RNSG 1413 - Foundations for Nursing Practice

Module: Physical Assessment Part II

Module Objectives:

Upon completion of the study of this module, the student should be able to:

Perform physical examination of the heart, lungs and peripheral pulses.

Before coming to learning lab be able to:

Identify and describe the chest landmarks and underlying structures.
Demonstrate the elements included in inspection of the interior and posterior thorax: AP diameter, respiratory rate, rhythm and pattern, abnormalities.
Define terms used in percussion of the thorax.
Demonstrate auscultation of the lungs, identifying the various areas of lung assessment.
Discuss the three classifications of normal breath sounds heard during auscultation and their anatomical location: bronchial, bronchovesicular, vesicular.
Describe the following adventitious or abnormal sounds: crackles, rhonchi, wheeze.
Discuss the anatomy of the heart and the complete cardiac cycle.
Describe the anatomic landmarks for assessment of the heart: precordium, aortic area, pulmonic area, tricuspid area, Erbs point, mitral area, PMI-apical pulse
Discuss inspection and palpation of the areas above.
Discuss the production of S-1, S-2 heart sounds and demonstrate auscultation of these sounds.
Define the extra heart sounds, S-3, S-4, snaps, clicks and murmurs.
Define the terms related to cardiovascular assessment.
Identify and assess the peripheral pulses: temporal, carotid, radial, brachial, femoral, popliteal, dorsalis pedis and posterior tibial.

Learning Activities:

	Review module objectives.
	Read: Harkreader edition 3- Chapter 6 and Chapter 8 (141-172) as needed. Review: Anatomy textbook of choice. Pay particular attention to the lungs, heart, and vascular system. Review prior to lab:Webpage version Powerpoint on Thorax (Closely follows notes physical assessment) Use the heart and lung teaching mannequin in the skills lab. Vocabulary Terms
	Optional Audiovisual Resources: you do not have to see or hear any particular ones. You may go to the library to use them. Please let your instructors know if you have any problems. The Physical Examination Putting It all Together; videocassette (37 minutes); WB 205 P5788 1991 Lecture on the basics of the physical exam with examples of techniques and procedures. Assessing Breath Sounds; WF 141 A846 1988; Video recording (30 minutes) Identifies abnormal breath sounds, and discusses their physiological cause. This tape has examples of lung diseases. You may use your own discretion about listening to all of it. Try to be able to recognize the normal sounds and the basic abnormal sounds. Assessing Heart Sounds; Video recording (30 minutes), WG 141.5 A9 A846 1988 Identifies normal and abnormal heart sounds and shows what causes them physiologically. Heart Sounds and murmurs, a practical guide; WG 18 E68h 1991; 1 sound cassette (60 minutes) Presents the information necessary to understand and recognize normal heart sounds and the most common abnormal sounds. Tape was made with a heart sound simulator using studio-recording equipment.
	Visit this website: Lung Sounds & Heart Sounds (works best with earphones) http://egeneralmedical.com/egeneralmedical/listohearmur.html or this one More complex sounds
	Complete Critical Thinking Exercises: Physical Assessment (go to assignments on Blackboard) Thoracic Skeleton
	Bring to lab: Pen light, watch with second hand, stethoscope Wear loose T-shirt or some other garment that allows for practice of physical assessment Notes - Complete Physical Assessment
	Practice Exercises and Mastery Check-off Practice - Physical Assessment bring to lab Guide to Physical Assessment Performance Mastery Mastery Checklist
	Review module objectives and check for knowledge gaps.
	Complete module quiz - "Physical Assessment" http://acconline.austincc.edu/