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2 Minute EBP Challenge

Monday, July 26, 2010
Ms. Shepard and DIC
This morning rapid response is called for Ms. Shepard who was admitted with a urinary tract infection and sepsis. Her blood pressure dropped during the evening hours and she is now hypotensive and is having difficulty breathing. Her IV sites are oozing and there is blood in the urinary catheter. Her physician suspects disseminated intravascular coagulation (DIC). The primary mechanism in the development of DIC is:

Monday, July 19, 2010
Thyrotoxicosis

Which of the following laboratory findings is indicative of thyrotoxicosis?

Monday, July 12, 2010
Urban CPR Patterns
In a recent study of inner-city neighborhoods, the authors found that out of hospital cardiac arrest was 2-3 times higher in some neighborhoods compared to others. In these high incidence neighborhoods what was the rate of bystander CPR?

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Home > 2 Minute EBP Challenge > Heart Sounds

Heart Sounds

Monday, January 18, 2010
 

Stay up-to-date the easy way!

How would you answer this question?

The most common cause for the development of a new S3 heart sound is:

a. Cardiac tamponade
b. Papillary muscle rupture
c. Acute heart failure
d. Myocardial infarction

The correct answer is "c" acute heart failure.

The normal "lub" and "dub" sounds of the heart are labeled as S1 and S2 respectfully.  Additional sounds can be a normal variation if they were present before an acute cardiac event, or can signal acute cardiac dysfunction in a patient in acute distress.

The S3 heart sound is heard after S2 and is lower in pitch and softer than the S2.  The word "Kentucky" is often used to help remember the pattern of an S3.  With "Ken" corresponding with the S1, "Tuc" with the S2, and "Ky" with the sound of the S3.  I prefer the phrase "Sloshing In" to remember the pattern of the S3.  The "Slosh" corresponds to S1, the "Ing" to S2, and "In" to S3.

An S3 heart sound occurs because the patient is volume overloaded and blood is "sloshing into" the heart.  Specifically, blood oscillates between the walls of the ventricle from blood rushing into the ventricle from the atria.  An S3 is best heard with the bell of the stethoscope at the apex of the heart.

Although an S3 can be a normal finding in young adults and athletes, the presentation of a new S3 indicates an acute condition of fluid volume overload -- or acute heart failure.  If they told you in report that your patient has an S3, then it probably is not acute; but if the S3 is new assess further for fluid overload and acute heart failure.

Congratulations to Julia Mason who won an autographed copy of my 101 Tips to Improve Your Nursing Care book for answering this week's question correctly.  Congratulations Julia!   

Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.

PS. Find the answer in this YouTube video...

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