NSE 13A/B Study Guide - Final Guide: Health Promotion, Ibm System I, Costovertebral Angle Tenderness
14 Jun 2018
School
Department
Course
Professor
Heart System
Introduction
- Hand hygiene
- Hello My name is …
- Today I will be assessing your ….
- This may involve some touching are you ok with that?
- I want assure you that everything done today will be kept between you me and the
healthcare team
General Survey (Must comment of 4 findings)
- Patient in upright
- Not in discomfort
- Ethnic background
- Approitalet dressed
PQRSTU (Must ask 10 questions)
- Palliative (1 Question) - What makes the pain better?
- Proactive (1 Question) - What makes the pain worse?
- Quantity (1 Question) - Mild, Moderate, Severe
- Quality (1 Question) - What is the type of your pain? (Sharp, Dull, Heavy)
- Region (1 Question)- Where is your pain? Can you Point to it?
- Radiation (1 Question) - Does your pain travel? If so where does it travel to?
- Severity (1 Question) - Use a scale of 0 -10. (Explain what 0 and 10 mean, use face
scale if need)
- Timing (2 Questions)- How long does the pain last? When did it start? What were you
doing when the pain started?
- Understanding (1 Question) - What do you think is causing the pain?
Subjective Questions - (Must ask 3 questions)
- Do you have a family history of cardiac problems?
- Do you experience shortness of breath?
- Do you cough? → What type of cough is it?
- Is your pain affected by any position?
- Have you noticed any change in skin colors?
Health promotion - (Must ask 2 questions)
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- What is your exercise pattern?
- How long do you exercise ?
- Have you had a change in stress?
- Do you have anxiety?
- Do you drink alcohol ?
Objective Assessment
*Start by using proper draping protocols*
- Put the patient into an upright position in the bed
- Inspect the neck
- Auscultate the carotid artery in 3 locations → Angle of jaw, Midcervical and base
of neck
- Do it bilateral
- Note: bruit or no bruit
- DEEP BREATH AND HOLD??
- Palpate the carotid artery
- Palpate each of the three areas one at a time
- Note the Force
- Note Contour
- Note Amplitude
- Ask the patient to lay down
- Inspect for pulseations (waves)
- Shine light on it
- Look for internal and external jugular veins
- Assess central venous pressure ????
- Note the findings of veins??
- Inspect the Jugular venous pulsation (Supine 30-40 degrees with pillow removed)
- External → Over sternomastoid muscle
- Note if it is present or full
- Internal → Suprasternal notch or origin of sternomastoid muscle
- Diffuse with two visible waves
- Move onto the PRECORDIUM SUPINE INSPECTION
- Inspect the apical pulse
- Note location
- Note if it is present or not
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- Note no hives and no lifts
- Palpate the Apical pulse
- Tell patient to “exhale and hold it”
- Note: Location, Size (1x2cm), Amplitude → short, gentle tap and duration →
short
- Apical pulse
- Landmark it
- Note rate and rhythm
- *In 50% of population you can’t feel it *
- Now move onto the Z PATTERN
- Use the diaphragm and find the 4 locations for the valves
- Tricuspid valve - 4th ICS at L sternal border
- Mitral valve - 5th ICS at L MCL
- Aortic valve - 2nd ICS at R sternal border
- Pulmonic valve - 2nd ICS at L sternal border
- Note: S1 is louder than s2 at apex, s2 is louder than 21 at base, S1
coincided with carotid pulse
- Now use the bell and find the 4 locations for the valves
Musculoskeletal System
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Document Summary
Put the patient into an upright position in the bed. Auscultate the carotid artery in 3 locations angle of jaw, midcervical and base of neck. Palpate each of the three areas one at a time. Look for internal and external jugular veins. Inspect the jugular venous pulsation (supine 30-40 degrees with pillow removed) Note if it is present or full. Internal suprasternal notch or origin of sternomastoid muscle. Note if it is present or not. Tell patient to exhale and hold it . Note: location, size (1x2cm), amplitude short, gentle tap and duration short. *in 50% of population you can"t feel it * Use the diaphragm and find the 4 locations for the valves. Tricuspid valve - 4th ics at l sternal border. Mitral valve - 5th ics at l mcl. Aortic valve - 2nd ics at r sternal border. Pulmonic valve - 2nd ics at l sternal border.
