Question

Discuss the assessment techniques of breath sounds in an adult and include one usual abnormal finding.

Discuss the assessment techniques of the heart and include one usual abnormal finding

Answer 1

Assessment of breath sounds in an adult include mainly by

Auscultation: In this step the areas of the lungs that can be listened to using a stethoscope

These are the posterior, lateral, and anterior lung fields.

The posterior fields can be listened to from the back and include: the lower lobes (taking up three quarters of the posterior fields)

The anterior fields taking up the other quarter

The lateral fields under the axillae, the left axilla for the lingual, the right axilla for the middle right lobe.

The anterior fields can also be auscultated from the front.

Normal breath sounds include Tracheal, bronchial, vesicular and bronchovesicular.

One usual abnormal findings include: Wheezes: It is a continuous musical sound on expiration or inspiration. A wheeze is the result of narrowed airways. Common causes include asthma and emphysema.

Assessment of heart sounds:

A stethoscope is used to auscultate for heart sounds.

The diaphragm of the stethoscope is used to identify high-pitched sounds, while the bell is used to identify low-pitched sounds.

There are two normal heart sounds that should be elicited in auscultation: S1 (lub) and S2 (dub).

The third and fourth sounds may be heard in some healthy people, but can indicate impairment of the heart function. S1 and S2 are high-pitched and S3 and S4 are low-pitched sounds.

The practitioner should listen over each of the four main heart valve areas: the aortic, pulmonary, tricuspid and mitral valve areas.

1. Aortic area
   1. Place the diaphragm of the stethoscope at the 2nd intercostal space, right sternal edge. This is the anatomical landmark for the aortic valve.
   2. Listen for at least 5 sec for the second heart sound, which represents the aortic valve closing.
2. Pulmonic area
   1. Place the diaphragm of the stethoscope at the 2nd intercostal space, left sternal edge. This is the anatomical landmark for the pulmonary valve.
   2. Listen for at least 5 sec for the second heart sound, which represents the pulmonary valve closing.
3. Tricuspid area
   1. Place the diaphragm of the stethoscope at the 4th - 5th intercostal space, left sternal edge. This is the anatomical landmark for the tricuspid valve.
   2. Listen for at least 5 sec for the first heart sound, which represents the tricuspid valve closing.
4. Mitral area
   1. Place the diaphragm of the stethoscope at the 5th intercostal space, mid-clavicular line (same area as the apex beat). This is the anatomical landmark for the mitral valve.
   2. Listen for at least 5 sec for the first heart sound, which represents the mitral valve closing.

One of the usual abnormal sounds is

Heart murmurs: Heart murmur caused by turbulent flow of blood across the heart valves, however, which may indicate heart disease.