NR 328 NURSING CARE: PEDIATRIC CIRCULATORY SYSTEM ASSESSMENT|2025 UPDATE
COMPLETE
The field of pediatric cardiology has experienced an evolution over the past half century. There have
been advances in diagnostic techniques, procedures, and pediatric anesthesia. Consequently, the
pediatric nurse is required to be more sophisticated in assessment, planning, implementation, and
evaluation of care when it comes to pediatric cardiovascular pathology.
Toddler Assessment
A caregiver brings their 4-year-old son in for a check-up. Which assessment finding should
the nurse be concerned about?
Pulse rate in preschool children decreases to about 85 bpm typically, so the nurse should be
concerned about a pulse rate of 130 in a 4-year-old.
Physical Assessment: Setting the Tone
The nurse is teaching the student nurse how to perform a physical assessment based on the
child's developmental stage. Which statement accurately describes a recommended guideline
for setting the tone of the examination for a school-age child?
For a school-age child, the nurse should include the child in all parts of the examination and speak to
the caregiver before and after the examination.
Vital Signs and Children
The nursing professor is observing the student nurse measure the vital signs of several
children. Which actions by the student demonstrate knowledge of the procedure? Select all
that apply.
The radial pulse is difficult to palpate accurately in children younger than 2 years of age because the
blood vessels lie close to the skin surface and are easily obliterated. Infants and young children are
often nervous or fearful, causing the heart rate to elevate; therefore, the nurse should listen to the
heart a few seconds before counting the pulse. For children younger than 10 years of age, auscultate
the apical pulse with the stethoscope for a full minute. Infants’ respirations are primarily
diaphragmatic, so count the abdominal movements. In infants, brachial and femoral pulses should be
palpated and compared bilaterally at the same time while assessing strength and regularity.
Cardiovascular Function in Children
There are a variety of pediatric concepts and alterations to consider when learning about
cardiovascular function in children. Before you explore specific alterations, let's consider the structure
and function of fetal circulation and the cardiovascular system in the early stages of life. For example,
as the child grows and develops, the circulatory system also grows and adapts to nutritional and
oxygen requirements. Moreover, the heart, blood vessels, and lymph system also develop.
To understand the transformation from fetal circulation to normal circulation, please review the fetal
circulation video. Pay particular attention to changes from fetal to normal circulation so that you can
further understand congenital heart defects that result from retention of fetal circulation components.
Now, let's consider electrical conduction in the heart. This conduction system (in yellow below)
controls the heart rate to ensure the heart is pumping effectively and efficiently to move blood
through the circulatory system. Therefore, this conduction system affects cardiac output (cardiac
output = stroke volume x heart rate).
, Cardiac Pathophysiology
After birth, which structures in the newborn heart need to close to allow for normal blood
circulation and make the lungs become fully operational? Select all that apply.
Closure of the foramen ovale and ductus arteriosus allow for the blood to pass through the lungs. At
this point, the lungs become fully operational and normal blood circulation is developed.
Indicators of Cardiac Dysfunction
In a pediatric patient, tachycardia may indicate decreased cardiac output and can be a sign of early
cardiac dysfunction.
Indicators of cardiac dysfunction that may be noted during the history and physical assessment
include:
Poor feeding
Tachypnea
Failure to thrive, poor weight gain, or activity intolerance
Developmental delays
Prenatal risk factors, including substance abuse, diabetes, and maternal infection
Family history of cardiac disease
COMPLETE
The field of pediatric cardiology has experienced an evolution over the past half century. There have
been advances in diagnostic techniques, procedures, and pediatric anesthesia. Consequently, the
pediatric nurse is required to be more sophisticated in assessment, planning, implementation, and
evaluation of care when it comes to pediatric cardiovascular pathology.
Toddler Assessment
A caregiver brings their 4-year-old son in for a check-up. Which assessment finding should
the nurse be concerned about?
Pulse rate in preschool children decreases to about 85 bpm typically, so the nurse should be
concerned about a pulse rate of 130 in a 4-year-old.
Physical Assessment: Setting the Tone
The nurse is teaching the student nurse how to perform a physical assessment based on the
child's developmental stage. Which statement accurately describes a recommended guideline
for setting the tone of the examination for a school-age child?
For a school-age child, the nurse should include the child in all parts of the examination and speak to
the caregiver before and after the examination.
Vital Signs and Children
The nursing professor is observing the student nurse measure the vital signs of several
children. Which actions by the student demonstrate knowledge of the procedure? Select all
that apply.
The radial pulse is difficult to palpate accurately in children younger than 2 years of age because the
blood vessels lie close to the skin surface and are easily obliterated. Infants and young children are
often nervous or fearful, causing the heart rate to elevate; therefore, the nurse should listen to the
heart a few seconds before counting the pulse. For children younger than 10 years of age, auscultate
the apical pulse with the stethoscope for a full minute. Infants’ respirations are primarily
diaphragmatic, so count the abdominal movements. In infants, brachial and femoral pulses should be
palpated and compared bilaterally at the same time while assessing strength and regularity.
Cardiovascular Function in Children
There are a variety of pediatric concepts and alterations to consider when learning about
cardiovascular function in children. Before you explore specific alterations, let's consider the structure
and function of fetal circulation and the cardiovascular system in the early stages of life. For example,
as the child grows and develops, the circulatory system also grows and adapts to nutritional and
oxygen requirements. Moreover, the heart, blood vessels, and lymph system also develop.
To understand the transformation from fetal circulation to normal circulation, please review the fetal
circulation video. Pay particular attention to changes from fetal to normal circulation so that you can
further understand congenital heart defects that result from retention of fetal circulation components.
Now, let's consider electrical conduction in the heart. This conduction system (in yellow below)
controls the heart rate to ensure the heart is pumping effectively and efficiently to move blood
through the circulatory system. Therefore, this conduction system affects cardiac output (cardiac
output = stroke volume x heart rate).
, Cardiac Pathophysiology
After birth, which structures in the newborn heart need to close to allow for normal blood
circulation and make the lungs become fully operational? Select all that apply.
Closure of the foramen ovale and ductus arteriosus allow for the blood to pass through the lungs. At
this point, the lungs become fully operational and normal blood circulation is developed.
Indicators of Cardiac Dysfunction
In a pediatric patient, tachycardia may indicate decreased cardiac output and can be a sign of early
cardiac dysfunction.
Indicators of cardiac dysfunction that may be noted during the history and physical assessment
include:
Poor feeding
Tachypnea
Failure to thrive, poor weight gain, or activity intolerance
Developmental delays
Prenatal risk factors, including substance abuse, diabetes, and maternal infection
Family history of cardiac disease
