LABORATORY SESSION 5

ASSESSING CARDIOVASCULAR AND PERIPHERAL

VASCULAR SYSTEM
5.1
5.2

Examination of the Heart and Precordium

Examination of the Peripheral Vascular System

Examination of Cardiac and Peripheral Vascular System Nursing History

Current Symptoms
Do you now or have you ever experienced any of the followings?
Chest pain

No

Yes

Fatigue

No

Yes

Dyspnoea

No

Yes

Palpitation

No

Yes

Dizziness

No

Yes

Swelling in lower limbs

No

Yes

Problems with your circulation

No

Yes

Pain / tingling / numbness

No

Yes

Describe the symptoms. ___________________________________________________________

_______________________________________________________________________________

Past History
Have you had any cardiac problem? ____________________________________________
Have you ever had any cardiac surgery? _________________________________________

Family History
Have any of your family ever suffered from the following illnesses / problems?
Hypertension

No

Yes

Myocardial infarction (MI)

No

Yes

Coronary heart disease (CHD)

No

Yes

Elevated cholesterol level

No

Yes

Diabetic mellitus (DM)

No

Yes

If so, please indicate who and when. ______________________________________________

Lifestyle and Health Practices

Do you smoke? __________________________________________________________________
Describe what you usually eat each day. _______________________________________________
Do you exercise? What type of exercise and how often? __________________________________
Do you take medications for cardiac problems? _________________________________________
Do you monitor your own heart rate or blood pressure? __________________________________

Remarks:

If the client reports any symptoms, use the COLDSPA mnemonic as a guide to
explore it further with a symptom analysis

Procedure 5.1: Examination of the Heart and Precordium Physical Examination

Purpose of Procedure
To determine the level of functioning of the cardiovascular system and the status of the
underlying cardiac structures (the heart and great vessels). (Physical examination of the
cardiovascular system focuses on the anterior chest wall or the precordium.)
Preparation
Required Equipment
1.
Stethoscope with bell and diaphragm
2.
Light source for tangential lighting
Client:
1.
Ensure client is comfortable and provide client with privacy.
2.
Keep female clients breasts draped.
Examiner
Stand on the clients right side to facilitate your hand placement and auscultation of the
precordium.
Environment
A room with comfortable temperature and quiet.
Examination order
1.
Pulse and blood pressure (see vital signs monitoring)
2.
Extremities (see 4.2, peripheral vascular examination)
3.
Neck vessels
4.
Precordium
Implementation of Procedure neck vessels and precordium examination
1.
Wash hands
2.
Identify client; introduce self to client.
3.
Explain procedure to client and gain verbal consent.
4.
Provide privacy
5.
Assist the client to a supine position and expose the anterior chest area.
6.
Perform a general inspection of the clients health status observing the face and neck for any
signs of cardiac distress (e.g., cyanosis, oedema, obvious distress).
7.
Auscultate the carotid artery

Keep clients neck in a neutral position.

Lightly apply the bell on the stethoscope over the carotid artery and ask the client to
hold his or her breath for a moment.
8.
Palpate the carotid arteries

Palpate each carotid artery medial to the sternomastoid muscle in the neck gently.
(Avoid excessive pressure on the carotid sinus area).

Place the pads of the index and middle fingers medial to the sternocleidomastoid
muscle on the neck.
4

9.

10.

11.

12.

13.

Note the contour and amplitude of the pulse.

Inspect the precordium directly and using tangential lighting:

Position the client in supine position with the head of the bed elevated between 30 and
45 and stand on the clients right side.

Observe the precordium for heaves, lifts or pulsations.

Locate the PMI (point of maximal impulse) if visible.

Observe and note breathing pattern

Note any scars or skeletal abnormalities
Palpate the major precordial landmarks with the palmar of the hand feeling for any
vibrations or thrills.

Landmarks: aortic, pulmonic, Erbs Point, tricuspid, and mitral.

Note any vibrations, pulsations or thrills. If any are noted describe further in terms of
location, amplitude, and duration.
Palpate the apical impulse with one finger
pad.

To locate the pulsation, ask the client to

exhale and then hold it.

Position the client midway to the left if

needed.

Noted the location, size, amplitude and

duration.
Auscultate the major precordial landmarks
proceeding systematically from one landmark
to the next in this order: aortic, pulmonic,
Erbs Point, tricuspid, and mitral
Source: Weber, J. (1996). Nurses handbook of
Listen for several cardiac cycles at each
health assessment (3rd ed.). Philadelphia: Lippincott.
landmark using the bell and the
diaphragm.
At each landmark identify S1 and S2 and
any extra heart sounds or murmurs.
The first heart sound S1, is heard loudest at the apex and the second heart sound, S2, is
heard loudest at the base of the heart.
Auscultate as above with the person assuming different positions (optional)
Auscultate with the person in the forward sitting or the left lateral decubitus position
The forward sitting position will bring the base of the heart closer to the chest wall and
the left lateral decubitus position will allow the apex of the heart to move closer to the
chest wall.

