Pulse deficit is a difference between simultaneously obtained apical and radial pulses. It indicates that there may be a cardiac dysrhythmia that would best be detected with ECG monitoring. Frequent BP monitoring, cardiac catheterization, and emergent car
a cardiac catheterization.
hourly blood pressure (BP) checks.
electrocardiographic (ECG) monitoring.
The resting HR does not change with aging, so the decrease in HR requires further investigation. Bundle-branch block and slight increases in PR interval or QRS duration are common in older individuals because of increases in conduction time through the AV
The PR interval is 0.21 seconds.
The QRS duration is 0.13 seconds.
The heart rate (HR) is 42 beats/minute.
There is a right bundle-branch block.
The PMI should be felt at the intersection of the fifth intercostal space and the left midclavicular line. A PMI located outside these landmarks indicates possible cardiac enlargement, such as with left ventricular hypertrophy. Cardiac enlargement is not
ask the patient about risk factors for atherosclerosis.
document that the PMI is in the normal anatomic location.
assess the patient for symptoms of left ventricular hypertrophy.
auscultate both the carotid arteries for the presence of a bruit.
Gallop rhythms generate low-pitched sounds and are most easily heard with the bell of the stethoscope. Sounds associated with the mitral valve are accentuated by turning the patient to the left side, which brings the heart closer to the chest wall. The di
bell of the stethoscope with the patient sitting and leaning forward.
diaphragm of the stethoscope with the patient lying flat on the left side.
diaphragm of the stethoscope with the patient in a supine position.
bell of the stethoscope with the patient in the left lateral position.
Increased levels of BNP are a marker for heart failure. The other laboratory results would be used to assess for myocardial infarction (troponin) or risk for coronary artery disease (Hcy and LDL).
B-type natriuretic peptide (BNP)
Low-density lipoprotein (LDL)
Visible pulsation of the abdominal aorta is commonly observed in the epigastric area for thin individuals. The nurse should simply document the finding in the admission assessment. Unless there are other abnormal findings (such as a bruit, pain, or hyper/
Instruct the patient to remain on bed rest.
Document the finding in the patient chart.
Notify the hospital rapid response team.
Teach the patient about aneurysms.
A sensation of warmth or flushing is common when the contrast material is injected, which can be anxiety-producing unless it has been discussed with the patient. The patient may receive a sedative drug before the procedure, but monitored anesthesia care i
monitored anesthesia care will be provided during the procedure.
arterial pressure monitoring will be required for 24 hours after the test.
it will be important to lie completely still during the procedure.
a flushed feeling may be noted when the contrast dye is injected.
When the patient is lying flat, the jugular veins are at the level of the right atrium, so JVD is a common (but not a clinically significant) finding. Obtaining vital signs and oxygen saturation is not warranted at this point. JVD is an expected finding w
Document this finding in the patient’s record.
Obtain vital signs, including oxygen saturation.
Observe for JVD with the patient upright at 45 degrees.
Have the patient perform the Valsalva maneuver.
The patient is instructed to keep a diary describing daily activities while Holter monitoring is being accomplished to help correlate any rhythm disturbances with patient activities. Patients are taught that they should not take a shower or bath during Ho
keep a diary of daily activities while the monitor is worn.
exercise more than usual while the monitor is in place.
remove the electrodes when taking a shower or tub bath.
connect the recorder to a computer once daily.
A bruit is the sound created by turbulent blood flow in an artery. Thrills are palpable vibrations felt when there is turbulent blood flow through the heart or in a blood vessel. A murmur is the sound caused by turbulent blood flow through the heart. Ausc
Cardiac troponins start to elevate 4 to 6 hours after myocardial injury and are highly specific to myocardium. They are the preferred diagnostic marker for myocardial infarction. Myoglobin rises in response to myocardial injury within 30 to 60 minutes. It
low-density lipoprotein (LDL) cholesterol.
creatine kinase-MB (CK-MB).
troponins T and I.
Murmurs are caused by turbulent blood flow, such as occurs when blood flows through a damaged valve. Relevant information includes the position in which the murmur is heard best (e.g., sitting and leaning forward), the timing of the murmur in relation to
Determine the timing of the murmur.
Compare the apical and radial pulse rates.
Palpate the quality of the peripheral pulses.
Find the point of maximal impulse.
The S1 signifies the onset of ventricular systole. S2 signifies the onset of diastole. A murmur occurring between these two sounds is a systolic murmur. The mitral area is the intersection of the left fifth intercostal space and the midclavicular line. Th
Systolic murmur heard at mitral area
Diastolic murmur heard at the point of maximal impulse
Systolic murmur heard at Erb’s point
Diastolic murmur heard at aortic area
The carotid pulses should never be palpated at the same time to avoid vagal stimulation, dysrhythmias, and decreased cerebral blood flow. The other assessment techniques also need to be corrected. However, they are not dangerous to the patient.
palpates both carotid arteries simultaneously to compare pulse quality.
documents a murmur heard along the right sternal border as a pulmonic murmur.
presses on the skin over the tibia for 10 seconds to check for edema.
places the patient in the left lateral position to check for the point of maximal impulse.
The nurse will need to teach the patient that the procedure is rapid and involves little risk. None of the other actions are necessary.
Administer oral sedative medications.
Insert an IV catheter.
Teach the patient about the procedure.
Confirm that the patient has been fasting.
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