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Nursing Field Notes / Nursing Core · Fundamentals of Nursing

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Exactly where to put your fingers and your stethoscope

NG-082 Nursing Core ADHD-friendly visual edition

Every vital sign from NG-079 has a physical spot on the body where you actually collect it. This page is the landmark map — pulse points, lung auscultation ladder, heart's five listening points, and the abdomen's four quadrants.

📄 Simple Nursing original — opens in Drive →

💓 7 pulse pointsRadial, brachial, carotid, femoral, popliteal, dorsalis pedis, posterior tibial.
⚠️ Never both carotids at onceBilateral pressure can slow heart rate or drop cerebral blood flow.
🫀 "All Pigs Eat Too Much"Aortic → Pulmonic → Erb's → Tricuspid → Mitral, top to bottom.
🩻 IAPP for the bellyInspect → Auscultate → Percuss → Palpate (auscultate BEFORE touching).
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PULSE POINTS

STEP 1 · FIND THE BEAT

Same seven sites you saw on NG-079 — here's the exact anatomy and the one you never press on both sides at once.

📍 The seven peripheral pulse points

Where the pulse points are on the body A front view of a person with nine points marked: temporal at the temple, carotid at the side of the neck, apical on the left chest at the fifth intercostal space, brachial at the inner elbow, radial at the thumb side of the wrist, femoral in the groin crease, popliteal behind the knee, dorsalis pedis on the top of the foot, and posterior tibial behind the inner ankle bone. Because this is a front view the patient's left side is on our right, which is why the apical point sits right of the midline. Temporal Carotid Brachial Radial Dorsalis pedis Apical Femoral Popliteal Post. tibial The four that catch people out Apical — listened to, never felt. 5th intercostal space, mid-clavicle. Popliteal — BEHIND the knee. Post. tibial — behind the inner ankle bone. Carotid — one side at a time, never both.
🧠 "CBR-FPD-T" top to bottom: Carotid, Brachial, Radial, Femoral, Popliteal, Dorsalis pedis, Tibialis (posterior). Walk down the body and you hit every site in order.

⚠️ Caution: carotid pulse

Never palpate both carotid pulses at the same time — bilateral compression can slow the heart rate (vagal response) or reduce blood flow to the brain.

🧠 "One side of the neck at a time — always."

✅ Circulation checks — distal to the pulse

  • Capillary refill: press nail bed, should return <3 sec
  • Skin turgor: pinch skin, should return <3 sec
  • Temperature should be equal bilaterally in all extremities
SEE ALSO NG-190 Head-to-Toe — where these fit in the full exam sequence.
🫁

LUNG AUSCULTATION

STEP 2 · WALK THE LADDER

A systematic zig-zag down the chest, comparing side to side at every stop — never straight down one side then the other.

🪜 The auscultation ladder — anterior & posterior

ANTERIOR clavicle 1 · above clavicle 2 · 2nd ICS midclav. 3 · 3rd ICS 4 · 4th ICS 5 · 5th ICS 6 · 6th ICS midaxillary (armpit) POSTERIOR lean forward, hands in lap 1 · top 2 3 4 · listen for CRACKLES here BASES best spot for HF fluid continue down to the basilar/lower lobes
  1. Start top-right, above the clavicle — listen for a full inhale + exhale
  2. Move to the opposite side, same spot — compare quality, depth, extra sounds
  3. Move down one interspace at a time, comparing side-to-side every stop
  4. Continue through the 6th ICS at the midaxillary line (armpit) — this covers the lower lobes
  5. Flip to posterior: client leans forward, hands in lap to separate the scapulae for a clean listen
🧠 "HF = Heavy Fluid." The lung bases are the best place to catch crackles from fluid overload / heart failure. "A is for Armpit" — the 6th ICS midaxillary line is right at the armpit and picks up the lower lobes.

🫱 Tactile fremitus

Use the ulnar and palmar surfaces of your hands against the chest wall while the client says "ninety-nine" — vibration should feel equal bilaterally.

🧠 Increased fremitus = consolidation (e.g., pneumonia). Decreased = air/fluid blocking transmission (e.g., pneumothorax, effusion).

🗣️ Charting the subjective symptom: dyspnea

Correct client language for shortness of breath: "It's hard for me to breathe and I feel short winded all the time."

