Auscultation

Question 1

Auscultation should be …

Answer 1

… done whenever the baby is quiet.

Question 2

Auscultation includes:

Answer 2

Heart Sounds – (neonatal stethoscope – both bell and diaphragm) (1 point for using both)
Assess precordium (1)
Rate – 1 minute (1)
Apical Pulse (1)
4 areas for auscultatory placement (what is different from adult)
(Aortic, pulmonic, tricuspid, mitral) (8)
Any murmurs? (1)

Question 3

Auscultation, video

Answer 3

If the baby is quiet, do auscultation.
First: the lungs - look at diagrams. Listen: right shoulder, left shoulder, left nipple area, right nipple area, right lower rib cage, left rib cage. Lift baby’s arm and listen under the axilla, bilaterally. If baby is really quiet, auscultate the back at this time. Same pattern as the front.

Second: the heart - only 4 areas, not 5 as in the adult. Aortic, pulmonic (up high near neck for these 2). Tricuspid (near left nipple). Mitral (between tricuspid point and axillary line). No Erb’s point. Listen with both the bell and the diaphragm. PMI and apical pulse are usually the same for the adult. On the baby, can be different. PMI near 5th intercostal area. Apical pulse is near the 4th mid-clavicular area.

Third: abdomen. Must listen in all four quadrants (in the adult, only had to listen in LRQ).

Question 4

Murmurs can be

Answer 4

normal in the first day or two.

Question 5

RR and HR

Answer 5

RR: 30 - 60
HR: 100-160

Listen for one minute to get the rate.