{"id":278,"date":"2021-08-28T02:35:23","date_gmt":"2021-08-28T06:35:23","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/palpation-of-the-precordium\/"},"modified":"2024-06-28T19:16:47","modified_gmt":"2024-06-28T23:16:47","slug":"palpation-of-the-precordium","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/palpation-of-the-precordium\/","title":{"raw":"Palpation of the Precordium","rendered":"Palpation of the Precordium"},"content":{"raw":"<p style=\"text-align: left\"><span style=\"color: #000000\">Palpation of the precordium involves palpating the chest wall and palpating the apical impulse.<\/span><\/p>\r\n\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Palpation of Chest Wall for Pulsations<\/span><\/h2>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Palpation of the chest wall provides information about the quality of cardiac blood flow.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Palpation for pulsations involves the following steps (see <strong>Video 7<\/strong>):<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">1. Maintain the client in a supine position and continue to use draping as needed.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">2. Palpate the base of the heart, the left sternal border, and the apex.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">3. Use one of two techniques to palpate:<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li><span style=\"color: #000000\">Use the metacarpophalangeal surface of your fingers starting at the base of the heart. Leave them in place as long as you need to, but usually about two to three seconds and then move onto the sternal border and then the apex. (This is the most common technique).<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">OR<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Use the ulnar surface of your hands starting at the base of the heart. Place your ulnar surface in several locations because its surface is smaller than your metacarpophalangeal surface. Leave them in place as long as you need to, but usually about two to three seconds and then move onto the sternal border and then the apex<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">4. Identify presence of any pulsations that feel like a vibratory sensation.\u00a0 \u00a0 \u00a0 \u00a0 <\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Tip:<\/strong> Place your fingertips over your trachea and stick your tongue out and say \u201cahhh.\u201d The vibrations that you feel on your fingertips are similar to what a thrill feels like on the chest wall.<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Healthy blood flow does not produce a vibratory sensation.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">The presence of any vibratory sensations are abnormal; turbulent blood flow can create a vibratory sensation (typically referred to as a thrill) felt on the chest wall. If you feel a thrill, you should auscultate for a murmur and expect other subjective findings associated with an incompetent valve (not opening and closing correctly). You should conduct a full cardiac and vital sign assessment and notify the physician\/nurse practitioner.<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">5. Note the <strong>findings<\/strong><\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Normal findings might be documented as: \u201cAbsence of vibratory sensations.\u201d<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Abnormal findings might be documented (example): \u201cThrill palpated at second intercostal space left sternal border.\u201d<\/span><\/li>\r\n<\/ul>\r\n[embed]https:\/\/youtu.be\/PaiYGbqgqRg[\/embed]\r\n\r\n<strong>Video 7<\/strong>: Palpation of precordium.\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Palpation of Apical Impulse\u00a0<\/span><\/h2>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Palpation of the apical pulse provides information about the location and the workload of the heart. You are specifically palpating for a physical pulsation over the apex of the heart. This involves the following steps (<strong>Video 8<\/strong>):<\/span><\/p>\r\n\r\n<ol style=\"text-align: left\">\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Maintain the client in a supine position and continue to drape.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Physically landmark the expected location of the apex. In adults, this is the fifth intercostal space at the left midclavicular line or just midline to the midclavicular line; in children, it is the fourth intercostal space at the left midclavicular line.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Place the finger pad of your index finger at this location in the intercostal space. Use the finger pad (not the fingertip) because it is more sensitive to pulsations. Thus, you will need to keep your hand\/wrist\/forearm low so that your hand\/wrist\/forearm are parallel to the client\u2019s chest.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Ask the client to hold their breath after taking a large breath in and out. You should feel the pulsation quite quickly if it is palpable.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">If you do not feel a pulsation, help the client into a left lateral position. This positioning rotates the apex of the heart and accentuates the impulse against the chest wall. Usually, you can leave your finger in place when re-positioning the client.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Note the <strong>findings\u00a0<\/strong><\/span><\/li>\r\n<\/ol>\r\n<ul>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Normal findings might be documented as: \u201cGentle tap of apical impulse, short duration, one smooth pulsation, 1\u20132 cm<sup>2<\/sup> at apex.\u201d Also note that it is normal not to feel an apical impulse in many clients as well. In this case, note \u201cNo apical impulse felt after re-positioning client in left lateral position.\u201d<\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cDouble systolic impulse lateral to left midclavicular line with sustained forceful thrust lasting throughout systole.\u201d (This is just one example of an abnormal finding.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n[embed]https:\/\/youtu.be\/FHDHE4Zrwxw[\/embed]\r\n\r\n<strong>Video 8<\/strong>: Palpation of apical impulse (NOTE: Not clearly seen in the video, ensure that you place your index finger at the left mid-clavicular line).\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\">You might feel what is perceived as an abnormal apical impulse for many reasons. The heart might be displaced and\/or have an accentuated impulse and extended duration with conditions such as left ventricular hypertrophy (enlargement of the left ventricle muscle), volume overload, and heart failure. The apical impulse can be accentuated with exercise, anxiety, fever, and other conditions when higher cardiac outputs are needed. Also, the apical impulse can shift laterally and up with pregnancy to accommodate the growing uterus.<\/span><\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Activity: Check Your Understanding<\/span><\/h2>\r\n<p style=\"text-align: left\"><span>[h5p id=\"225\"]<\/span><\/p>\r\n&nbsp;","rendered":"<p style=\"text-align: left\"><span style=\"color: #000000\">Palpation of the precordium involves palpating the chest wall and palpating the apical impulse.<\/span><\/p>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Palpation of Chest Wall for Pulsations<\/span><\/h2>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Palpation of the chest wall provides information about the quality of cardiac blood flow.