Palpation involves feeling the body to evaluate texture, size, consistency, and tenderness for assessing cardiovascular health. The following steps are organized in a head-to-toe order:
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above the sternal angle, corresponding to 6-8 cm H₂O relative to the right atrium. Elevated JVP can indicate right-sided heart failure or fluid overload.
Thorax Examination
Key Areas for Heart size and vibration:
Point of Maximal Impulse (PMI):
It is located at the fifth intercostal space, on the left midclavicular line. A displaced PMI may indicate cardiac enlargement.
Heaves and Lifts:
Palpate for heaves or lifts along the left sternal border. These are forceful chest wall movements that may indicate ventricular hypertrophy or other cardiac abnormalities.
Pulse Assessment
Carotid, Radial, and Femoral Arteries: Assess the pulse for rate, rhythm, and force.
Capillary Refill
Capillary refill assesses peripheral perfusion and cardiac output. Position the patient's hands near heart level, squeeze a nail bed until it blanches, then release and observe the time it takes for color to return. Normal refill time is less than 2 seconds. Delayed refill can indicate poor perfusion, shock, or peripheral vascular disease.
Extremities Examination
Temperature, Moisture, and Edema:
Asymmetry in Limb Circumference:
Cold Extremities:
From Chapter 13:
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