{"id":276,"date":"2021-08-28T02:35:08","date_gmt":"2021-08-28T06:35:08","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/inspection-of-the-precordium\/"},"modified":"2024-06-28T18:11:27","modified_gmt":"2024-06-28T22:11:27","slug":"inspection-of-the-precordium","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/inspection-of-the-precordium\/","title":{"raw":"Inspection of the Precordium","rendered":"Inspection of the Precordium"},"content":{"raw":"<p style=\"text-align: left\"><span style=\"color: #000000\">The precordium is the region on the chest wall that overlays the heart area. The base of the heart is located in the region of the second intercostal space and the apex is located in the region of the fifth intercostal space on the left side. As you inspect the chest wall, you will collect data that provides information about cardiac function.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Inspection of Precordium<\/strong><\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">1. Place the client in supine position with their head on a pillow.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">2. Provide draping.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">3. Use tangential lighting with a penlight across the heart area.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">4. Inspect the base of the heart, left sternal border, and apex of heart. You may do this in sequence so that you are only exposing the area that you are assessing and then move on to the next area. See <strong>Figure 6 <\/strong>and<strong> Video 6<\/strong>.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">5. Observe for the presence or absence of <strong>[pb_glossary id=\"496\"]impulses[\/pb_glossary]<\/strong>\u00a0against the chest wall and note the location.<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Pulsations: These are gentle flickers observed on the skin of the chest wall. They can be considered normal when observed on clients with thin chest walls. Otherwise, these are cues that require further assessment because they may be suggestive of increased cardiac workload associated with conditions such as an enlarged heart.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Heaves: These are a more forceful movement (a thrust) observed on the skin over the chest wall. These cues require further assessment because they also may be suggestive of increased cardiac workload such as an enlarged heart.<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">6. Note the <strong>finding<\/strong><\/span><\/p>\r\n\r\n<ul>\r\n \t<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\">Normal findings might be documented as: \u201cNo cardiac impulses observed against chest wall.\u201d<\/span><\/li>\r\n \t<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\">Abnormal findings might be documented as (example): \u201cGentle pulsation observed at apex.\u201d or \u201cHeave observed at apex.\u201d<\/span><\/li>\r\n<\/ul>\r\n<img src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/2.-Inspection_Of_The_Precordium-755x1024.jpg\" alt=\"A man's naked chest with the heart and ribs drawn on top of the area.\" width=\"323\" height=\"601\" class=\"alignnone wp-image-579\" \/>\r\n\r\n<strong>Figure 6<\/strong>: Location of the <span style=\"color: #000000\">base of the heart, left sternal border, and apex of heart.<\/span>\r\n\r\n<span style=\"color: #000000\">Photo by<\/span>\u00a0<a href=\"https:\/\/www.pexels.com\/@armin-rimoldi\">Armin Rimoldi<\/a>\u00a0<span style=\"color: #000000\">from<\/span>\u00a0<a href=\"https:\/\/www.pexels.com\/\">Pexels<\/a>\u00a0<span style=\"color: #000000\">(image was cropped and illustrated upon for the purposes of this chapter)<\/span>\r\n\r\n&nbsp;\r\n\r\n[embed]https:\/\/youtu.be\/ewHiNavhmKc[\/embed]\r\n\r\n<strong>Video 6<\/strong>: Inspection of precordium.\r\n\r\n&nbsp;\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\" style=\"text-align: center\">Knowledge Bites \u2013 Pathophysiology<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Impulses observed on the chest wall should always be assessed further because they are suggestive of some sort of increased workload of the heart and\/or vasculature (such as the aorta). A heave can be associated with cardiac hypertrophy (enlargement of the heart muscle) or a dissecting aorta (a tear in the inner arterial wall that can lead to a rupturing of the aorta). These can be caused by many conditions such as hypertension, valvular disease, septal defects, and infarction. Your assessment can contribute to the database about whether the impulse is benign, such as may appear with a client who has a thin chest wall, or whether the impulse may have a pathophysiological cause.<\/span><\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\"><strong>Activity: Check Your Understanding<\/strong><\/span><\/h2>\r\n<p style=\"text-align: left\"><span>[h5p id=\"222\"]<\/span><\/p>\r\n<span>[h5p id=\"223\"]<\/span>\r\n\r\n<span>[h5p id=\"224\"]<\/span>\r\n\r\n&nbsp;","rendered":"<p style=\"text-align: left\"><span style=\"color: #000000\">The precordium is the region on the chest wall that overlays the heart area. The base of the heart is located in the region of the second intercostal space and the apex is located in the region of the fifth intercostal space on the left side. As you inspect the chest wall, you will collect data that provides information about cardiac function.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Inspection of Precordium<\/strong><\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">1. Place the client in supine position with their head on a pillow.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">2. Provide draping.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">3. Use tangential lighting with a penlight across the heart area.