Pericardial knock: A pericardial knock can be present in patients with constrictive pericarditis, as the early filling of the LV is limited from the constrictive process. The knock occurs earlier than a S3 heart sound. which is the distinguishing factor; this is because the S3 heart sound occurs from a stretch of a very compliant LV, which takes a short time longer. Show The assessment technique of auscultation involves listening to the body. Although this is typically performed with a stethoscope, you can sometimes hear sounds from the body using just your ear. For example, you have probably heard your own or another person’s stomach growling; another example is heavy breathing after exercise. You can perform auscultation on the body to hear several sounds including:
To perform auscultation, you need a high-quality stethoscope. See Figure 1.10 for an acoustic stethoscope with a separate diaphragm on one side and a bell on the other side. The diaphragm is used for auscultating high-pitched sounds, while the bell is used for auscultating low-pitched sounds. Another option is an acoustic stethoscope in which the diaphragm and bell are manufactured as one piece: using this type of stethoscope, you can alternate pressure to auscultate for high- or low-pitched sounds, using light pressure to accentuate low-pitched sounds and firmer pressure to accentuate high-pitched sounds. There are also electronic stethoscopes to help amplify sounds for people with hearing loss. Some advanced stethoscopes facilitate better ambient noise reduction, sound amplification, and capability to record sounds (Leng et al., 2015). Unlike electronic stethoscopes, an acoustic stethoscope does not amplify the body’s sounds; it simply reduces interference from extraneous noises around you. Figure 1.10: Stethoscope with a separate diaphragm and bell Use of the stethoscopeProper use of a stethoscope involves several steps.
Figure 1.11: Positioning in the ears Film clip X: Opening and closing the stethoscope Make note of your findings when performing auscultation. For example, findings may include “clear air entry bilaterally in all lobes” or “high-pitched gurgling bowel sounds present in all four quadrants.” How best to listen The best practice, supported by evidence, is to conduct assessments on bare skin. Always place the end piece of the stethoscope on bare skin, and never listen over the client’s gown or clothing as this can modify the sounds that you are hearing. In the clinical setting, you will witness many healthcare providers listening over clothing, but this is not the correct way to auscultate sounds. Substantial amounts of hair (e.g., on the chest, back or abdomen) can also create extraneous noise, making it difficult to hear the expected sounds. For infants, the best time to auscultate is while the infant is sleeping or quiet; if they start crying, encourage the care partner to console the infant by repositioning, breastfeeding/bottle, or soother (if permitted). If you are trying to auscultate the lungs of a young child, you could ask the child to take a big breath and pretend they are blowing bubbles or blowing out candles on a birthday cake. It is important to know the expected normal sounds and the abnormal sounds. You should trust what you are hearing. If you are struggling to identify the sounds you are hearing, try closing your eyes and focusing. If a sound is not normal, act on this and/or ask for a second opinion from your clinical instructor or preceptor. It is always good practice to listen to body sounds in partnership with an expert nurse. Activity: Check Your UnderstandingHigh-pitched sounds are sounds with a high frequency that resemble a shrill or a piercing, sharp scream. Low-pitched sounds are sounds with a low frequency that resemble a booming drum or a person with a deep, low voice. Which type of sound is Auscultated with the bell of the stethoscope quizlet?Which type of sounds is auscultated with the bell of the stethoscope? The bell of the stethoscope is a concave cup that best transmits low-pitched sounds. The nurse would hold the bell of the stethoscope very lightly on the skin to listen to low-pitched sounds such as heart murmurs.
What is the bell of the stethoscope used for quizlet?Explanation: The bell of the stethoscope is used to listen to low-pitched sounds, such as heart murmurs. The diaphragm of the stethoscope is used to listen to high-pitched sounds such as normal heart sounds, breath sounds, and bowel sounds.
Which is the correct technique for using the bell portion of the stethoscope?Use the bell to pick up low-pitched sounds, such as third (S 3) and fourth (S 4) heart sounds. Hold the bell lightly against the patient's skin, just hard enough to form a seal. Holding the bell too firmly causes the skin to act as a diaphragm, obliterating low-pitched sounds.
Where is the bell of a stethoscope?The bell of the stethoscope is placed over the brachial artery with a good seal using light pressure. Applying too much pressure with the bell of the stethoscope will cause it to act like the diaphragm, and high-pitched sounds will be heard better than low-pitched sounds.
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