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Heart Sounds, Lung Sounds, Bowel Sounds

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Heart Sounds, Lung Sounds, Bowel Sounds

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    1. Heart Sounds, Lung Sounds, & Bowel Sounds Georgia College & State University

    2. Heart Sounds

    3. Subjective Assessment Chest pain Dyspnea Shortness of breath Orthopnea Cough Fatigue

    4. Chambers Chambers Right and left atria Right and left ventricle

    5. Valves

    6. Conduction System SA node is pacemaker Normal pacemaker is 60-100 Bradycardia <60 Tachycardia >100

    7. Cardiac Cycle

    8. Assessment Areas

    9. Auscultate the Precordium with Diaphragm & Bell Note the rate and rhythm Identify S1 and S2 Extra heart sounds S3 S4 Pericardial friction rubs

    10. Rate and Rhythm Listen to this irregular heart rhythm Note any patterns Note rate

    11. S1 & S2 Identify S1 (heard best at apex) S1 signals the beginning of systole Identify S2 (heard best at base) S2 signals the beginning of diastole Pause after S2

    12. Extra Heart Sounds

    13. S3 Heard after S2 Lower pitch than S2 Heard better with the bell Heard best at the apex of heart

    14. Split S2 Caused by delay in closure of Pulmonic valve Same pitch as S2 Heard better with the diaphragm Heard best at base of heart

    15. S4 Heard immediately before S1 Lower pitch than S1 Heard better with bell Heard best at apex of heart

    16. Murmurs Restricted forward flow thru stenotic valve Backward Flow thru regurgitant valve Abnormal open in chambers

    17. Six Characteristic of Mumurs

    18. Systolic Mumur

    19. Diastolic Mumur

    20. Breath Sounds

    21. Subjective Assessment Cough Shortness of breath Chest pain with breathing Past medical history COPD Asthma, emphysema, or bronchitis Pneumonia Tuberculosis Cigarette smoking

    22. Borders of the Lungs Anterior Apex above clavicles Base at the 6th rib, midclavicular line

    23. Borders of Lungs Lateral Central axillary area to 7th or 8th rib

    24. Borders of Lungs Posterior Apex at C7 Base at T10-T12

    25. Auscultation of Posterior Chest Normal breath sounds Bronchial Bronchovesicular Vesicular

    26. Tips for Auscultation Use the diaphragm Listen to one full respiration at each location Follow the same pattern Compare side to side

    27. Normal Bronchial Breath Sounds Heard over the trachea and larynx High-pitched Loud Inspiration < expiration Harsh, hollow, and tubular

    28. Normal Bronchovesicular Breath Sounds Posterior Heard between scapula Anterior Heard around Angle of Louis Medium-pitch Moderate amplitude Inspiration=expiration Mixed quality

    29. Normal Vesicular Heard over peripheral lung fields Low-pitched Soft amplitude Inspiration > expiration Sounds like rustling of leaves on a tree

    30. Absent Breath Sounds No air exchange in a lobe or entire lung Caused from pneumothorax, ateletasis, or pleural effusion.

    31. Discontinuous, Fine Crackles Produced by inhaled air colliding with previously deflated airways. Airways suddenly pop open High-pitched (Sibilant) Heard mostly on inspiration Not cleared by coughing Clinical examples Pneumonia CHF COPD

    32. Discontinuous, Course Crackles Produced by inhaled air colliding with secretion in trachea and large bronchi Loud, low-pitched (Sonorous) Start in inspiration and may be present in expiration May decrease with coughing or suction Clinical examples: Pulmonary edema, pneumonia, pulmonary fibrosis

    33. Continuous, Sibilant Wheeze Produced by air being squeezed through narrowed air passages High-pitched Musical quality Predominate in expiration, but may be heard in inspiration too Acute asthma Chronic emphysema

    34. Continuous, Sonorous Wheeze Produced by airflow obstruction Low-pitched Snoring or moaning sounds More prominent on expiration May clear with coughing or suction Bronchitis Tumor in single bronchus

    35. Stridor Caused by constriction of larynx, trachea, or upper airway obstruction High-pitched, crowing sound Heard on inspiration and louder in neck area Croup Acute epiglotitis Foreign body Inhalation injury

    36. Abnormal Breathing Patterns

    37. Bowel Sounds

    38. Bowel Sounds Use diaphragm Move in the following pattern: RLQ, RUQ, LUQ, LLQ Normal bowel sounds are intermittent gurgles

    39. Abnormal Sounds Absent bowel sounds Caused by obstruction of intestines (adhesions, hernias, and masses) or paralytic ileus Hypoactive bowel sounds Caused by peritonitis, inflammation, electrolyte imbalances Hyperactive bowel sounds Caused by gastroenteritis, diarrhea, & laxative use

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