Heart Failure Physical Exam | Lecturio Nursing Assessment
Aug 26, 2023
Heart Failure Physical Exam | Lecturio Nursing Assessment
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Content
0.126 -> Now, let's talk about a few specific
findings of some cardiac conditions.
6.27 -> First off, heart failure.
7.889 -> You're definitely going
to come across patients
9.493 -> with acute decompensated
heart failure
12.168 -> with whether systolic or diastolic,
or mix in nature.
16.596 -> And a few cardinal features
can really help us.
19.399 -> We already talked about
the third heart sound, the S3,
22.479 -> which again,
we're going to appreciate
23.871 -> with the bell of the stethoscope,
25.062 -> and the left lateral
decubitus position at the apex.
29.07 -> But another very important part
of the cardiovascular exam
32.318 -> when you're trying to assess
for heart failure
34.485 -> is to assess volume status.
36.303 -> And that's best done by looking
at central venous pressure
39.931 -> as estimated by
jugular vein distension,
43.97 -> by your jugular vein pressure.
45.913 -> And the way that
we're going to do that
47.366 -> is by tilting his head
off to the right,
49.435 -> just tilt your left to your left.
sorry, Shawn.
51.93 -> We can now visualize
the vessels of his great neck
56.797 -> underneath his skin.
61.252 -> Alright, so having talked about
Jugular Vein Distension,
64.102 -> and seeing how well
that can help to identify
66.825 -> acute congestive heart failure.
69.043 -> We're also going to want to look for
peripheral edema,
71.035 -> which can be
an important sign as well.
73.249 -> So, let's take a look
down here at the legs.
75.964 -> The most common place
to find peripheral edema
77.838 -> is gonna be
in your lower extremities,
79.647 -> particularly in,
if I may rotate the leg here,
81.602 -> the pretibial areas
in front of the shin,
84.765 -> the shin bone.
85.731 -> And down here in the pedal areas
so called pedal edema.
90.33 -> Assessing for edema is very simple.
91.656 -> You're going to push
on top of the skin,
94.151 -> hold for two or three seconds,
and then quickly release.
97.609 -> And you're going to look
and see if there's any pitting.
99.586 -> That is if there's an
indent left by your thumb,
103.079 -> after you pull your thumb away.
106.182 -> And typically if it
stays as a depression
109.659 -> for a longer span of time,
111.04 -> that may suggest more of a
proteinaceous kind of edema
113.628 -> like early lymphedema.
115.185 -> Whereas, if it resolves
within five seconds or so,
118.19 -> that may suggest more of a
hydrostatic type of edema
121.511 -> associated with heart failure,
123.111 -> or even an oncotic pressure
type of edema,
126.666 -> for example, from hypoalbuminemia,
or cirrhosis, etc.
132.06 -> The most common cause, though,
of edema in the lower extremities
136.513 -> is none of those very advanced
organ dysfunction problems.
141.69 -> It's actually just
chronic venous insufficiency,
143.897 -> which is a failure
of the valves in the veins
146.403 -> to return blood
effectively to the heart.
148.86 -> So all that is edema
is not heart failure.
151.874 -> And that's why
peripheral edema turns out
153.495 -> to not be a particularly useful
prognostic sign, or diagnostic sign
159.559 -> when you're trying to make
a diagnosis of heart failure.
161.755 -> That being said,
it's extremely useful
164.056 -> when you're tracking
a patient over time
166.458 -> as you're diuresing them,
for example.
168.479 -> In the same way that
tracking somebody's weight
170.466 -> can be helpful
171.498 -> when you're trying to see
if you've diurist them
173.292 -> or over diurist them, etc.
175.431 -> So, not useful to make a diagnosis
177.69 -> but useful to track patients
over time.
179.853 -> Importantly,
when you do push on the skin,
182.839 -> you may find that a patient
184.125 -> looks like the leg is
swollen and edematous.
187.37 -> But you push down and immediately
when you pull your thumb off,
191.34 -> the indent is gone.
192.855 -> And that can be suggestive of
lymphedema.
196.083 -> Advanced lymphedema.
197.86 -> When somebody has
acquired lymphedema,
200.098 -> or secondary lymphedema
201.428 -> that has been progressive
for a long span of time,
204.381 -> whether it's from a prior
lymph node dissection,
207.136 -> perhaps in the upper extremity,
208.7 -> or even folks who have
chronic venous insufficiency
211.256 -> for a long span of time
212.653 -> can develop this
lymphedematous process
216.136 -> a secondary lymphedema
or verrucous lymphedema,
218.906 -> you're going to find
220.229 -> that the skin is so
fibrost and thick
223.427 -> that when you push,
you can't push in very far,
226.025 -> and there's no indentation
that's left afterwards.
228.847 -> So the interpretation of edema
can be very nuanced.
231.636 -> And it's important to
realize that it's useful
234.579 -> but it's not going to make or break
a diagnosis of heart failure.
239.232 -> Since we're here
in the legs though,
240.487 -> it's worth us taking the look
at the at the pulses
243.44 -> that you can identify in the legs.
245.79 -> We're going to talk more in a moment
about the posterior tibial pulse.
249.48 -> It's right here behind
the medial malleolus
251.523 -> You can palpate it there.
253.47 -> The dorsalis pedis pluse
is going to be located here,
256.42 -> just a little bit lateral
to the very prominent
260.254 -> first MTP joint there.
263.105 -> Secondly,
there is a popliteal pulse,
265.435 -> very difficult to find,
for me at least.
268.172 -> But it's going to be found
in the popliteal fossa
271.189 -> between the semimembranosus and
semitendinosus tendons on the left
276.118 -> and or the medial and lateral
aspects of the back of the knee.
280.417 -> And then the femoral artery
is going to be up here.
Source: https://www.youtube.com/watch?v=fNGJtb9tDms