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">4. Inspect the base of the heart, left sternal border, and apex of heart. You may do this in sequence so that you are only exposing the area that you are assessing and then move on to the next area. See <strong>Figure 6 <\/strong>and<strong> Video 6<\/strong>.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">5. Observe for the presence or absence of <strong><button class=\"glossary-term\" aria-describedby=\"276-496\">impulses<\/button><\/strong>\u00a0against the chest wall and note the location.<\/span><\/p>\n<ul style=\"text-align: left\">\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Pulsations: These are gentle flickers observed on the skin of the chest wall. They can be considered normal when observed on clients with thin chest walls. Otherwise, these are cues that require further assessment because they may be suggestive of increased cardiac workload associated with conditions such as an enlarged heart.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Heaves: These are a more forceful movement (a thrust) observed on the skin over the chest wall. These cues require further assessment because they also may be suggestive of increased cardiac workload such as an enlarged heart.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">6. Note the <strong>finding<\/strong><\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\">Normal findings might be documented as: \u201cNo cardiac impulses observed against chest wall.\u201d<\/span><\/li>\n<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\">Abnormal findings might be documented as (example): \u201cGentle pulsation observed at apex.\u201d or \u201cHeave observed at apex.\u201d<\/span><\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/2.-Inspection_Of_The_Precordium-755x1024.jpg\" alt=\"A man's naked chest with the heart and ribs drawn on top of the area.\" width=\"323\" height=\"601\" class=\"alignnone wp-image-579\" \/><\/p>\n<p><strong>Figure 6<\/strong>: Location of the <span style=\"color: #000000\">base of the heart, left sternal border, and apex of heart.<\/span><\/p>\n<p><span style=\"color: #000000\">Photo by<\/span>\u00a0<a href=\"https:\/\/www.pexels.com\/@armin-rimoldi\">Armin Rimoldi<\/a>\u00a0<span style=\"color: #000000\">from<\/span>\u00a0<a href=\"https:\/\/www.pexels.com\/\">Pexels<\/a>\u00a0<span style=\"color: #000000\">(image was cropped and illustrated upon for the purposes of this chapter)<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"Inspection of Precordium\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/ewHiNavhmKc?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><strong>Video 6<\/strong>: Inspection of precordium.<\/p>\n<p>&nbsp;<\/p>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\" style=\"text-align: center\">Knowledge Bites \u2013 Pathophysiology<\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p style=\"text-align: left\"><span style=\"color: #000000\">Impulses observed on the chest wall should always be assessed further because they are suggestive of some sort of increased workload of the heart and\/or vasculature (such as the aorta). A heave can be associated with cardiac hypertrophy (enlargement of the heart muscle) or a dissecting aorta (a tear in the inner arterial wall that can lead to a rupturing of the aorta). These can be caused by many conditions such as hypertension, valvular disease, septal defects, and infarction. Your assessment can contribute to the database about whether the impulse is benign, such as may appear with a client who has a thin chest wall, or whether the impulse may have a pathophysiological cause.<\/span><\/p>\n<\/div>\n<\/div>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\"><strong>Activity: Check Your Understanding<\/strong><\/span><\/h2>\n<p style=\"text-align: left\"><span><\/p>\n<div id=\"h5p-222\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-222\" class=\"h5p-iframe\" data-content-id=\"222\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Ch 4 - Inspection of the Precordium M\/C\"><\/iframe><\/div>\n<\/div>\n<p><\/span><\/p>\n<p><span><\/p>\n<div id=\"h5p-223\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-223\" class=\"h5p-iframe\" data-content-id=\"223\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Ch 4 - Inspection of precordium dialog card\"><\/iframe><\/div>\n<\/div>\n<p><\/span><\/p>\n<p><span><\/p>\n<div id=\"h5p-224\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-224\" class=\"h5p-iframe\" data-content-id=\"224\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Inspection of the Precordium\"><\/iframe><\/div>\n<\/div>\n<p><\/span><\/p>\n<p>&nbsp;<\/p>\n<div class=\"glossary\"><div class=\"glossary__tooltip\" id=\"276-496\" hidden><p>are movements visualized on the chest wall.<\/p>\n<\/div><\/div>","protected":false},"author":34,"menu_order":9,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":"cc-by-nc"},"chapter-type":[],"contributor":[72],"license":[56],"class_list":["post-276","chapter","type-chapter","status-publish","hentry","contributor-december-2021","license-cc-by-nc"],"part":260,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/276","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/users\/34"}],"version-history":[{"count":6,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/276\/revisions"}],"predecessor-version":[{"id":2822,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/276\/revisions\/2822"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/parts\/260"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/276\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/media?parent=276"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapter-type?post=276"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/contributor?post=276"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/license?post=276"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}