FOR BLOCK B ONLY:
wHEn you go on duTy ON Thursday, listen to the heaRt sound of your patIent. Describe In DeTail wHat you Heard and deduce whether it is NoRmaL or not.
Tuesday, July 10, 2007
Posted by nHeLia at 2:13 AM
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I was assigned @ the OPD section, a patient entered…my co-student nurse got her blood pressure and it was high that the patient was already experiencing hypertension @ the moment. The doctor told me to get her cardiac rate…With the aid of a stethoscope I heard the characteristic sounds of the normal heartbeat, typically described as a "lub-dub." The first heart sound or "lub" is a rather low-pitched and a relatively long sound. The second heart sound, or "dub," is typically heard as a sharp snap. The pattern that I’ve heard was one of: "lub-dub" pause, "lub-dub" pause, and so on. But then, the second time that I’ve laid the stethoscope on her chest, I heard a slow "lub-dub" sound and her cardiac rate was 64 bpm. It was then I realized that a hypertensive patient has an irregular heartbeat that could eventually lead to heart attack or stroke.
As student nurse, I have many responsibilities specially in the hospital about caring the patient. My patient that I handled had an illness called "plueral sepsis. I found out that this patient is suffering from heart abnormalities due to the vital signs and the physical assessment that i got and observed. When I interviewed my patient, she told me that her health condition is not doing fine because of the present condition that she had. When I listened to the beat of her heart using a stethoscope, I heard the two distinct sound during its cardiac cycle. It only implies that the condition of her beats is not normal. The heart sound are often describe by the two syllables "lub" and "dup" pause and so on. The first sound (lub) is cause by the closing, the second heart sound (dup) occurs seminilunar values close at the end of systole.
This is my third day of duty at the 'OPERATING ROOM" of quirino provincial hospital and finally we had a patient who undergone "APPENDECTOMY".Upon entry to the "OR" the patient AFRAID of getting him there.The fear of our patient to this operation were put him to have a cold clummy skin,pale lips,pale nail beds, and a little bit higher on his breathing. My first thing to do is I provide an emotional support to lesser his anxiety to the operation and got his blood pressure and my finding is 130/90 mmHg. His pulse was faster than the normal one 126 beats per minute it is due to the FEAR he felt I think.After taking the vital sign(BP and RR) I reffer it to the anesthesiologist.I also got his cardiac rate independently and I heard a fast and alternating sound of "LUB DUB",which I think he has a normal heart sound but the rapid pumping of his heart has something to do with his emotion(anxiety) on the procedure.
The cardiovascular system is the most important to assess because it is the body system that the other system of the body deppend.through the regular pumping of the heart,oxygen and the needed nutrients are delivered to and tissue waste products are removed from all cell of the body.The cardiovascular system also transports reguatory materials such as hormones,enzymes and antibodies to the body system. It can adapt to changes in the body adjustment of the rate and force of the heart pumping , change in the size of the blood vessels, and alteration in the blood volume and composition of the blood.
For families with member experiencing a cardiovascular disorder or disease, undrstanding the functioning of the heart and circulation is a first step toward coping with the illness.
When I listen to the heart sound of my pt. using stethoscope I heard a lub-dub sound and what I think it is normal because indicates that valves, ventricle and aorta works normally and there are no adventitios sounds being heard. The BP of my pt is 130/90 and it indicates normal BP of an adult pt(120/80).
when I auscultate my patient last thursday, I hear the sounds LUB DUBB this are sounds of a normal heart.This sound comes from the valves shutting on the blood inside the heart.
The first sound (the lub) happens when the mitral and tricuspid valves close. The next sound (the dub) happens when the aortic and pulmonary valves close after the blood has been squeezed out of the heart.
Last Thursday our group (group I) handled two patients each, some assigned to female ward and the other assigned to male ward and I’m one of them. The case of my two patients that day was: old fracture and the other one has baker’s cyst. With the aid of stethoscope I hear the normal heart sound on both of them which medically term as the “lub-dub” sound. In my patient with the case of old fracture, the lub-dub sound was continuously hear as lub-dub lub-dub lub-dub…… but in my patient with the case of baker’s cyst, the lub is in low long pitch followed by the dub with high pitch sound.
Last thursday on my duty at emergency room with the use of stethoscope I heard the the characteristic sounds of the normal heart beat described as "lub-dub".These sounds are produced by the closure of the heart valves.The first heart sound "lub" results from closure of the tricuspid and mitral valves.It is a rather low-pitched and a relatively long sound which as indicated in represents the beginning of ventricular systole.The second heart sound "dub' marks the beginning of ventricular diastole.It is produce by closure of the aortic and pulmonary semilunar vanes when the intraventicular pressure begins to fall.This sound is typically heard as a sharp snap.
The normal sound of the heart when it beats is “LUB DUB” but of course it is not always the same with other peoples heart sound, when I heard the heartbeat of my patient upon auscultation, i heard “LUB DUB…ssssshh…LUB DUB…” in a low pitch sound...
