Final answer:
In assessing a client with substernal precordial pain, a nurse listens for abnormal heart sounds such as murmurs or S4 to aid in diagnosis. These sounds, which deviate from the typical 'lub-dub' pattern, can indicate structural heart issues or ventricular failure, respectively.
Step-by-step explanation:
When a nurse is assessing heart sounds of a client who reports substernal precordial pain, identifying abnormal sounds is crucial. The four types of sounds that can be identified are murmur, S4, pericardial friction rub, and ventricular gallop. A murmur is an unusual sound resulting from turbulent blood flow, typically due to abnormalities in the heart's structure such as valve defects. S4 is indicative of a stiff or hypertrophic ventricle, commonly associated with left ventricular failure. The murmur is typically graded on a scale from 1 to 6, with 6 being the most severe.
Auscultation, the practice of listening to heart sounds, is a proven, safe, and inexpensive diagnostic tool. Sounds are recorded using electronic stethoscopes that can create phonocardiograms or auscultograms. This fundamental technique can detect alterations in normal heart sounds, such as S1 ('lub') and S2 ('dub'), which may indicate a range of heart conditions. The nurse must carefully document the specific sound heard to provide accurate information for further diagnosis, which may lead to additional tests such as echocardiograms.