Before Starting

• Make sure the patient’s bed is at 45 degrees
• Ask the patient to fully expose their chest
• ❗ Remember if the patient is female to pay attention to modesty and allow her to cover herself with a sheet or towel as soon as it’s appropriate

Inspection

• ABCD Assessment
• CVS Specific Environment Assessment
• [ ] Look for chest deformities
  • [ ] Pectus excavatum
  • [ ] Kyphoscoliosis
• [ ] Scars (Check axillary area and make it obvious)

Palpation

• [ ] Check the tracheal position
• [ ] Look for a cardiac pacemaker

• [ ] Feel for the Apex beat (5th intercostal space, midclavicular line, left side)
• [ ] Feel for heaves: Presss flat of hand firmly to L of sternum
  • Hand easily lifted with chest wall movement (Indicates ventricular hypertrophy)
• [ ] Feel for thrills: Thrills are palpable murmur (usually systolic)
  • [ ] Feel at apex
  • [ ] Feel at both sides of sternum with flat of fingers

Auscultation

• Listen to all 4 valve areas with the diaphragm AND the bell of the stethoscope while palpating for the carotid pulse.
• Heart Sounds (Test yourself)