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Notes

History CP, palpitations, syncope, fatigue, extremity changes (numbness, tingling, cold feet or hands, leg cramps, edema, lymphedema), activity intolerance, dyspnea on exertion, shortness of breath, orthopnea, number of pillows used for sleeping, hyperlipidemia, MI, CAD, PVD, DM, HTN, CHF, DVT, stents, CABG, pacemaker.
Medication Beta/Ca-channel blockers, nitrates, diuretics, ACE inhibitors, anticoagulants, antiarrhythmics.
Neck Venous distention (JVD), bruits, pulsations.
Chest
  • Scars, symmetry, movement, deformity.
  • Auscultate lungs for pulmonary edema.
  • Compare apical and radial pulses for apical-radial pulse deficit (p. 6).
  • Heart valves for normal S1, S2 (lub, dub) heart sounds-abnormal sounds include extra beats (S3, S4), bruits, murmurs, pericarditic rubs, and artificial valve clicks.
  • PMI for pulsations, thrills, or heaves.
Abdomen
  • Scars, edema, ascites, pulsations, and thrills.
Extremities
  • Color, temperature, moisture, and hair growth.
  • Nail beds for cyanosis and clubbing.
  • Lower extremities for swelling and edema.
  • Compare pulses right to left.
  • Grade radial and pedal pulses.
  • Grade peripheral edema.

Capillary Refill

  • Normal...............................................3 sec
  • Delayed..............................................>3 sec

Pulse Strength Grading Scale

  • 0..........................................................Absent
  • 1..........................................................Weak
    2..........................................................Normal
  • 3..........................................................Full
    4..........................................................Bounding