RETURN DEMONSTRATION EVALUATION TOOL FOR:

Assessing the Heart and Central Vessels

Name: _____________________________________ Grade: _____________
Time started: ____________ Time ended: ____________ Date of RD: ________________________

AREA FOR EVALUATION RATING COMMENTS

SKILLS (35%) 5 4 3 2 1 0
ASSESSMENT /PLANNING
1. Check doctor’s order.
2. Assemble equipments:
 Stethoscope
 Centimeter ruler

IMPLEMENTATION
3. Identifies client.
4. Explains to the client what you are
going to do, why it is necessary,
and how he or she can cooperate.
5. Washes hands and observes
other appropriate infection control
procedures.
6. Provides for client’s privacy.
7. Determines client’s history of the
following:
 Family history of incidence and
age of heart disease, high
cholesterol levels, high blood
pressure, stroke, obesity,
congenital heart disease, and
rheumatic fever.
 Client’s past history of rheumatic
fever, heart murmur, heart attack,
varicosities, or heart failure.
 Present symptoms indicative of
heart disease
 Presence of diseases that affect
heart
 Lifestyle habits that are risk
factors for cardiac disease.
8. Simultaneously inpects and
palpates the precordium for the
resence of abnormal pulsations,
lifts, or heaves.
a. Inspects and palpates the aortic
and pulmonic areas, observing
them at an angle and to the side,
to note the presence or absence
of pulsations.
b. Inspects and palpates the
 tricuspid area for pulsations and
heaves or lifts.
c. Inspects and palpates the apical
area for pulsation, noting its
specific location.
d. Inspects and palpates the
epigastric area at the base of the
sternum for abdominal aortic
pulsations.
9. Auscultates the heart in all four
anatomic sites: aortic, pulmonic,
tricuspid, and apical (mitral).
Carotid Arteries
10. Palpate the carotid artery. (Use
extreme caution)
11. Auscultates the carotid artery.
Jugular Veins
12. Inspect the jugular veins for
distention.
- The client is placed in a semi-
fowler’s position, with the head
supported on a small pillow.
13. If jugular distention is present,
assess the jugular venous
pressure (JVP).
a. Locate the highest visible point of
distention of the internal jugular
vein.
b. Measure the vertical height of this
point in centimeters from the
sternal angle.
c. Repeat the steps above on the
other side.
EVALUATION/DOCUMENTATION
1. Documents findings in the client’s
record.
KNOWLEDGE: (15%)
1. Gives rationale of the procedure.
2. Explains the elements and
mechanics of the procedure.
3. Knows the elements of nursing
process as applied.
4. States principles applied in the
procedure.
ATTITUDE: (10%)
1. Is well groomed.
2. Wears prescribed, neat, and clean
uniform.
3. Arrives on time for the RD.
4. Speaks to CI and client tactfully.
5. Minimizes use of energy, time, and
effort
6. Utilizes supplies efficiently.
7. Considers client’s safety, privacy, and
comfort.
8. Is well organized.
9. Keeps working area clean at all times.
10. Gives high value for aesthetics.

Comments: _______________________________________________________________
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Clinical Instructor’s signature: ____________________________________