Cardiovascular Assessment Steps
1. Wash your hands, introduce yourself to the patient and clarify their identity. Explain what you would like to do and obtain consent. A chaperone should be offered for this examination Introduce yourself to the patient
2. For this examination the patient should be on the bed with their trunk at 45degrees, they should be exposed from the waist up. 3. Begin by observing the patient from the end of the bed.
You should note whether the patient looks comfortable.
Are they cyanosed or flushed?
Is their respiration rate normal?
Are there any clues around the bed such as PCA machines, GTN sprays or an oxygen mask? Comments should be provided to the examiner on each of these areas. Observe the patient from the end of the bed
4. Inspect the patient’s hands. Initially note how warm they feel as this gives an indication of how well perfused they are. Particular signs which you should be looking for are nail clubbing, splinter haemorrhages, palmar erythema, janeway lesions, osler’s nodes, and nicotine staining. Inspect the patient's hands
5. Take the radial pulse. It is not a suitable pulse for describing the character of the pulsation, but can be used to assess the rate and rhythm. At this point you should also check for a collapsing pulse – a sign of aortic incompetence. Remembering to check that the patient doesn’t have any problems with their shoulder, locate the radial pulse and place your palm over it, then raise the arm above the patient’s head. A collapsing pulse will present as a knocking on your palm. Take the radial pulse
Check for a collapsing pulse
6. Examine the extensors aspect of the elbow for any evidence of xanthomata. 7. At this point you should say to the examiner that you would like to take the blood pressure. They will usually tell you not to and give you the value. 8. Move up to the face. Look in the eyes for any signs of jaundice (particularly in the sclera beneath the upper eyelid), anaemia (in the...
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