I placed the stethoscope on the lower part of her breast, because I was not convinced with what I heard, but then I heard the same sound “LUB DUB….ssssshh…LUB DUB” I asked my self.. Is that normal? Indeed it is “not”. It was a crazy sound…
Throughout the ages, the heart has been referred to as a source not only of virtue but also of intelligence. Even today we use phrases like, ''I know in my heart it's true,'' indicating that we know the heart is more than merely a pump. making our heart healthy is very important for us to have a normal "life".
The heartsound of my patient is normal.The sound heard onthe surface of thechest in the heart region is "lUB and DUP.They are amplified by and heard mor distinctly through a stethoscope.These sound are caused by the vibration generated during the normal cardiac cycle.They may be produced by muscular actoin,valvular action, motion of heart and blood as it passes through the heart.
My patient heart sound is not normal because he has a murmur sound which is S1-lub S2-dub and S3-murmur sound.
we are assigned at the operating room,during our duty,i assessed one of our patient heart sound through sthetoscope,and i heard it normal which is LUB-DUB.
Interpretation of heart sounds requires detailed knowledge of cardiac physiology and pathophysiology of cardiac diseases.
During my nursing assessment with my patient particularly concerning her heart, I found that everything is going right. Her heart sounds are normal, I heard the loud sounds of the S1 and S2 or the lub-dubb sounds. Aside from these, there are no further abnormal sounds heard such as murmurs, gallops, snaps and clicks. The S1 refers to the first heart sound which produced by the closing of the mitral and tricuspid valve while the S2 is produced by the closing of the aortic and pulmonic valves. The time between S1 and S2 corresponds to the systole. The time S2 and S1 is the diastole. The heart rate of my patient is also normal. It ranges from 80 to 85 beats per minute.
I done this physical examination by auscultating the heart of my patient with the use of a stethoscope. The patient is on supine position during the examination with her room calm or quite because the television was off and her watchers /significant others were all out. Therefore, I assessed my patient’s cardiac sounds clearly and accurately.
The closure of the heart valves produces vibrations of the surrounding heart tissueand blood, that can be detect as the audible "lub-dup" sound heard with a stethoscope during cardiac auscultation. There are four heart sounds, the 1st and 2nd sound are heard in all healthy individuals. The 3rd and 4th sound usually are not heard and may or may not indicate. The 1st and 2nd heart sound represent closureof the atrioventricular and semilunar valves, respectively, the 3rd heart sound "lub" which has a lower pitch and last longer 0.14 seconds. The second sound marks the onset of systole and the closure of atrioventricular valves. The 2nd heart sound "dup" occur with the closure of the semilunar valves. It is shorter and has a higher pitch than the first heart sound. The 3rd heart sound is low pitch and occurs during rapid filling of ventricles early in diastole, after the 2nd heart sound. It usually heard only in young person or in patient with heart failure. The 4th heart spund is produce by atrial contraction during the last 3rd of diastole; it is audible only in condition in which resistance to ventricular filling occur during late diastole. Heart "mur-mur" are cause by abnormal vibration produced by turbulent blood flow. Auscultation to detect mur-mur or abnormalities of the heart sound is valuable diagnostic procedure. My 1st patient have renal heart failure, it have abnormalities or mur-mur sound to his heart and my 2nd patient has a normal sound. I detect it through auscultation using my stethoscope.
Last thursday,July 12,2007,I and my groupmates were assigned at the OR.We had only one case on that day,our pt. undergone Appendectomy.Upon admitting the pt. at the OR,I observed that he is afraid for the procedure that will be done to him.When the anesthesiologit entered at the OR she ordered us to get the BP and pulse rate of the pt.The pt's BP were 130/90 and 115 bpm for the PR.While were having conversation with the pt. and rendering emotional support I got the cardiac sound by auscultation and I heard the lub-dubb sound of the heart and it is normal.But the heart beat of our pt. is faster than the normal cardiac rate of an adult.Because of the reason that he is afraid for the procedure that will be done to him.
Last Thursday,I was assigned at the female ward and I handled two patients. My first patient has a diagnosis of colon malignancy and the second one is Pre Renal failure. As a student nurse I have the responsibilities to assess my patient well. During my assessment in my two patients, I used stethoscope to get their cardiac rate... And I found out that both of them has a normal heartbeat. The heartbeat that I heard is the "Lub-Dubb". This sounds are best often heard in a normal patient. The First sound "Lub" pertains to the mitral and tricuspid valve close and second one "Dubb" is the semilunar valve closed after the blood has squeezed out of the heart..The cardiac rate of my patients are "72 bpm and 67 bpm" and their blood pressure are "110/90 and 100/80" which indicate that my patient are both in normal of their cardiac rate.
