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2 Minute EBP Challenge

Monday, March 08, 2010
Restoring Hemoglobin
One of the goals for a patient who has a large blood loss is the restoration of normal hemoglobin levels.  This is partially done by blood transfusions, usually to a hemoglobin level of about 10g/dL.  A hemoglobin level that low will leave the patient feeling fatigued, but should be high enough to protect the heart from anemic ischemia.

Sunday, February 28, 2010
Renal Dysfunction
Mrs. Mersa is admitted with sepsis and hypotension.  Her labs indicate:
BUN 58 mg/dl
Serum creatinine 2.1 mg/dl
Urine sodium 70 mEq/L
Urine specific gravity 1.010, with cellular casts and RBCs in the urine.
Based on these findings you would consider:

Friday, February 12, 2010
Which action first?
Which information about a patient who has just been admitted to the hospital with nausea and vomiting will require the most rapid intervention by the nurse?

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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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