your pa + Normal radial ple is symmetrical, gu and between 40-90 per minte Femoral Pulse Pal ‘Press deeply, below the inguinaligamentand about midway between symphysis ppubisand anterior sper iis sane «the tro hans, one on top of re othe to fel the femoral pulse + note the adequacy o the pulse volume 1 ate the strength of the pulse 0 O lassen 1 eereased) 24 normad + peat the procedure on the opposite side {coasting of fmol ara pls by silanes option ‘Normal femoral pulse as same characters a6 Yoda! pulse and is Simultaneous in tming ‘Auscutaton . sete Use the cuphragm of stethoscope to lstan over the femoral artery fora brit {A’pltaton is normaly heard, but without addline! sounds during systole Lower Extremity Popliteal, Posterior Tibial & Dorsalis Pedis Pulses *Ingpect for color changes, kin lesions, stasis ulcers or lack of hair growth and Hoare’ ign + Paipate the pulse symmetry ancl amplitude of esch leg vesse! "Gently lee te Kees and fol for he popliteal pulse by doop palpation in ‘midline in popites! ona + the posterior tibial pulse canbe fet behind and below the mesial malleolus + he Sorsalis pedis pues paipabie on the dorsum a the foot nthe frst imermetatarsal space jst eral to the extensor tendon of the * palate te foot to atss vaca: + capillary refi 1 elevation pallor 1 Sapendent ruboe «Speck anton ie given 10 signs of chronic arterial cr venous insufficiency “Examine along the course of superficial veins ~