peds cardiac intro/murmurs Flashcards
What are the key stressors for a child and family with a cardiovascular concern?
Physical, emotional, social, psychological, financial.
What are key nursing interventions for children with cardiovascular concerns?
Education and quality of care.
What aspects of history are important in a cardiac assessment?
Prenatal and birth history, family history of cardiac conditions, sudden cardiac death before age 55, history of heart/chromosomal disorders, child’s current health status, prior hospitalizations, developmental milestones, activity level.
What physical exam findings are assessed in a cardiac assessment?
Demeanor (calm, distressed, fatigued, lethargic), skin color, capillary refill (<2-3 sec), mucous membranes, cyanosis, apical impulse, thrills, lifts, heaves, PMI evaluation.
Where is the PMI normally located in children?
Fourth or fifth intercostal space, midclavicular line.
What can a deviated PMI indicate?
Enlarged heart due to illness, heart failure, or congenital heart defects.
How should cardiac auscultation be performed?
Use the diaphragm (high frequency) and bell (low frequency), listen while supine and sitting.
What respiratory signs are important in a cardiac assessment?
Work of breathing, frequent upper/lower respiratory infections, hepatomegaly, feeding status, input/output, edema (especially periorbital), neurological status, tissue perfusion.
What is a heart murmur?
Turbulent flow through an abnormal valve, vessel, or chamber.
What is an innocent murmur?
A murmur not associated with any intracardiac disease.
What is a pathologic murmur?
A murmur associated with a cardiac anomaly or altered cardiac function.
What conditions can alter the characteristics of an innocent murmur?
Anemia, fever, pregnancy, anxiety.
What details should be documented for a murmur?
Position in cardiac cycle (systole, diastole, continuous), quality (harsh, soft, blowing), pitch (high or low), intensity (loudness), location (point of maximum intensity), radiation, presence of a thrill, response to exercise or position changes.
What is the Levine Grading Scale for Systolic Murmurs?
Grade I: Barely audible, only heard in a quiet room.
Grade II: Soft, but easily heard.
Grade III: Moderately loud, without a thrill.
Grade IV: Loud, associated with a thrill.
Grade V: Very loud, heard with the stethoscope barely touching the chest.
Grade VI: Heard with the stethoscope off the chest.
