M4NSG530

The assignment is a discussion board response to a student’s post
**Minimum of two scholarly (peer-reviewed) references
**References must be within the last 5-7 years
** This is a master’s program for nursing; answers should be in the context of nursing
**This is a master’s discussion post and should be written at that level.

**Formal scholarly work does not include personal pronouns or passive voice
**This is not a critique of the student’s work.

**This post should build on, add to, or offer a differing viewpoint of the topic written about in the student’s post or initial

prompt

** Reference list entries must include the doi link starting with  http://doi…..
** I will attach the grading rubric for reference; please contact me with any questions.

**Finished writing will be submitted to Turnitin; similarity score must be less than 10%

** Do not use the student’s sources

The initial prompt that the student responded to (for reference only) is below:

Mrs. K is a 60-year-old white female who presented to the ER with complaints of her heart “beating out of my chest.” She is complaining that she is having increased episodes of shortness of breath over the last month and in fact has to sleep on 4 pillows. She also notes that the typical swelling she’s had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day. In the past week, she’s been experiencing fatigue and decreased urine output. Her past history is positive for an acute anterior wall myocardial infarction and coronary artery bypass surgery. She was a 2 pack a day smoker, but quit 8 years ago.

On physical examination, auscultation of the heart revealed a rumbling S3 gallop and inspiratory crackles. She has +3 edema of the lower extremities.

 Discuss the pathophysiology of an S3 heart sound and include causes for an S3 gallop?

PLEASE HAVE THIS POST BE  A STAND-ALONE POST AND NOT REFER TO THE STUDENTS POST. PLEASE DO NOT CRITIQUE.

 PLEASE TIE IN THE CLINICAL SCENARIO OF MRS. K INTO THIS RESPONSE. THE PURPOSE OF A RESPONSE IS TO ADD TO A 

CONVERSATION NOT TO FOCUS ON THE WRITING STYLE OR INCLUSION OF THE STUDENT. IF THEY MISSED SOMETHING  OR

 YOU HA DIFFERENT VERSION SHOULD BE CONSIDERED INCLUDE IT BUT DO NOT MENTION THEY MISSED IT. 

The student’s post (Respond to this)

Ana F. posted

 The S3 heart sound can be heard in children, young adults, most pregnant women, and athletes and is not abnormal. (Mahmood & Hoque, 2019)  When auscultating S3, one should use the bell of the stethoscope at the apex of the heart.  It is recommended to have the patient be in a left lying position in a quiet room.  (Techniques – Heart Sounds & Murmurs Exam – Physical Diagnosis Skills – University of Washington School of Medicine, n.d.) S3 originates from the rapid filling phase in the ventricles.  After the age of 40, S3 is indicative of dysfunction.

In the case of Mrs. K, her complaints point towards the type of dysfunction she is experiencing.  The pitting edema, crackles, shortness of breath, and orthopnea suggest that the presence of S3 is because of heart failure.  While heart failure is most often the reason behind the presence of S3, it is not the only reason.  Severe anemia, beriberi, and renal failure, and severe mitral regurgitation are also reasons for auscultating an S3 heart sound.  (Pechetty & Nemani, 2020)

References

Mahmood, M., & Hoque, H. (2019). Third and fourth heart sounds: Clinical and haemodynamic significance [Editorial]. University Heart Journal, 15(2), 40. https://doi.org/10.3329/uhj.v15i2.42644

Pechetty, R., & Nemani, L. (2020). Additional heart sounds—part 1 (third and fourth heart sounds). Indian Journal of Cardiovascular Disease in Women WINCARS, 5(02), 155–164. https://doi.org/10.1055/s-0040-1713828

Techniques – heart sounds & murmurs exam – physical diagnosis skills – university of washington school of medicine. (n.d.). University of Washington Department of Medicine. Retrieved September 21, 2021, from https://depts.washington.edu/physdx/heart/tech2.html