Auscultation Skills: Breath & Heart Sounds

254 Pages·2013·68.3 MB·English

by  Jessica Shank Coviello (ed.)

Auscultation
~
S k i l l s
Breath & Heart Sounds
Clinic411 l:dito.r:
Jessica Shank Coviello

Auscultation Skills
Breath & Heart
Sounds
Fifth Edition

Auscultation Skills
Breath & Heart
Sounds
Fifth Edition
Jessica Shank Coviello, DNP, APRN, ANP-BC
Associate Professor
Yale University School of Nursing
West Campus, West Haven, Connecticut
I
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Library of Congress Cataloging-in-Publication Data
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Coviello, Jessica Shank, author.
Auscultation skills: breath & heart sounds I Jessica Shank Coviello.
Fifth edition.
p.;cm.
Preceded by Auscultation skills. 4th ed. c2010.
Includes bibliographical references and index.
ISBN 978-1-4511-8999-5 (alk. paper)
I. Auscultation skills. Preceded by (work): ll. Title.
[DNLM: 1. Heart Auscultation-methods-Examination Questions.
2. Heart Auscultation-methods-Handbooks. 3. Heart Sounds
physiology-Examination Questions. 4. Heart Sounds--physiology
Handbooks. 5. Respiratory Sounds-physiology-Examination
Questions. 6. Respiratory Sounds--physiology-Handbooks. WF 39]
RC76.3
616.07'544-dc23
2013023781
Care has been taken to confirm the accuracy of the information presented
and to describe generally accepted practices. However, the authors,
editors, and publisher are not responsible for errors or omissions or for
any consequences from application of the information in this book and
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10 9 8 7 6 5 4 3 2 1
Contents
Online audio cues vii
Clinical contributors ix
How to use this book x
Why use this book? xi
SECTION 1 Heart sound fundamentals 1
CHAPTER 1 TlfE HEART AND AUSCULTATION 2
Pretest. Anatomy and physiology, Traditional auscultatory areas,
Alternative auscultatory areas, Auscultatory techniques, Enhancement
teclmiques, Posttest
CHAPTER 2 HEART SOUND DYNAMICS 14
Pretest, Heart sound origins, Basic heart sounds, Depolarization and
repolarization. Documenting heart sounds, Posttest
SECTION 2 Normal heart sounds 23
CHAPTER 3 TlfE FIRST HEART SOUND 24
Pretest. Normal Slt Abnormal S split, Posttest
1
CHAPTER 4 TlfE SECOND HEART SOUND 28
Pretest. No rma1 S2, S2 split sounds. Posttest
CHAPTER 5 TltE TltiRD AND FOURTH HEART SOUNDS 37
Pretest. Ventricular filling sounds, Third heart sound, Fourth heart
sound, S~ and S4: Similarities and differences, Posttest
SECTION 3 Abnormal heart sounds 47
CHAPTER 6 OTtER DIASTOLIC AND SYSTOUC SOLIIDS 48
Pretest. Opening snaps, Systolic ejection sounds, Posttest
CHAPTER 7 MURMUR FUNDAMENTALS 56
Pretest. Thcbulent blood flow, Characteristics, Posttest
CHAPTER 8 SYSTOLIC MURMURS 81
Pretest, Anatomy and physiology, Systolic ejection murmurs,
Ventricular outflow obstruction murmurs, Systolic regurgitation
murmurs, Ventricular septal defect murmur, Posttest
CHAPTER 9 DIASTOLIC MURMURS
Pretest. Anatomy and physiology, Aortic regurgitation murmurs,
Pulmonic regurgitation murmurs, Other diastolic murmurs, Posttest
CHAPTER 10 CONTINUOUS MURMURS 88
Pretest. Two causes, Cervical venous hum murmurs, Patent ductus
arteriosus murmurs, Posttest
CHAPTER 11 OTtER AUSCULTATORY SOUNDS 92
Pretest. Prosthetic valve sounds and murmurs, Aortic prosthetic valves,
Mitral prosthetic valves, Pericardial friction rubs, Mediastinal crunch,
Posttest
v
Vi Conten1s
Breath sound fundamentals
SECTION 4 103
CHAPTER 12 THE RESPIRATORY SYSTEM AND AUSCULTATION 104
Pretest, Anatomy and physiology, The mechanics of breathing,
Auscultatory areas, Auscultatory techniques, Posttest
CHAPTER 13 INTRODUCTION TO BREATH SOUNDS 122
Pretest, Breath sound production, Tenninology, Documenting
auscultation findings, Posttest
Normal breath sounds
SECTION 5 129
CHAPTER 14 BREATH SOUNDS HEARD IN HEALTHY INDIVIDUALS 130
Pretest, Anatomy and physiology, Posttest
SECTION 6 Abnormal breath sounds 135
CHAPTER 15 BRONCHIAL BREATH SOUNDS 136
Pretest, Sound production, Posttest
CHAPTER 16 ABNORMAL VOICE SOUNDS 142
Pretest, Sound production, Posttest
CHAPTER 17 ABSENT AND DIMINISHED BREATH SOUNDS 147
Pretest, Sound production, Posttest
Other abnormal breath sounds
SECTION 7 155
CHAPTER 18 CLASSIFYING ADVENTITIOUS SOUNDS 156
