11.5 Objective Assessment
Objective assessment of the cardiac system includes assessing the carotid arteries, the jugular veins, and the heart.
Typically, you will complete an objective assessment after the subjective assessment, but in urgent situations, objective assessment and associated interventions may become the priority of care.
Remember to do all assessments on bare skin.
Clinical Tips
A trauma-informed approach to cardiac assessment is important because areas of the chest will need to be assessed and exposed. Maintain privacy by closing the door and/or curtains. Ask the client if they would like a family member or friend present or another health care provider. Provide a drape to the client and only expose the necessary areas of the chest. Always ask permission to touch. And last, explain what you are doing throughout the assessment. Sometimes it is helpful to show on your own chest (over your uniform) where you will be palpating and placing the stethoscope.
Contextualizing Inclusivity: Chest Binding
An inclusive approach to health assessment is vital because clients need to feel accepted for who they are. Some non-binary and transmasculine clients may wear a chest binder because they feel uncomfortable or distressed about having breast tissue. Binders are garments designed to flatten the appearance of the chest wall. They come in different forms and can extend from the chest down to the diaphragm or to the hips: they may look like a sports bra or tank top, and some clients may use compression bandages.
The binder needs to be removed to adequately assess the heart. You may or may not be aware of whether the client you are assessing wears a chest binder, so you can apply an inclusive approach by acknowledging the vulnerability that clients may feel. Provide step-by-step instructions so that they are prepared, and ask nonjudgmental questions like “Assessing your heart requires me to assess on the bare skin of your chest. Is there anything that would impede me from doing so?” You can also ask if they have any questions before beginning.
You should also assess the binder for proper fit: a good fit allows for normal chest expansion and deep breathing.