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Palpation for pulsations involves the following steps (see <strong>Video 7<\/strong>):<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">1. Maintain the client in a supine position and continue to use draping as needed.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">2. Palpate the base of the heart, the left sternal border, and the apex.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">3. Use one of two techniques to palpate:<\/span><\/p>\n<ul style=\"text-align: left\">\n<li><span style=\"color: #000000\">Use the metacarpophalangeal surface of your fingers starting at the base of the heart. Leave them in place as long as you need to, but usually about two to three seconds and then move onto the sternal border and then the apex. (This is the most common technique).<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">OR<\/span><\/p>\n<ul style=\"text-align: left\">\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Use the ulnar surface of your hands starting at the base of the heart. Place your ulnar surface in several locations because its surface is smaller than your metacarpophalangeal surface. Leave them in place as long as you need to, but usually about two to three seconds and then move onto the sternal border and then the apex<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">4. Identify presence of any pulsations that feel like a vibratory sensation.\u00a0 \u00a0 \u00a0 \u00a0 <\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Tip:<\/strong> Place your fingertips over your trachea and stick your tongue out and say \u201cahhh.\u201d The vibrations that you feel on your fingertips are similar to what a thrill feels like on the chest wall.<\/span><\/p>\n<ul style=\"text-align: left\">\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Healthy blood flow does not produce a vibratory sensation.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">The presence of any vibratory sensations are abnormal; turbulent blood flow can create a vibratory sensation (typically referred to as a thrill) felt on the chest wall. If you feel a thrill, you should auscultate for a murmur and expect other subjective findings associated with an incompetent valve (not opening and closing correctly). You should conduct a full cardiac and vital sign assessment and notify the physician\/nurse practitioner.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">5. Note the <strong>findings<\/strong><\/span><\/p>\n<ul style=\"text-align: left\">\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Normal findings might be documented as: \u201cAbsence of vibratory sensations.\u201d<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Abnormal findings might be documented (example): \u201cThrill palpated at second intercostal space left sternal border.\u201d<\/span><\/li>\n<\/ul>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"Palpation of Precordium\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/PaiYGbqgqRg?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><strong>Video 7<\/strong>: Palpation of precordium.<\/p>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Palpation of Apical Impulse\u00a0<\/span><\/h2>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Palpation of the apical pulse provides information about the location and the workload of the heart. You are specifically palpating for a physical pulsation over the apex of the heart. This involves the following steps (<strong>Video 8<\/strong>):<\/span><\/p>\n<ol style=\"text-align: left\">\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Maintain the client in a supine position and continue to drape.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Physically landmark the expected location of the apex. In adults, this is the fifth intercostal space at the left midclavicular line or just midline to the midclavicular line; in children, it is the fourth intercostal space at the left midclavicular line.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Place the finger pad of your index finger at this location in the intercostal space. Use the finger pad (not the fingertip) because it is more sensitive to pulsations. Thus, you will need to keep your hand\/wrist\/forearm low so that your hand\/wrist\/forearm are parallel to the client\u2019s chest.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Ask the client to hold their breath after taking a large breath in and out. You should feel the pulsation quite quickly if it is palpable.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">If you do not feel a pulsation, help the client into a left lateral position. This positioning rotates the apex of the heart and accentuates the impulse against the chest wall. Usually, you can leave your finger in place when re-positioning the client.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Note the <strong>findings\u00a0<\/strong><\/span><\/li>\n<\/ol>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Normal findings might be documented as: \u201cGentle tap of apical impulse, short duration, one smooth pulsation, 1\u20132 cm<sup>2<\/sup> at apex.\u201d Also note that it is normal not to feel an apical impulse in many clients as well. In this case, note \u201cNo apical impulse felt after re-positioning client in left lateral position.\u201d<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cDouble systolic impulse lateral to left midclavicular line with sustained forceful thrust lasting throughout systole.\u201d (This is just one example of an abnormal finding.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><iframe loading=\"lazy\" id=\"oembed-2\" title=\"Palpation of Apical Impulse\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/FHDHE4Zrwxw?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><strong>Video 8<\/strong>: Palpation of apical impulse (NOTE: Not clearly seen in the video, ensure that you place your index finger at the left mid-clavicular line).<\/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\">You might feel what is perceived as an abnormal apical impulse for many reasons. The heart might be displaced and\/or have an accentuated impulse and extended duration with conditions such as left ventricular hypertrophy (enlargement of the left ventricle muscle), volume overload, and heart failure. The apical impulse can be accentuated with exercise, anxiety, fever, and other conditions when higher cardiac outputs are needed. Also, the apical impulse can shift laterally and up with pregnancy to accommodate the growing uterus.<\/span><\/p>\n<\/div>\n<\/div>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Activity: Check Your Understanding<\/span><\/h2>\n<p style=\"text-align: left\"><span><\/p>\n<div id=\"h5p-225\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-225\" class=\"h5p-iframe\" data-content-id=\"225\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Ch 4 - palpation of precordium m\/c\"><\/iframe><\/div>\n<\/div>\n<p><\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"author":34,"menu_order":10,"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-278","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\/278","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":4,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/278\/revisions"}],"predecessor-version":[{"id":2825,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/278\/revisions\/2825"}],"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\/278\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/media?parent=278"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapter-type?post=278"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/contributor?post=278"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/license?post=278"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}