Pretest, Confusion over terminology, Current classification system,
Posttest
CHAPTER 19 ADVENTITIOUS SOUNDS: CRACKLES 158
Pretest, Sound production, Documentation, Late inspiratory crackles,
Early inspiratory and expiratory crackles, Pleural crackles, Posttest
CHAPTER 20 ADVENTITIOUS SOUNDS: WHEEZES 168
Pretest, Sound production, Expiratory polyphonic wheezes, Fixed
monophonic wheezes, Sequential inspiratory wheezes, Random
monophonic wheezes, Stridor, Posttest
Auscultation findings for common disorders 176
Assessment flowcharts for common auscultation findings 182
English-Spanish phrases used in cardiac
and respiratory assessment 19D
PosHest answers 198
Selected readings 218
Additional Web site 219
Glossary 22D
Index 232
Online audio cues
The following sounds can be beard on the companion Web site tbat accompanies this book.
AUDIO CUES
Heart sounds 31 Supravalwlar aortic stenosis murmur
Track Sound 32 Aortic valvular stenosis murmur
1 Normal S and S (base of heart) 33 Subvalvular aortic stenosis murmur
1 2
2 sl (mitral area) 34 Tricuspid regurgitation
3 sl split (insufficiency) murmur
4 Abnormal S split 35 Holosystolic mitral regurgitation
1
5 s2 (pulmonic area) (insufficiency) murmur
6 s2 split during inspiration and 36 Acute mitral regurgitation
expiration (insufficiency) murmur
7 Increased intensity of p2 37 Mitral valve prolapse murmur with
8 Increased intensity of A click
2
9 Diminished~ 38 Early diastolic aortic regurgitation
10 s2 split during inspiration and murmur
expiration 39 Austin Flint murmur
11 Paradoxical S2 split heard during 40 Graham Steell murmur
expiration 41 Normal pressure pulmonic valve
12 Persistent s2 split murmur
13 Persistent s2 split in pulmonary 42 Mitral stenosis murmur (atrial
hypertension fibrillation)
14 Wide, fixed s2 split 43 Mitral stenosis murmur (normal
15 Fused paradoxical s2 split sinus rhythm)
16 S3 over mitral area (Sit S2, S3) 44 Tricuspid stenosis murmur
17 AbnormalS3 45 Cervical venous bum murmur
18 Pericardia! knock 48 Patent ductus arteriosus murmur
19 Right-sided s3 47 Aortic prosthetic valve sound and
20 s4 (S4, s~. S:z) murmur
21 Summation gallop 48 Mitral prosthetic valve sound and
22 Right-sided s4 murmur
23 Opening snap of mitral valve 49 Pericardial friction rub
24 Pulmonic ejection sound 50 Mediastinal crunch
25 Aortic ejection sound
26 Midsystolic click Breath sounds
27 Innocent systolic ejection murmur Track Sound
28 Supravalvular pulmonic stenosis 51 Tracheal and mainstem bronchi
murmur breath sounds
29 Pulmonic valvular stenosis murmur 52 Normal breath sounds heard over
3D Subvalvular pulmonic stenosis other chest wall areas
murmur 53 Broncbovesicular breath sounds
vii
viii Online audio cues
54 Bronchophony (normal) 76 Normal breath sounds
55 Egophony (normal) (pleural effusion)
56 Whispered pectoriloquy 77 Diminished breath sounds
57 Tracheal and mainstem bronchi (pleural effusion)
breath sounds 78 Diminished breath sounds
58 Normal breath sounds (midlung) (hyperinflated lungs)
59 Normal breath sounds (apex) 79 Diminished breath sounds (obesity)
60 Bronchial breath sounds 80 Diminished breath sounds
(consolidation) (positive end-expiratory pressure)
61 Bronchial breath sounds (atelectasis) 81 Coarse crackles
62 Bronchial breath sounds (fibrosis) 82 Fine crackles
63 Bronchophony(consolidation) 83 Wheezes
64 Bronchophony(normal) 84 Low-pitched wheezes
65 Bronchophony(consolidation) 85 Late inspiratory crackles (atelectasis)
66 Whispered pectoriloquy (atelectasis) 86 Late inspiratory crackles Oobar
67 Whispered pectoriloquy (normal) pneumonia)
68 Egophony (tumor, pleural effusion) 87 Late inspiratory crackles
69 Egophony (normal) (interstitial fibrosis)
70 Diminished breath sounds 88 Late inspiratory crackles
(shallow breathing) Oeft-sided heart failure)
71 Diminished breath sounds 89 Early inspiratory crackles (chronic
(diaphragmatic paralysis) bronchitis)
72 Absent breath sounds 90 Early-to-midinspiratory crackles
(pneumothorax) (bronchiectasis)
73 Normal breath sounds 91 Pleural crackles
(pneumothorax) 92 Expiratory polyphonic wheezes
74 Absent breath sounds 93 Fixed monophonic wheezes
(pneumothorax) 94 Sequential inspiratory wheezes
75 Diminished breath sounds (pleural 95 Random monophonic wheezes
effusion) 96 Stridor