Nursing Assessment of the Heart

by Samantha Rhea, MSN, RN

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    00:01 Now let's talk here for a second about the heart and what you're going to hear.

    00:05 Now, anytime you listen to the heart, take your stethoscope get your ears placed into your heart, you always hear that lub dub, lub dub.

    00:14 So a lub dub is one, lub dub is two, that's how you're going to count you're listening to your heart or auscultate.

    00:21 So this is what we call your S1 and S2 heart sounds.

    00:25 Now this is going to correlate with the blood pumping out of the ventricles, and then you're going to hear the closing of valves.

    00:32 So the first sound that you hear, that lub, this is what we call our S1.

    00:37 Now, at the bottom of this image of the heart, the ventricles are really important here.

    00:42 Here's where they can tract and they're going to pump blood out of the body.

    00:46 And we're going to hear that little bit of closing of that tricuspid and that mitral valve.

    00:51 Now that's where we're going to hear the S1 from the closing of these valves.

    00:55 So there's our lub.

    00:57 Now for moving on to our S2, which is our dub.

    01:00 This is after we've received that blood, and then we start hearing the diastole phase.

    01:06 So this is where we hear the aortic and that pulmonic valve close, causing a little bit of that vibration causing the S2.

    01:14 So don't forget, you hear a lub dub S1, S2, and that is 1B.

    01:20 Now just know the increase in intensity of the sound can main mean that there's certain conditions.

    01:25 And again, there's various of sound such as clicks or something else that you may hear whooshes.

    01:32 Just note these and make sure you talk to your patient and also make sure that you check with your health care provider.

    01:42 Now let's take a little bit deeper look of how we perform a cardiovascular assessment and some key considerations.

    01:49 Now we're going to use our diaphragm of our stethoscope here and we're going to auscultate or listen.

    01:55 For 30 beats three really big things.

    01:58 So we need to number one see, is the rhythm regular? So if you recall, we're going to listen to that lub dub, S1, and it should be very regular and on time.

    02:08 So it may sound like lub dub, lub dub, lub dub, lub dub, and as you can hear very regular and on time.

    02:17 Now sometimes you may hear some irregularity.

    02:20 Now this could be mean that the patient has a irregular rhythm such as atrial fibrillation, and that's important to know.

    02:27 So it may sound like lub dub, lub dub, lub dub, lub dub, lub dub lub dub, so you can see that's not regular and that's important to know and communicate with the healthcare provider.

    02:40 And of course, don't forget about the heart rate of your patient.

    02:43 As you recall, 60 to 100 is what we consider normal, but your patient's resting heart rate may be a little bit different.

    02:50 So it's important for you to assess it and note that first.

    02:54 You may listen to the heart rate, and it may be really fast, like tachycardia, or really slow.

    03:00 So this is important to know based on medications and other treatments that the patient may have.

    03:06 And of course, if you hear any whooshes or clicks, you want to note these as well.

    03:11 You might hear something like an artificial heart valve when you're listening to your patient.

    03:16 An important note as well, if you're given some certain cardiac medications like digoxin, for example.

    03:22 It's really important that you listen to the heart or auscultate for one full minute and get a true apical pulse.

    03:30 Now this is important for that particular med because with digoxin, if the patient's heart rate is less than 60, we will hold that med.

    03:39 So here to get the truest and most accurate assessment, we listen for an apical pulse.

    03:46 So when we're talking about auscultation with a cardiovascular assessment, if you take a look at these images, and you see all these little red circles or hotspots, these are all different areas of the thorax or the chest that you can listen to, to auscultate the heart.

    04:02 However, the erbs point that you see pointed out here is the auscultation location for heart sounds and heart murmurs and this is really preferred.

    04:13 Now as you can see, this is located between about the third intercostal space in the left lower sternal border.

    04:20 And now here at this erbs point, you should be listening for the S1 and S2 here.

    04:26 Now again, nice thing if you think about you put your stethoscope to the patient's chest at any of these points, even maybe down to the apex, that horde is going to radiate and that sound can radiate.

    04:39 So you want to make sure you listen to the spot that you can pick up and listen to that lub dub.

    04:44 But again, for heart sounds or heart murmurs, that erbs point is definitely preferred.

    About the Lecture

    The lecture Nursing Assessment of the Heart by Samantha Rhea, MSN, RN is from the course Assessment of the Cardiovascular System (Nursing).

    Included Quiz Questions

    1. Tricuspid
    2. Mitral
    3. Aortic
    4. Pulmonic
    1. At the third intercostal space and the left lower sternal border
    2. Between the 5th and 6th intercostal space and the midclavicular line
    3. Between the 3rd and 4th intercostal space and the midclavicular line
    4. At the fifth intercostal space and the left lower sternal border

    Author of lecture Nursing Assessment of the Heart

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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