Assess of Cardiovascular System

Skill	Document: assessment, interventions, outcomes
Inspect	Overall condition and appearance. Inspect skin, nailbeds, and extremities for flushing, pallor, cyanosis, bruising, and edema. Observe chest for scars, symmetry, movement, and deformity. Inspect neck for JVD and inspect the PMI (point of maximal impulse) for any remarkable pulsations. Analyze ECG recording if available.
Palpate	Skin temperature and moisture. Palpate PMI for any lifts, heaves, thrills, or vibrations. Palpate and grade radial, dorsalis pedis, and posterior tibial pulses, noting rate and rhythm. Palpate and grade edema if present.
Percuss	Starting at the midaxillary line, percuss toward the left cardiac border along the 5th ICS. Sound should change from resonance to dullness at the midclavicular line.
Auscultate	Use a stethoscope and auscultate the apical pulse and compare it with the radial pulse. Auscultate heart valves for normal S1 (lub) and S2 (dub) heart sounds. Abnormal sounds include extra beats (S3 and S4), bruits, valvular murmurs, paricarditic rubs, and artificial valve clicks.