Among various roles and responsibilities, emergency department nurses must understand the basics of cardiovascular examination and the necessary steps to assess the vital signs and observe the patient. Despite the evident technological progress and quick CT scans or electrocardiogram results, a thorough cardiac exam should never be ignored. Palpation, auscultation, and inspection are the three basics of any physical examination among cardiac patients (Keenan & Kucia, 2022). The first interaction is important as it allows the nurse to look at the patient, pay attention to facial expressions, and create an overall impression. The next step contains precordial inspection and palpation of any visible pulsations, physical damage (lesions, scars, or other trauma signs), the areas of valves, and the apex beat (Keenan & Kucia, 2022). The jugular venous distention is a required measurement of central venous pressure to estimate right-sided heart pressure (Thibodeau & Drazner, 2018). The nurse needs to look at the patient’s skin, nails, and mouth to develop other associations about the condition.
The patient from the case is alert and oriented, but her complaints of chest pain, headache, and blurred vision worsen, leading to excessive hunger, thirst, and urination. Thus, auscultation of heart sounds should be a cornerstone during the nurse’s exam. The patient is usually positioned in a semi-recumbent position for the examiner to reach, but other standard positions like left/right lateral decubitus are recommended (Keenan & Kucia, 2022). The nurse focuses on murmurs and describes them as systolic or diastolic, defining timing, location, duration, intensity, and quality. The Valsalva maneuver is effective in slowing down the heart beating and obtaining normal rhythm (Thibodeau & Drazner, 2018). In this case, the patient has lost 10 kg in the last month, and this fact should be considered during the examination of body build and skin color. Each element of the physical examination contributes to understanding the client’s history and current symptoms.
References
Keenan, J., & Kucia, A. M. (2022). Cardiovascular assessment. In A. M. Kucia & I. D. Jones (Eds.), Cardiac care: A practical guide for nurses (2nd ed., pp. 67–80). Wiley-Blackwell.
Thibodeau, J. T., & Drazner, M. H. (2018). The role of the clinical examination in patients with heart failure. JACC: Heart Failure, 6(7), 543-551.