Physical: Cardiac & Peripheral Vascular

Critical Elements

• Understanding of the importance and variations that can occur with cardiac and peripheral vascular assessments.
• Create appropriate physical environment.
• Provide privacy,
• Explain procedure.
• Clean equipment prior to use.
• Wash hands.

Procedure

Prior to Treatment: (Critical Thinking)

• Gather appropriate physical assessment equipment: stethoscope.
• Consider age related variations for exam.

Patient Interaction: (Safety)

• Patient identifiers.
• Create appropriate physical environment.
• Provide privacy.
• Explain procedure.
• Clean equipment prior to use.
• Wash hands.

Ask the Following Questions: (Patient Centered Care)

1. Are you hurting, have pain or discomfort in your chest or legs?
2. Are you experiencing any shortness of breath or irregular heartbeats

Assess the Following: (Patient Centered Care)

Inspection and Palpation

1. Inspect mucous membranes for color variations and dryness.
2. Observe for jugular venous distension.
3. Observe for arm and leg discolorations, lesions or trophic skin changes.
4. Palpate capillary refill on each hand and foot.
5. Palpate temperature of periphery.
6. Palpate for peripheral edema.
7. Palpate pulses including radial, femoral, popliteal, dorsalis pedis and posterior tibialis.

Auscultation

1. Auscultate the apical pulse for 1 minute, noting rate and rhythm.
2. Auscultate 4 cardiac sites and identify S1 & S2 and any variations.

After Procedure (Patient Centered Care, Safety)

• Provide appropriate nursing management for abnormal findings.

Documentation (Informatics, Communication)

• Outcome of assessment.
• Interventions used for nursing management of care.
• Patient’s response to interventions.

Resources

• Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition
• ATI Physical Assessment: Adult
• Mayo Clinic