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Trisquel.ink/Nursing
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Adult Health Assesment
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Chapter 20: Heart & Neck Vessels
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Cardiovascular System – Physical Examination (Normal Findings)
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Cardiovascular System – Physical Examination (Normal Findings)

Physical Examination (Long Format)
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📝 Cardiovascular History – Key Questions

📌 Personal History

  • Have you ever been told you have heart trouble or a heart condition?
  • Do you have high blood pressure (hypertension)?
  • Have you ever had a heart attack or been diagnosed with coronary artery disease?
  • Do you have a history of heart failure, or irregular heartbeat?

👨‍👩‍👧 Family History

  • Does anyone in your family have a history of heart disease, heart attacks, hypertension, or sudden cardiac death?
  • Any relatives diagnosed with congenital heart defects, arrhythmias, or strokes?

💓 Current Symptoms

  • Do you ever feel chest pain or discomfort?
    • When did it start?
    • What brings it on (exertion, stress, rest)?
    • How long does it last?
    • Does it radiate (to arm, jaw, back)?
  • Do you ever feel palpitations (skipping, racing, or pounding heartbeat)?
  • Do you notice shortness of breath (with activity, at rest, or when lying flat)?
  • Have you had any swelling in your ankles or legs?
  • Do you experience dizziness, fainting, or fatigue?

👀 Inspection: Neck & Precordium

  • Neck: No jugular vein distention (JVD) or abnormal venous pulsations.
  • Precordium/Chest: Symmetric; skin color consistent with ethnicity; no scars or lesions.
  • No abnormal heaves, lifts, or visible pulsations.
  • No abnormal chest deformities;

💅 Palpation: Skin & Nails

Skin: Smooth, Warm, dry, intact; color appropriate for ethnicity.

  • Normal texture, thickness, mobility, and turgor (no tenting).
  • No lesions, scars, masses, or abnormal pigmentation patterns.

Nails: clean, smooth, and firmly attached

  • Nail beds pink, with normal shape.
  • No clubbing, cyanosis, deformities, or lesions.
  • Capillary refill < 2 seconds bilaterally.

✋ Palpation: Neck & Precordium

  1. Carotid Arteries: Pulse is present, 2+ normal amplitude, regular rhythm, no thrills.
  2. No precordial thrills, pulsations.
  3. Precordial Landmarks Palpated:
    • Aortic (2nd right ICS, RSB)
    • Pulmonic (2nd left ICS, LSB)
    • Erb’s point (3rd left ICS, LSB)
    • Tricuspid (4th–5th left ICS, LSB)
    • Mitral (5th ICS, left MCL, apex)

      • → No abnormal pulsations, thrills, or lifts detected.

  4. PMI (Point of Maximum Impulse): Palpated at 5th ICS, left MCL.

ICS = intercostal Space

MCL = Mid Clavicular line

🎧 Auscultation: Heart Sounds

  • S1 and S2: Normal in intensity, regular rate and rhythm.
  • S1 best heard at apex; S2 best at base.
  • Carotid pulse palpated to correlate S1 with systole.
  • No extra sounds present. (S3, S4)
  • No murmurs or abnormal heart sounds.