July 12,2007,Our group was assigned at the operating room wherein we had only one case which is the appendectomy. During our duty as a student nurse we are responsible for taking the vital signs of our patient for baseline data we have gathered BP-130/90,CR-118bpm. I also heard that the sound of his heart is normal which best described of the two word "LUB DUB" but in a fast manner. After getting the ff.datas I asked our patient what he feels and he said that "kinakabahan ako dahil first time kong maoperahan" so from that statement,our patient is anxious on that time because of the procedure that he will undergo. So as a student nurse we provided the pt. emotional support to lessen the anxiety.
Last Thursday,I was assigned at the male ward and I handled two patients but one of my patient is requesting to transfer to another hospital thats why i just auscultate the other one. My patient has a diagnos of bleeding, peptic ulcer. As a student nurse I have the responsibilities to assess my patient well. During my assessment I used stethoscope to hear his cardiac sound... And I found out that my patient has a normal heartbeat. The heartbeat that I heard is the "Lub-Dub". This sounds are best often heard in a normal patient. The First sound is "Lub" and the second one is "Dub". And when he knew that he will undergo blood transfusion his heartbeat becomes faster.
As i went to our duty last thursday,we were assigned at the male ward.I handled a patient who will undergo appendectomy.On my first assessment,i heard his heart sound as normal "Lub Dub". But as we went on with our interaction and im going to assess again his heart sound,I recognized the fast "Lub Dub" sound. I realized that it was because of his anxiety due to the operation. That was his first time to undergo major operation.
To my other patient,when i heard his heartbeat,i heard that there was a slow "Lub Dub" sound. I realized that it is because he is weak and he has a decrease production of RBC.
last thursday my duty i was assigned at VIP room`s of CVSH..with the aid of stethoscope i heard the heart sound of my patient with LBM as normal hertbeat "lub-dub"..some of the patient has abnormal heart sound like CVA patient..gudluck!!! the banker...
It was a nice sunny Thursday when we had a duty at Quirino Provincial Hospital, I was assigned to a patient with a case of DHF and there I started providing primary health care. Aside from having as usual duty, I was aware that morning that I will be having one more task- listen to my patient’s heart sound and deduce whether it is normal or not.
After NPI, morning care and vital signs taking, I assisted my patient in supine position. Using stethoscope with a bell which is necessary for accurate auscultation of the heart, I placed my stethoscope’s diaphragm at my patient’s apical area and progressed it upward along the left sternal border to the pulmonic and aortic areas. (Although S1 is heard over the entire precordium, it is heard best at the apex of the heart and S2 is heard louder at the base.) Initially, S1 (LUB) is heard and next, S2 (DUB) is identified. Finally, I assisted my patient to turn on the left side and I placed my stethoscope on the apical area where mitral murmurs are more readily detected but same as the first, LUB DUB is heard. After listening to my patient’s heart sound, I deduced and concluded that my patient has a normal of it as evidenced by the absence of any abnormal sounds such as snaps and click, murmurs, and sssshhh sound.
Last July 12, 2007, at Cagayan Valley Sanitarium and Hospital, my C.I. assigned me to a patient diagnosed with Pneumonia and Pleural effusion, she was with right Chest tube thoracostomy. It was her fourth day of hospitalization. My patient has a history of asthma. I introduce myself to her and to her husband; I told to that I’d be with her until Saturday 7an to 3 pm shift only. That morning she seems very weak, I listen to her heart beat, we all know that the normal sound was lub-dub, but not to my patient, I heard a wheezing sound its was a long wheeze sound on the start to the end of one beat. In every beat there’s a long wheeze sound before the lub-dub sound, I even asked my group mate to recheck it, according to the staff nurse assigned to her, she had a complicated upper respiratory illness, she was complaining of DOB for a couple of months before her doctor at CVSH diagnosed that there were fluids on her right lung. My patient seems prone to Cardiovscular disease, but still her family is doing everything for her wellness soon.
during my assessment to my patient i used ascultation, my patient remain supine position and i examined in quiet possible room so that it is easy for me to hear the heart beat of my patient if the room area is quiet and i used also the stethoscope the bell is necesary for ascultate of the heart.
using the diaphragm of the stethoscope first i start on the apical area and progress upward along the pulmonic and aortic areas. through mt examine i heared the normal heart sound of my patient that is labdab sound. it is hard to hear the normal beat of the heart but you should extra careful in hearing the sound because this is my basis to her the normal soun d of the heart.
As i listened to the heart sound of my patient, i can say that it is normal because there is an absents of abnormal sound and her cardiac rate is 68 per min. the first sound which is the s1 is produce by the closing of the mitral and tricuspid valve and i hearded at the apex of the heart. the seconf heart sound is the s2 produced by the closing of the aortic and pulmonic valves and the loudness of the base of the heart. so my patient has normal heart sound.
During my assessment to my pt.and assessing the sound of her heart, I've heard some abnormalities which is the rhonchi sound, which I use the stethoscope through auscultating my pt.My pt. has a diagnose of CVA and she was still unconcious during I assess him.
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