NU-664B Week 5 Assignment 2: Cardiac Annotated Study Guide

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Last modified	Friday, 3 February 2023, 12:37 PM
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Annotated Study Guide for Cardiac Murmurs

Instructions

Each of the cardiac topics you are responsible for knowing have been collected in the readings for the module and study guide. To help recall and master this material, you will annotate each topic in this study guide with notes, thoughts, and/or images as you perform the required readings at the start of this week. There will be prompts, but do not consider yourself constrained by these, as long as each topic is annotated in some way.

Cardiac Murmurs

• Review of heart valves and circulation

 

Timing

• Heard longer than heart sounds
• Palpate the carotid arterial pulse
• Systolic, diastolic, or continuous

 

 

Intensity of Sound

• Crescendo grows louder, decrescendo gets softer, crescendo-decrescendo, plateau

 

Location

• Where does the sound originate from?
• Listen to all areas- aortic, pulmonic, tricuspid, mitral

 

Radiation

• Where does the sound radiate to?
• Think about direction of the blood flow

 

Intensity

• Graded from I to VI
• Grade I – very faint
• Grade II- faint but heart immediately, louder than grade II
• Grade III- Moderately loud
• Grade IV- loud, thrill
• Grade V- heard with stethoscope partly off chest, thrill
• Grace VI- heard with stethoscope off chest, thrill
• Loud murmurs can have a thrill

 

Pitch

• What does it sound like- high, medium, low

 

Quality

• Musical, blowing, harsh, clicking, blowing

 

Position & Maneuvers

• Is there a change with position- sitting
• Is there a change with respiration
• Valsalva or standing will decrease murmurs except for hypertrophic cardiomyopathy & mitral valve prolapse

 

Extra Sounds

• S3 is associated with CHF
• S4 is associated with LVH

 

Systolic Murmurs

• Mitral regurgitation, aortic stenosis
• Benign murmurs

 

Mitral Regurgitation

• Heard at apex of heart
• Radiates to axilla
• Loud blowing & high pitched
• Holosystolic / pansystolic murmur

 

Aortic Stenosis

• Heard at 2^nd ICS right side of the sternum
• Radiates to neck
• Harsh & noisy murmur
• Mid-systolic ejection murmur

 

Diastolic Murmurs

• Mitral stenosis, aortic regurgitation
• Diastolic murmurs are abnormal

 

Mitral Stenosis

• Heard at the apex
• Low pitch rumbling murmur
• Opening snap
• Little radiation
• Can be caused by rheumatic heart disease

 

Aortic Regurgitation

• Heard at 2^nd ICS right of sternum
• High pitched blowing murmur, decrescendo

 

Mitral Valve Prolapse

• S2 click followed by a systolic murmur
• Loud & musical
• May be at higher risk for embolism, TIA, AF
• Diagnosed with echo & Doppler

 

Continuous Murmurs

• Begin during systole and continue into diastole
• Pericardial friction rub- scratching / scraping
• Patent Ductus Arteriosis (PDA)- machinery like, harsh
• Mammary souffle- heard during late 3^rd trimester / lactation

 

• Where will you expect to hear mitral valve prolapse?

 

• Describe the sounds of aortic stenosis.

 

 

• Name 2 systolic murmurs.

 

 

• Name 2 diastolic murmurs.

 

 

• What is the most common murmur?

 

 

• What is the expected location to hear mitral regurgitation?

 

 

 

 

Matching

Match the intensity of the murmur to the Grade

 

Head with stethoscope not touching chest, thrill present                               Grade II

 

 

Loud, accompanied by a thrill                                                                        Grade VI

 

 

Very faint, not heard if the person changes position                                      Grade I

 

 

Usually readily heard, slightly louder, heard in all positions                         Grade III

 

 

Loud but not accompanied by a thrill                                                            Grade IV

 

 

Can be heard with stethoscope barely on chest, thrill present                       Grade V

 

Lopes Write Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: 

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource