Healthy People 2030-cardiovascular or respiratory systems

Posted: February 3rd, 2024

This week you have studied cardiovascular, peripheral vascular, and respiratory advanced physical assessment.

What additional resources for these advanced health assessment skills have you found beneficial in developing your knowledge and psychomotor skills this week? 

• Share at least two new resources you’ve found this week for cardiovascular, peripheral vascular or respiratory assessment that you will use in practice after graduation.  
• Explain what makes the resource essential to your practice. 
• Incorporate Healthy People 2030 in your discussion—describe two goals related to the cardiovascular or respiratory systems that will require assessment data to evaluate. 

1. Cardiovascular Advanced Physical Assessment:

• Inspection:

• Observe for jugular venous distention (JVD), which indicates increased central venous pressure.
• Inspect the precordium for visible pulsations or heaves, which may suggest ventricular hypertrophy or other cardiac abnormalities.²
• Note any signs of edema, cyanosis, or diaphoresis.
• Palpation:

• Palpate the apical impulse (point of maximal impulse, PMI) to assess its location, size, and character. A displaced or enlarged PMI may indicate cardiomegaly.
• Palpate for thrills, which are palpable vibrations that suggest turbulent blood flow (e.g., murmurs).
• Palpate the carotid pulses, noting their amplitude, contour, and symmetry.
• Auscultation:

• Auscultate heart sounds systematically, using both the diaphragm and bell of the stethoscope.
• Identify the first (S1) and second (S2) heart sounds, noting their intensity and splitting.
• Listen for extra heart sounds (S3, S4), murmurs, or rubs.

• S3: May indicate ventricular overload or heart failure.
• S4: May indicate decreased ventricular compliance.
• Murmurs: Assess their timing (systolic or diastolic), intensity, pitch, and location.
• Pericardial friction rub: A scratchy sound that may indicate pericarditis.
• Auscultate the carotid arteries for bruits, which suggest turbulent blood flow due to atherosclerotic plaques.

2. Peripheral Vascular Advanced Physical Assessment:

• Inspection:

• Inspect the extremities for color, temperature, edema, and skin changes (e.g., ulcers, hair loss, shiny skin).
• Observe for venous distention or varicosities.
• Palpation:

• Palpate peripheral pulses (radial, brachial, femoral, popliteal, dorsalis pedis, posterior tibial), assessing their amplitude and symmetry.
• Assess for capillary refill time, which should be less than 2 seconds.
• Palpate for edema, noting its location and severity.
• Perform the Allen test to evaluate the patency of the radial and ulnar arteries.
• Assess for arterial or venous insufficiency.
• Auscultation:
• Auscultate for arterial bruits in the peripheral arteries (e.g., femoral, renal).

3. Respiratory Advanced Physical Assessment:

• Inspection:

• Observe respiratory rate, rhythm, and depth.
• Note the use of accessory muscles, which indicates respiratory distress.
• Inspect the chest wall for symmetry, shape, and movement.
• Observe for signs of cyanosis or clubbing of the fingers.
• Palpation:

• Palpate the chest wall for tenderness, masses, or crepitus (subcutaneous air).
• Assess for tactile fremitus, which is the vibration of the chest wall during speech. Increased fremitus may indicate consolidation, while decreased fremitus may indicate air or fluid in the pleural space.
• Assess chest expansion.
• Percussion:

• Percuss the chest wall to assess lung resonance.
• Hyperresonance may indicate hyperinflation (e.g., emphysema), while dullness may indicate consolidation or pleural effusion.
• Auscultation:

• Auscultate lung sounds systematically, comparing both sides of the chest.
• Identify normal breath sounds (vesicular, bronchovesicular, bronchial).
• Listen for adventitious breath sounds:

• Crackles (rales): May indicate fluid in the alveoli (e.g., pulmonary edema, pneumonia).
• Wheezes: May indicate airway narrowing (e.g., asthma, bronchitis).
• Rhonchi: May indicate secretions in the large airways.
• Stridor: A high-pitched sound that may indicate upper airway obstruction.
• Pleural friction rub: A grating sound that may indicate pleural inflammation.

Integrating Findings:

• Correlate findings from the cardiovascular, peripheral vascular, and respiratory assessments to develop a comprehensive understanding of the patient’s cardiopulmonary status.
• Consider the patient’s medical history, symptoms, and risk factors.
• Use findings to guide further diagnostic testing and treatment.

This detailed approach to advanced physical assessment provides valuable information for the diagnosis and management of cardiopulmonary conditions.