Checklists for Clinical Nursing Skills

26

skill 2-6 Assessing the cardiovascular system (continued)

Comments

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Satisfactory

Needs practice

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15. Auscultate systematically, beginning at the aortic area, then moving to the pulmonic area, Erb’s point, the tricuspid area and finally the mitral area. Ask the patient to breathe normally. Use the stethoscope diaphragm to listen for high-pitched sounds and then use the bell to listen for low-pitched sounds. Focus on the overall rate and rhythm of the heart and the normal heart sounds. 16. Inspect the extremities for colour, temperature, continuity, lesions, venous patterns and oedema. 17. Palpate the peripheral pulses. 18. Assist the patient in replacing the gown and then assist them into a position of comfort. 19. Remove used PPE/equipment and dispose of them in the appropriate receptacle. 20. Perform hand hygiene. 21. Document your assessment findings on the patient’s chart and make any necessary referrals. Report any abnormal results to a senior nurse, medical officer or endorsed nurse practitioner immediately.

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Copyright © 2014 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Checklists for Clinical Nursing Skills by Louise Sparkes, Jennifer Bassett and Elisabeth Jacob.