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Hey there, pal!

Being the dedicated nursing rockstar that you are, I figured you’d want an in-depth look at the nursing cardiac physical assessment. Plus, who doesn’t love a free cheat sheet right?

Download your FREE Nursing Cardiac Assessment Cheat Sheet Here:

Cardiac Assessment Techniques

For a cardiac assessment, we primarily use inspection, palpation and auscultation. If you want a detailed review of these three nursing techniques, you can check that out here. I’ll cover them here just as they relate to the cardiac assessment.

Inspection is the act of just looking and observing the patient, without touching them or listening with your stethoscope. This includes looking at the patients skin tone and vein patterns to give you clues about the condition of their heart.

Palpation is gently touching the patient with your palms or finger tips. This helps you find vein pulsations or areas that may be painful.

Auscultation is the primary assessment technique of the heart. This is the act of listening to the patient’s heart with your stethoscope. This helps you hear abnormal heart sounds such as murmurs and friction rubs.

The first technique is to inspect the patient. While looking at them, ask yourself a few questions:
1. Are they alert and oriented? (Mental status changes may indicate a lack of blood flow to the brain)
2. Are they overweight or thin?
3. Is their skin pale, moist, dusky, or another abnormal color?
4. Are their fingers clubbed? (This indicates a lack of oxygen for an extended period of time)
5. Do they have bulging neck veins (jugular vein distention)? (May indicate right sided heart failure)
6. Do they have any other bulging veins or pulsations?

As you gain confidence with your assessment skills (trust me, it WILL happen), you will be able to hold a normal conversation with the patient as you inspect their cardiovascular status.

I encourage you to practice your interviewing skills as early as possible and multi-task your assessments. You don’t want to be awkwardly staring at the patient’s chest, now that would just be weird! So definitely don’t do that. 🙂

Palpation is the second technique you will use in your cardiac nursing assessment. Lightly move your palms in a press and release motion (as if you were banging a piano) and move down the patient’s chest, ending at the epigastric area of the belly. Pay special attention to any pulsations (may indicate increase blood volume or heart failure) or vibrations (may indicate a murmur).

The third technique is auscultation. This is really what you think of when you hear “cardiac assessment.”

Seriously, friend, make sure you’re stethoscope is on. We don’t want any awkward moments like the one we had before when we were just staring at our patient. 🙂

The Cardiac Physical Assessment

There are 5 primary stethoscope placements for your nursing assessment: the aortic valve, pulmonic valve, Erb’s point, tricuspid valve and the mitral valve.

They look like this on the heart:

APETM Valves of the Heart

Location Terminology

These placement locations are described using three phrases: intercostal space, sternal boarder, and midclavicular.

An intercostal space is the space between the ribs. So the first intercostal space is right below the collar bone (clavical) and the first rib, the second is right below the second rib, and so on. So if you are looking for the 4th intercostal space, you will count the spaces between the ribs and land on the fourth space.

The sternal boarder is the outline of the sternum, where your sternum meets the ribs. So if you are looking for a placement that is left of the sternal border, you will find the sternum and feel to the left of it and find the point where the sternum meets the ribs, and that is your placement.

The clavical is your collar bone. Mid clavicular means in the middle of the collar bone. To find heart sounds along the midclavicular line, draw an imaginary line down the center of the collar bone to the bottom of the ribs. Your stethoscope placement should be on or close to that imaginary line.

Heart Sound Locations

The aortic valve is heard at the 2nd intercostal space, right of the sternal border. This means you will find the outline of the patients sternum on their right (not your right) and count down 2 spaces between ribs. Place your stethoscope at this point and you should hear a clear heart sound.

The pulmonic valve is heard at the 2nd intercostal space, left of the sternal border. So once you’ve found the aortic value, you can just move your stethoscope along the same line (2nd interconstal space) to the left of the sternum. Don’t worry if you lose your placement, just simply count the spaces between ribs again.

Erb’s point can be heard at the 3rd intercostal space, left of the sternal boarder. From the pulmonic valve, just move your stethoscope down one intercostal space.

The tricuspid value can be heard at the 4th and 5th intercostal spaces, left of the sternal border. From Erb’s point, move your stethoscope down either one or two more spaces.

The mitral valve is heard at the 5th intercostal space at the midclavicular line. Draw that imaginary line from the center of the clavical down to the bottom of the rib cage. Move your stethoscope to where the 5th intercostal space meets that line.

Your placements should look something like this:

Cardiac Stethoscope Placements

Cardiac Assessment Mnemonics

I have heard many mnemonics for the cardiac assessment, and I bet you have to! Stick with your favorite one, or you can choose one of these to keep forever:
All People Enjoy Time Magazine
All Pigs Eat Too Much

Don’t forget to claim your FREE cheat sheet!

Alrighty friend, that’s it for today!

Comment below and tell me what your favorite cardiac assessment mnemonic is.

References:
Comerford, K. C., & Hodgson, B. E. (2013). Assessment made incredibly easy. Ambler, PA: Lippincott Williams & Wilkins.