Advanced Cardiovascular Assessments – With Evidence-Based Examination Techniques

Credit

Speaker

Lydia Bertschi, DNP, ACNP-BC, APRN Related seminars and products

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Lydia Bertschi, DNP, ACNP-BC, APRN, has worked as an acute care nurse practitioner within the intensive care unit team at Carle Health – Methodist in Peoria, Illinois since 2012 and teaches at Illinois Wesleyan University School of Nursing as an adjunct clinical instructor. Additionally, she has joined the writing team for Jarvis: Physical Examination and Health Assessment (8th, 9th, and 10th editions). Dr. Bertschi will draw from her passion for patient care, assessment practices, and clinical teaching.

Speaker Disclosures:
Financial: Lydia Bertschi has an employment relationship with Cade Health. She receives a speaking honorarium from PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Lydia Bertschi is a member of the American Association of Critical Care Nurses.

 

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Objectives

1. Determine key cardiovascular information from the review of systems, including questions important for all adult patients and questions specific to common cardiovascular conditions.
2. Analyze the cardiovascular physical exam, including examination techniques (inspection, palpation, and auscultation) and their clinical significance.
3. Evaluate evidence-based recommendations for and against select examination techniques.
4. Synthesize relevant subjective and objective data from patient case studies, along with corresponding assessment findings.

Outline

• Chest pain, shortness of breath, cough, fatigue, activity tolerance, edema, night-time symptoms
• Past medical and family history, risk factor assessment

• Inspection
• General survey, the neck vessels, the precordium
• Percussion: Research update on the cardiac border
• Palpation: Patient position for apical impulse and other precordial movements, such as heaves, lifts, and thrusts
• Auscultation
• Variations in S1
• Variations in S2
• Gallops: S3 and S4
• Clicks (focus on mid-to-late systolic click of mitral valve prolapse)
• Murmurs:
• Systolic (focus on AS/PS, MR/TR), diastolic (focus on AR/PR, MS/TS)
• General approach: location, timing, quality, grading
• Clinical value of assessing for murmurs

• Angina, comparison of typical vs atypical vs nonanginal chest pain, ASCVD risk calculation (ACC/AHA)

• Diagnostic value of non-EKG findings (type of pain, vital signs, other signs)

• Shortness of breath, estimation of CVP, abdominojugular test, location of apical impulse, S3/S4, bendopnea, Valsalva, and other associated findings (crackles, dependent edema), tools for classification (ACC/AHA vs NYHA)

• Afib, CHA2DS2 –VASc

• Aortic stenosis, auscultatory findings, other cardiac and non-cardiac findings

Target Audience

• Physicians 
• Physician Assistants
• Nurses