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Whether heart sound is muffled in obese patient - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Very Good Posted in: Hypertension and Heart Disease
Answered by

General & Family Physician
Practicing since : 2004
Answered : 40 Questions
User :   I am a nursing student working in a medical-surgical floor. I am working on a care plan for a client admitted for UTI and confusion S/P fall. She is obese, has DM II, HTN, and a hx of uterine cancer treated surgically in 2008. When performing my nursing assessment, I was unable to auscutate her heart sounds. I tried repositioning her on her side, but still silent. Later, I attempted again, and heard something loud and strange. It took me a second to realize they were not heart sounds I was hearing but bowel sounds. I notified my nurse who said that she's heard that before but doesn't know why. My instructor said that it is not uncommon for heart sounds to be muffled in an obese client, but doesn't know why I would hear bowel sounds in her chest. Recent CXR was normal and CT scan of abd and pelvis showed hydronephrosis, but nothing else significant. Could this finding ever be "normal" for a client?
Doctor :   Hi
Doctor :  
Let me read.
User :   Hello.
Doctor :  
Bowel sound are usually not heard in the chest unless there is a hiatus hernia.
Doctor :  
However, if the position of the chest was not good , or if the bowel sound had been too loud, like those of the loud borygogomi
Doctor :   Then probably what you had heard may be the radiation of the sound to the chest and not exactly bowel in the chest.
Doctor :   Have you followed?
Doctor :  
* if the positioning was not correct and if the sounds were loud, then the possible explanation for bowels sounds heard at the chest is radiation of the sound.
Doctor :  
Are you there?
User :   I understand about if the bowel sounds were loud, but what do mean by "if the positioning is not correct"?
Doctor :  
I mean improper position of the chest while exmaining.
Doctor :  
These are the possiblities I can think of from the brief history that you provided.
Doctor :   I would suggest you to confirm this with the doctor who is treating her.
Doctor :  
He would in the better position to explain to you what the cause may be.
Doctor :  
Have you followed?
User :   In your experience, is it sometimes difficult to auscutate the heart sounds of an obese client. Would you ever use a doppler?
Doctor :   Heart sound may be muffled in an obese patient.
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