What is making the Lub-Dub sounds? How many structures are involved, and do
they work simultaneously?
for
&
the structures
and the
"
"
Dub
that
Sound
are
making
?
the aor tic
is
Lub Dub sound
the
closing
pulmonic value
the
is
-
Sz
at
tricuspid
mitral
valve
closing
the
"
"
hub
(Si
.
When, in the cardiac cycle, are you hearing the S1 sound?
The
found
is
sound
S,
the
at
beginning
of
systole
.
When, in the cardiac cycle, are you hearing the S2 sound?
The
Sz
Sound
found
is
the end
at
of
systole
or
the
beginning
diastole
of
.
Lub =>atrioventricular valves closing; tricuspid and mitral
Dub=>aortic and pulmonic valves closing
A=>aortic valve (s2 louder than s1/Dub)
P=>pulmonic valve (s2 louder than s1/Dub)
E=>Erb’s point (s1s2 sounds should be equal)
T=>tricuspid valve (s1 louder than s2/Lub)
M=>mitral valve (s1 louder than s2/Lub)
1
111
1. Notice the locations of these “hearts”. Why would you need to know these
locations?
One
would need
For any
to
know
such
abnormalities
locations
these
as
galloping ,
murmurs
in
order to
and
more
arsenate
for
heart
sounds
and
listen
.
2. What is the acronym for these locations? What does each letter stand for?
The
Erb's
acronym
point ,
for
T stands
these
for
is
APETM A
M stands
for Mitral
locations
tricuspid
and
.
stands
for
.
3. Label each small heart with the appropriate letter.
4. What do you hear the strongest at each site?
I
can
heart
hear
and 5 ,
Sz
Sounds
sounds
strongest
loudest
at
at
the
the
apex
base
of
the
aor tic ,
P stands
for
pulmonic , E
stands for
sound)
Practice Gathering subjective data on a classmate (write six-eight questions you will ask)
Initials _________________date____________
Are
Do
Do
you
experiencing
Do
you have
DO
you
have
you
smoke
any family
history
of
disease ?
heart
?
heart
problems
history of edema?
any
have
you
Do
any medications
you have
Do
chest pain?
frequently?
exercise
you
any
a
Practice, Practice, Practice the cardiac physical exam on a classmate:
****URGENT ASSESSMENT****Chest pain, Dyspnea, cyanosis, diaphoresis or dizziness, numbness of an extremity, cool limbs,
capillary refill > 5 seconds
Basic cardiac Bedside Assessment
Basic PVS and lymphatic system
Inspection neck (jugular veins), precordium
Inspect arms and legs for symmetry, range of
motion color, hair nails
Palpate arm and legs for tenderness, warmth,
erythema
Palpate peripheral pulses
Palpate arms and legs (capillary refill)
Test for skin turgor
Palpate for edema
Inspect arm and legs for tenderness, warmth,
erythema
Palpate carotid arteries
Auscultate carotid arteries
Inspect the precordium
Palpate the precordium
Palpate the PMI
Auscultate the Apical pulse for 1 minute
Auscultate the precordium for S1, S2 murmurs,
extra sounds
Practice documentation of a cardiac and peripheral vascular assessment on a classmate
Document your assessment here
carotid pulses Apical
Patient had regular JVD and Zt symmetrical
with
Pulses
no
abnormalities There were
no
.
lower
present in
extremities
besides
sounds
extra
popiteai No thrill
.
murmurs
-
No
within
present
Precardium
60 -100mm
within
was
pulse
edema present in
.
nor
peripheral
.
.
Practice, Practice, Practice the cardiac and peripheral vascular physical exam on a standardized patient:
Basic cardiac Bedside Assessment
Basic PVS and lymphatic system
Inspection neck (jugular veins), precordium
Inspect arms and legs for symmetry, range of
motion color, hair nails
Palpate arm and legs for tenderness, warmth,
erythema
Palpate peripheral pulses
Palpate arms and legs (capillary refill)
Test for skin turgor
Palpate for edema
Inspect arm and legs for tenderness, warmth,
erythema
Palpate carotid arteries
Auscultate carotid arteries
Inspect the precordium
Palpate the precordium for thrills
Palpate the PMI
Auscultate the Apical pulse for 1 minute
on
because
Done
*boyfriend
was
there
time
not
in
assess
enough
to
class
second
patient
.
Auscultate the precordium for S1, S2 murmurs,
extra sounds
Document your assessment here
Patient
had
a
symmetrical
normal
with
symmetrical
found
with
extremity
lower
.
JVD
no
and
thrills
full
.
Zt
pulse
Apical
range
Pulses
pal portable
of
found
.
carotid
645pm
was
motion
.
arteries
-
Arms
No edema
,
,
Murmur
and
Precordium
found
Arms
.
legs
tenderness
,
non
was
and
legs
tender ,
erythema
or
all
warmness
Check your documentation with samples provided
Vital sims Manikins: Listen to abnormal heart sound
• Aortic stenosis- 2nd or 3 right intracostal space (ICS)
• Mitral stenosis- 5 ICS mid clavicular
• Pulmonic stenosis-2 or 3 left intracostal space (ICS)
rd
th
rd
Listen to lung, abdominal and cardiac sounds with Harvey and cardiotronics