Dys-PNEA = Difficult breathing — a PRIORITY symptom.

🚨 Priority interventions — "breathing problems"

  • Ensure the airway is open
  • Monitor O2 saturation
  • Place client in High Fowler's
  • Evaluate effectiveness of respiratory effort after intervening
🧠 Most important objective data confirming hypoxia: ABGs (arterial blood gases) — not just the SpO2 number.

👀 Cyanosis assessment sites

Bluish discoloration from hypoxia is checked at:

  • Nailbeds — peripheral cyanosis
  • Conjunctiva — central/mucosal cyanosis, more reliable in darker skin tones
  • Earlobes
🧠 Also watch for: clubbing of the fingernail beds (chronic hypoxia), vertigo/dizziness, and increased pulse rate as signs of longer-term hypoxia.
🫀

HEART & ABDOMEN

STEP 3 · THE OTHER TWO STOPS

Five points for the heart, four quadrants for the belly — and one order you can't mix up.

🫀 Heart auscultation — 5 points, "All Pigs Eat Too Much"

A — Aortic (2nd R ICS) P — Pulmonic (2nd L ICS) E — Erb's point (3rd L ICS) T — Tricuspid (4th L ICS) M — Mitral (5th L ICS midclav.)
🧠 "All Pigs Eat Too Much" — Aortic, Pulmonic, Erb's point, Tricuspid, Mitral, top to bottom down the left sternal border, ending at the apex (mitral/apical — the same spot you count the apical pulse from NG-079).

🩻 Bowel sounds — four quadrants

RUQ LUQ RLQ LLQ umbilicus

Listen for sounds in all four quadrants. If absent, listen for a full 5 minutes before charting "absent."

🧠 Chart as active, hyperactive, or hypoactive — never just "present."

🚨 The order you can't mix up: IAPP

1️⃣ Inspect
▼
2️⃣ Auscultate
▼
3️⃣ Percuss
▼
4️⃣ Palpate

The abdomen is the ONE exception to the usual inspect→palpate→percuss→auscultate order — palpating or percussing first can artificially stimulate bowel sounds and give a false reading.

🧠 "Look, Listen, THEN Touch" for the belly — auscultate before you ever press on it.

🫃 Normal abdominal shape

Belly should be flat, non-pulsating, and even/symmetric. Ask about pain with palpation — a rigid, board-like abdomen with fever and tachycardia is peritonitis until proven otherwise and is a priority to report.

SEE ALSO NG-190 Head-to-Toe Assessment — where heart, lung, and abdominal auscultation fit into the full systematic exam sequence.
⚡

QUICK RECALL

SAY IT OUT LOUD
💓 7 pulse pointsnever both carotids at once
🫁 6th ICS midaxillarylowest stop on the ladder = lower lobes
🫀 APE To ManAortic → Pulmonic → Erb's → Tricuspid → Mitral
🩻 Auscultate before palpateonly true for the abdomen
🎯 Cover & check — 4 rapid-fire questions
Q1: Why should you never palpate both carotid pulses at once?
Bilateral pressure can slow the heart rate via a vagal response or reduce cerebral blood flow.
Q2: Where is the best place to auscultate for fluid overload in the lungs?
The posterior lung bases — listen for crackles ("HF = Heavy Fluid").
Q3: What's the correct order of abdominal assessment, and why is it different from other systems?
Inspect, Auscultate, Percuss, Palpate — auscultate before touching so you don't artificially stimulate bowel sounds.
Q4: List the five heart auscultation points in order.
Aortic (2nd R ICS) → Pulmonic (2nd L ICS) → Erb's point (3rd L ICS) → Tricuspid (4th L ICS) → Mitral (5th L ICS, midclavicular) — "All Pigs Eat Too Much."
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STUDY SHEETS

FROM YOUR SAVED SET
The terms that turn up in every question stem — dyspnea, dysphagia, dysuria, hematuria, hematemesis, cyanosis, edema, jaundice and the rest.
The terms that turn up in every question stem — dyspnea, dysphagia, dysuria, hematuria, hematemesis, cyanosis, edema, jaundice and the rest. — swipe it sideways if it is cut off, or tap to open it full size.

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