3. A. C. has come for a monthly prenatal visit. While listening to her heart, the examiner notes an exaggerated splitting of S1, a loud, easily heard S3, and a grade ii systolic murmur. Other findings remain unchanged since the last visit.
Explain what a grade ii murmur means.
Murmurs refer to heart sounds that are produced when the flow of blood through the conduit is short of being laminar. The flow of blood is turbulent. The turbulence in the flow is therefore denoted by the audible noise, which is described as being a murmur. Murmurs are graded according to classes based on the character of the murmur. Being a grade II murmur means that the murmur is not distinct. However, as soon as a stethoscope is placed on the chest wall, the murmur becomes more discernable and it becomes more audible. This property of the murmur is the intensity of the murmur.
4. A 6-year-old boy is brought to the clinic by his mother. She says that she has noticed that he quickly squats to rest between spurts of activity. His mother is worried that he does not seem to be as "? Far along"? As his older sister was at this age.
In order to do an effective cardiovascular assessment, it is important to obtain a relevant history from the child before proceeding to do an examination. In this case, the 6-year-old school age child is likely to be shy and scared of allowing other people to ask questions let alone examine him. It is important to carry his mother along during the whole process. When taking the history, it is important to be as gentle as possible while trying to make the session a lively one. Moreover, it will not be out of place to directly involve the mother in the process of asking the questions. This will no doubt go a long way to allay the fear and the anxiety of the boy about answering the questions. When it is time to examine the boy, it is also preferable to do the examination of the cardiovascular system while the child is on the mother's lap. The child is also less likely to be anxious of the procedure if the mother is present in the examining room with the boy. The mother can provide words of encouragement to the child in order to further gain his trust and cooperation.
What information provided by the mother should the nurse be most concerned about? Why?
The mother has noticed that the boy has easy fatigability in between spurts of activity. This is a significant cardiovascular symptom for the boy considering the fact that the mother can easily notice a sharp difference in the boy's behavior and that of his sister when she was about her age. In addition, other symptoms that are alarm signs include chest pain or chest tightness also in-between spurts of activity. In addition, this very serious symptom must be properly assessed because it can be a pointer to the kind of pathology affecting the cardiovascular system.
In conclusion, a proper and effective cardiovascular assessment by the child would be necessary to determine the real pathology that the child is suffering from. It is the duty of the nurse to elicit these signs and symptoms in order to reach a rational nursing diagnosis. In doing this, the help of the mother will no doubt be invaluable in order to do a proper evaluation of the cardiovascular examination of the boy.
Medlineplus (2013). Heart Murmurs and other Sounds. Medline plus; Trusted Health Information for you. Medline 2013.
Martin A (1990). Clinical Methods: The History, Physical and Laboratory Examinations. Third Edition: Chapter 26. Walher HK (Eds). Boston: Butterworths.
Claire F (2012). Cardiovascular disease risk in healthy children and its association with body mass index: systematic review and meta-analysis. BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e4759 (Published 25 September 2012)