Pulse Sites
Where is the radial pulse located?
On the wrist, thumb side.
Lung sound indicating fluid present, that is Discontinuous; produces popping sounds, like hair being rubbed between fingers?
Crackles
■ Fine crackles: Early pulmonary edema, pneumonia, or interstitial lung disease. (Soft, high-pitched, short in duration.)
■ Coarse crackles: Fluid in larger airways, COPD, heart failure, orbronchitis. (Louder, lower-pitched, longer in duration.)
What heart sound is associated with the closure of the mitral and tricuspid valves?
S1 ("Lub").
What is the normal range for heart rate (pulse)?
60-100 bpm
Less than 60bpm=Bradycardia
Greater than 100bpm=Tachycardia
What is assessed during inspection of the skin?
Color, temperature, moisture, and any lesions.
What pulse site is used during CPR in adults, Commonly used in emergency situations?
Carotid pulse.
What sound is heard during inspiration in cases of upper airway obstruction and considered a medical emergency?
Stridor.
Where is the S2 heart sound best heard?
At the APEX or base of the heart (second intercostal space at both sternal borders).
What is the normal range for respiratory rate?
12-20 breaths/min
**less than 12=Bradydpnea**
**Greater than 20=Tachypnea**
***Opioids cause respiratory depression***
What should you assess when examining the eyes?
Pupil size, reactivity to light, and accommodation (PERRLA).
What pulse site is commonly used to measure blood pressure?
Brachial pulse.
What lung sounds indicate narrowed airways, which are commonly associated with conditions such as:
Wheezes
What is the third heart sound (S3) often called, and what does it indicate?
Ventricular gallop; indicates rapid ventricular filling, common in heart failure.
What is the normal blood pressure range for an adult?
120/80 mmHg
**low BP=Hypotension**
**High BP=Hypertension**
What is auscultated when assessing the heart?
Heart rate, rhythm, and the presence of S1, S2, or abnormal sounds like murmurs(The heart sounds).
What is the most reliable pulse site for assessing heart rate and rhythm?
Apical pulse.
Which lung sound is catergorized by Secretions or mucus in larger airways, often seen in bronchitis or pneumonia; sounds like low-pitched snoring
Rhonchi
Which heart sound occurs just before S1 and is associated with a stiff ventricle?
S4 ("Atrial gallop").
What is the normal temperature range in Fahrenheit/Celsius?
97.8-99.5°F or 36.5-37.5°C
**Greater than 100.4=Febrile or Fever**
What should you palpate for during a peripheral vascular assessment?
Peripheral pulses (e.g., radial, dorsalis pedis), capillary refill, and signs of edema
Which pulse site is located behind the knee?
Popliteal pulse.
What lung sound is described as soft, low-pitched, and normal over most lung fields?
Vesicular breath sounds.
What are the five key auscultatory areas for assessing heart sounds?
Aortic, Pulmonic, Erb’s Point, Tricuspid, and Mitral areas.
What is the acceptable oxygen saturation range for a COPD patient?
88-92%
What are the proper steps for conducting an abdominal assessment? (This is different from other system assessments)
1. Inspect: for symmetry, scars, or distention;
2. Auscultate: bowel sounds in all four quadrants
3. Palpation:lightly palpate for tenderness, rigidity, or masses.
4. Percuss: for tympany and dullness to assess underlying structures and detect abnormalities.