Module 5
Identify the route of blood flow.
Right atrium> right ventricle> Lungs> left atrium> left ventricle.
Describe the normal sounds of the heart
- The first heart sound (S1) occurs with the closure of the AV valves and signals the beginning of
the systole. S1 is loudest at the apex.
- The second heart sound S2 occurs with the closure of the semilunar valves and signals the end
of systole.
S1 (lub) and S2 (dub)
When do you hear Heart sounds
- Normal sounds of the heart: S1 (lub) and S2 (dub) should be heard when the person is supine
with head and chest slightly elevated.
- S1 is heard when the mitral and tricuspid valves close at the beginning of systole. S2 is heard
when the aortic and pulmonic valves close.
What does a heart murmur sound like?
- Is a gentle , blowing, swooshing sound as blood flows across narrowed or abnormal valve
1. When describing a heart murmur what would you document
- Pitch ( High, Medium , Low )
- pattern - ( growing louder (Crescendo), Tapering off ( Decrescendo ), peaking
- Quality ( Musical , blowing , harsh )
- Location ( where heard best ?)
- posture (change with position change)
- Radiation ( heard in another place )
Grade 1/6 murmur
- barely audible; heard only in a quiet room, and then with difficulty
Grade 2/6 murmur
- clearly Audible but faint
Grade 3/6 murmur
moderately loud , Early to Hear
Grade 4/6 murmur
loud; Associated with a thrill palpable on the chest wall
Grade 5/6 murmur
Very loud, heard with stethoscope partially off chest; associated thrill
Grade 6/6 murmur
- Loudest ; still heard with entire stethoscope lifted just off the chest wall; associated thrill
subjective data of the heart/ peripheral vascular system
- Chest pain
- Dyspnea
, - Orthopnea
- Cough
- Fatigue
- Cyanosis or pallor
- Edema
- Nocturia
- Past cardiac history
- Family cardiac history
- Difficult breathing
- loss of consciousness
- Patient-centered care(cardiac risk factors)
Chest pain objective data
- Neck (carotids) auscultation and jugular vein pulsation
- Precordium inspection, any pulsations, heaves, or lifts
- Apical impulse palpation, note any thrills
- Auscultation of the heart BPM, note the rhythm, if S1-S2 are I sounds or murmurs
Chest Pain Additional history Information
Any chest pain or tightness? Ask about
- onset and location.
- characteristics.
- precipitating events.
- associated symptoms.
- relieved by or made worse by.
- medication or treatments.
Dyspnea questions
Any shortness of breath? Ask about
- Type of activity and occurrence.
- onset and duration.
- affect of positional changes and interruption of sleep.
- presence of orthopnea.
- affect ADLs,
risk factors associated with heart disease and stroke.
- Elevated LDL ( High Cholesterol )
- High Blood pressure
- Diabetes
- Obesity
- Smoking
- Sedentary lifestyle
Identify the route of blood flow.
Right atrium> right ventricle> Lungs> left atrium> left ventricle.
Describe the normal sounds of the heart
- The first heart sound (S1) occurs with the closure of the AV valves and signals the beginning of
the systole. S1 is loudest at the apex.
- The second heart sound S2 occurs with the closure of the semilunar valves and signals the end
of systole.
S1 (lub) and S2 (dub)
When do you hear Heart sounds
- Normal sounds of the heart: S1 (lub) and S2 (dub) should be heard when the person is supine
with head and chest slightly elevated.
- S1 is heard when the mitral and tricuspid valves close at the beginning of systole. S2 is heard
when the aortic and pulmonic valves close.
What does a heart murmur sound like?
- Is a gentle , blowing, swooshing sound as blood flows across narrowed or abnormal valve
1. When describing a heart murmur what would you document
- Pitch ( High, Medium , Low )
- pattern - ( growing louder (Crescendo), Tapering off ( Decrescendo ), peaking
- Quality ( Musical , blowing , harsh )
- Location ( where heard best ?)
- posture (change with position change)
- Radiation ( heard in another place )
Grade 1/6 murmur
- barely audible; heard only in a quiet room, and then with difficulty
Grade 2/6 murmur
- clearly Audible but faint
Grade 3/6 murmur
moderately loud , Early to Hear
Grade 4/6 murmur
loud; Associated with a thrill palpable on the chest wall
Grade 5/6 murmur
Very loud, heard with stethoscope partially off chest; associated thrill
Grade 6/6 murmur
- Loudest ; still heard with entire stethoscope lifted just off the chest wall; associated thrill
subjective data of the heart/ peripheral vascular system
- Chest pain
- Dyspnea
, - Orthopnea
- Cough
- Fatigue
- Cyanosis or pallor
- Edema
- Nocturia
- Past cardiac history
- Family cardiac history
- Difficult breathing
- loss of consciousness
- Patient-centered care(cardiac risk factors)
Chest pain objective data
- Neck (carotids) auscultation and jugular vein pulsation
- Precordium inspection, any pulsations, heaves, or lifts
- Apical impulse palpation, note any thrills
- Auscultation of the heart BPM, note the rhythm, if S1-S2 are I sounds or murmurs
Chest Pain Additional history Information
Any chest pain or tightness? Ask about
- onset and location.
- characteristics.
- precipitating events.
- associated symptoms.
- relieved by or made worse by.
- medication or treatments.
Dyspnea questions
Any shortness of breath? Ask about
- Type of activity and occurrence.
- onset and duration.
- affect of positional changes and interruption of sleep.
- presence of orthopnea.
- affect ADLs,
risk factors associated with heart disease and stroke.
- Elevated LDL ( High Cholesterol )
- High Blood pressure
- Diabetes
- Obesity
- Smoking
- Sedentary lifestyle