Procedure 5.2:

Peripheral Vascular Examination -- Physical Examination

Purpose of Procedure
To determine the level of functioning of the peripheral vascular system and the presence of the
arterial pulses.
Preparation
Required Equipment
1.
Stethoscope with bell and diaphragm
2.
Examination gown for client
3.
Disposable gloves if universal precautions required
Client:
1.
Ensure client is comfortable and provide client with privacy.
2.

Assist the client wear an examination gown and sit upright.

Environment
A room with comfortable temperature and without drafts
Implementation of Procedure
1.
Wash hands
2.
Identify client; introduce self to client.
3.
Explain procedure to client and gain verbal consent.
4.
Ensure client is comfortable and provide client with privacy.
5.
Assist the client to a supine position and expose the body appropriately.
an examination gown to assist with exposing the applicable areas.
6.

Inspect both arms from the fingertips to the shoulders.

The client can wear

Note:

The size and symmetry and any oedema.

The temperature of the skin and any moisture present.
The venous pattern.
The color of the skin and nail beds and the texture of the skin.
7. Palpate the brachial, ulnar and radial arterial pulses

Palpate using the fingertips and palpate the left and right pulses individually as well as
simultaneously (Exception: Never palpate both carotid pulses at the same time).

Palpate each pulse to determine the rate, rhythm, symmetry, and amplitude
Amplitude of the pulses can be classified using the following guide:
4 = Bounding
3 = Increased
2 = Normal
1 = Weak
0 = Absent or non-palpable

Note the temperature

8. Perform the Allen test

To evaluate patency of the radial or ulnar arteries.

Rest the clients hand palm side up on the examination table and make a fist.
Compress the clients both radial and ulnar arteries with your thumb, and ask the client to
open and close the fist several times.

Continue to compress the arteries and have the person open the hand
To assess ulnar patency: release the pressure on the ulnar artery and watch for colour to
return to the hand within 3-5 seconds.

To assess radial patency: to repeat the procedure as before, but at the last step, release
pressure on the radial artery.

9. Inspect both legs from the groin and buttocks to the feet.

Note:

The size and symmetry and any oedema.

The temperature of the skin and any moisture present.
The venous pattern and any venous enlargement in the legs (e.g., varicose veins).
Hair distribution and any pigmentation, rashes, scars, or ulcerations.
The colour and texture of the skin, the colour of the nail beds, and the distribution of hair
on the lower legs, feet, and toes.

10. Inspect for varicosities and thrombophlebitis

Client is in standing position.
Observe the superficial vein and palpate for tenderness if thrombophlebitis noted.
11. If arterial occlusion is suspected, auscultate the carotid and femoral arteries for bruits, using
the bell of the stethoscope.
12. Palpate the femoral, popliteal, dorsalis pedis and posterior tibial pulses

Palpate using the fingertips and palpate the left and right pulses individually as well as
simultaneously.

Palpate each pulse to determine the rate, rhythm, symmetry, and amplitude.
Amplitude of the pulses can be classified using the following guide:
4 = Bounding
3 = Increased
2 = Normal
1 = Weak
0 = Absent or non-palpable

Note the temperature.

ASSESSMENT OF CARDIOVASCULAR AND PERIPHERAL VASCULAR SYSTEM

Name of Client:
Date of examination:
PHYSICAL EXAMINATION

CLINICAL FINDINGS/JUDGEMENT

Inspect (Stand on RHS):

Chest
PMI
Palpate:
R&L 2nd ICS
L 3rd ICS (Erbs point)
L 4th ICS
L 5th ICS
Auscultate (Using diaphragm and bell):
2nd ICS RSB (aortic)
2nd ICS LSB (pulmonic)
3rd ICS LSB (pulmonic)
5th ICS LSB (tricuspid)*
Apex 5th ICS LMCL (mitral)
(record rate)

ASSESSMENT OF CARDIOVASCULAR AND PERIPHERAL VASCULAR SYSTEM (contd)

Name of Client:
Date of examination:
PHYSICAL EXAMINATION
UPPER EXTREMETIES
Inspect

CLINICAL FINDINGS/JUDGEMENT

Upper extremities

Palpate

Carotid pulses

Brachial pulses
Radial pulses
Allen test
LOWER EXTREMETIES
Inspect

Lower extremities

Palpate

Popliteal pulses

Dorsalis pedis pulses

Posterior tibial pulses