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Respiratory and Cardiovascular Assessment Guide

This document provides a script for performing a respiratory and cardiovascular assessment. It includes instructions to inspect and auscultate the chest, measure respiratory rate, check capillary refill time, examine the heart sounds and pulses at various locations, and check the jugular veins and peripheral pulses in the legs. The assessor is directed to verbalize their findings at each step, such as noting clear lung sounds and regular heart sounds with normal pulses.

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328 views2 pages

Respiratory and Cardiovascular Assessment Guide

This document provides a script for performing a respiratory and cardiovascular assessment. It includes instructions to inspect and auscultate the chest, measure respiratory rate, check capillary refill time, examine the heart sounds and pulses at various locations, and check the jugular veins and peripheral pulses in the legs. The assessor is directed to verbalize their findings at each step, such as noting clear lung sounds and regular heart sounds with normal pulses.

Uploaded by

ronjgina
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Respiratory Cardiovascular Assessment Script

Perform Hand Hygiene

Putting Routine

Explain procedure

Inspect anterior chest

Verbalize: No visible abnormalities

Breathing even and unlabored

Pt denies respiratory distress

Auscultate

12 spots on the front

Verbalize: Lung sounds even, regular and clear bilaterally

Auscultate respiratory rate

Listen for 1 minute or 30 secs x2 if respirations are even and regular

Verbalize: rate bpm

Palpate Cap refill

Press a nail on each hand

Verbalize: Cap refill is less than 3 secs bilaterally

Inspect posterior chest

Verbalize No visible abnormalities

Breathing even and unlabored

Inspect thoracic chest expansion

Place hands with thumbs touching below the costal vertebral angle

Verbalize: Expansion is equal bilaterally

Auscultate posterior chest

10 spots on the back

Verbalize: Lungs sounds even, regular and clear bilaterally

Auscultate heart sounds


Aortic - Right sternal border 2nd intercostal space

Pulmonic – Left sternal border 2nd intercostal space

Erb’s point – Left sternal border 3rd intercotal space

Tricuspid – Left sternal border 5th intercostal space

Mitral (Apex, PMI) – 5th intercostal space midclavicular line.

Verbalize: Heart sounds regular and even. S1 and S2 clearly heard . No adventitious
sounds noted.

Palpate apical pulse

Mitral – 5th intercostal space midclavicular line

Verbalize: pulse is palpable, regular and even.

Inspect jugular vein

Verbalize: Within normal limits. No distention noted.

Palpate: carotid pulse (one at a time)

brachial pulses

Radial pulses

Take radial heart rate

Verbalize: heart rate bpm

verbalize femoral pulses

popliteal pulses

posterior tibialis

dorsalis pedis

Verbalize: Pulses present, 3+, regular and even bilaterally.

Palpate cap refill of feet

Press a nail on each foot

Verbalize: Cap refill less than 3 secs bilaterally

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