Inspection

• No pulsations are visible, except at point of maximal impulse (PMI).
• No lifts, heaves, or retractions are evident in four valve areas of chest wall.

Palpation

• No vibrations or thrills are evident.
• No lifts or heaves are evident.
• No pulsations are visible, except at PMI and epigastric area.

Vascular palpation

• Note skin temperature, texture, and turgor.
• Capillary refill is no more than 3 seconds.
• Pulses should be regular in rhythm and strength.
  • 4+ = bounding
  • 3+ = increased
  • 2+ = normal
  • 1+ = weak
  • 0 = absent

Auscultation

• First heart sound (S₁) heard best with stethoscope diaphragm over mitral area.
• Second heart sound (S₂) heard best with stethoscope diaphragm over aortic area.
• Third heart sound (S₃) heard best with stethoscope bell over mitral area.
• Additional heart sound (S₄) heard best with stethoscope bell at mitral area.

[Outline]

• Inspection
• Palpation
• Vascular palpation
• Auscultation