Hi. My Name is , a nursing student at USA. Please lay down and we will get started with the cardio exam.
The apical pulse is found in the 5th ICS at the midclavicular line. It is not visible on this patient. No lifts or heaves noted. The apex is the tip of the heart and is located at the 5th ICS, left midclavicular line. The base is the top of the heart, located at the 3rd ICS from the right border of the sternum to the left midclavicular line.
PALPATE The apical pulse is at the 5th ICS at about the midclavicular line. Apical pulses are palpable in about half adults. It is present in this patient.
Now I am palpating the apex, left sternal border and base for thrills, lifts, or heaves. None are noted.
Now I will percuss the borders of the heart. Over the lungs I will hear resonance and dullness over the heart. Left border is at midclavicular line at the 5th ICS. The right border matches the sternal border. Heart is of normal size and there appears to be no enlargement.
Now I will ascultate the five majors areas: aortic, pulmonic, Erb’s point, tricuspic, and mitral valves with both the diaphragm and the bell.
Normal S1 and S2 sounds noted in the aortic valve area, 2nd ICS, right sternal border.
Pulmonic valve area is in the 2nd ICS left sternal border.
Erb’s point is at the 3rd left ICS at the left sternal border.
Tricuspid valve area is at the 5th ICS at the left sternal border.
Mirtal valve area is at the 5th ICS left midclavicular line. Normal rate and rhythm noted with an S1 and S2. No splitting, extra sounds or murmurs noted.
S 1 is created by the closing of the AV valves at the start of systole and is heard loudest at the apex. S 1 coincides with the carotid artery pulse. S2 is created by the closing of the SL valves at the end of systole. S2 is loudest at the base.
I have pre-assessed Miss Davis’ heartbeat as 70 beats per minute. The rhythm is regular. Normal adult range is 60 to 100 BPM.
Apical pulse and carotid pulse re identical. No pulse deficit.
Radial pulse has regular rhythm and is a 2+ on a 4 point scale for both sides.
Bracial pulse is the same.
Femoral pulse is found in the groin area, below the inguinal ligament between the pubis and illiac spine.
Popliteal pulse is also a 2+.
The posterior tibial pulses are regular and is a 2+.
Dorsalis pedis pulses are regular and also a 2+.
With the carotid pulses, I am going to use the bell and listen for bruits. No swooshing sounds of bruits are present.
Lastly I am going to examine your nails. Nails are pink, smooth, slightly curved. Nail base is firmly attached to nail bed. Angle is 160 degrees, no indication of clubbing. Capillary refill time is prompt, less than 2 seconds indicating good peripheral fusion and cardiac output.
