Page 380 - Saunders Comprehensive Review For NCLEX-RN

borders and to check for cardiac enlargement
(denoted by resonance over the lung and dull notes
over the heart).

6. Auscultation

a. Areas of the heart (Fig. 12-4)
b. Auscultate heart rate and rhythm;
check for a pulse deficit (auscultate the
apical heartbeat while palpating an
artery) if an irregularity is noted.
c. Assess S1 (“lub”) and S2 (“dub”)
sounds, and listen for extra heart
sounds, as well as the presence of
murmurs (blowing or swooshing noise
that can be faint or loud with a high,
medium, or low pitch).
d. Grading a murmur: See Box 12-9.
7. Peripheral vascular system
a. Assess adequacy of blood flow to the
extremities by palpating arterial pulses
for equality and symmetry and
checking the condition of the skin and
nails.
b. Check for pretibial edema and measure
calf circumference (see Table 12-2).
c. Measure blood pressure.
d. Palpate superficial inguinal nodes
(using firm but gentle pressure),
beginning in the inguinal area and
moving down toward the inner thigh.
e. An ultrasonic stethoscope may be
needed to amplify the sounds of a
pulse wave if the pulse cannot be
palpated.
f. Carotid artery: Located in the groove
between the trachea and
sternocleidomastoid muscle, medial to
and alongside the muscle
g. Palpate 1 carotid artery at a time to
avoid compromising blood flow to the
brain.
h. Auscultate each carotid artery for the
presence of a bruit (a blowing,
swishing, or buzzing, humming
sound), which indicates blood flow
turbulence; normally a bruit is not
present.
i. Palpate the arteries in the extremities

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