Exam 3 NURS 630 (cardiac, mental health, MS, HA, metabolic) with 100- correct responses

Exam 3 NURS 630 (cardiac, mental
health, MS, HA, metabolic) with 100%
correct responses

• Murmur grading:
o Grade I: - ** VERIFIED ANSWERS **✔✔Barely audible; heard faintly
after a period of attentive listening


• Murmur grading:
o Grade II: - ** VERIFIED ANSWERS **✔✔Soft but easily audible


• Murmur grading:
o Grade III:
o Grade IV: Loud, present over widespread area; no thrill Grade V:
Loud, audible with stethoscope barely on the chest; precordial thrill
present
o Grade VI: Heard without stethoscope (rare) - ** VERIFIED ANSWERS
**✔✔Moderately loud; no thrill



• Murmur grading: o Grade IV: - ** VERIFIED ANSWERS **✔✔Loud,
present over widespread area; no thrill


• Murmur grading:
Grade V: - ** VERIFIED ANSWERS **✔✔Loud, audible with stethoscope
barely on the chest; precordial thrill present


• Murmur grading:
o Grade VI: - ** VERIFIED ANSWERS **✔✔Heard without stethoscope
(rare)

,• Innocent murmurs
• Important questions to ask? - ** VERIFIED ANSWERS **✔✔- Any
shortness of breath with exercise?
- Any dizziness or syncope with exercise?
- Any family history of sudden cardiac death?


murmur work up and restrictions - ** VERIFIED ANSWERS **✔✔-
Cardiac consultation
- Echocardiogram
- No sports participation until work-up completed


pathalogic murmur •Characteristics and things to ask - ** VERIFIED
ANSWERS **✔✔- Radiation

- Diastolic
- Grade > IV
- Interferes with S1 and/or S2
- Increases with sitting or standing
- Unequal femoral and/or radial pulses
- Displaced PMI
- Abnormal history


innocent murmur characteristics and things to ask - ** VERIFIED
ANSWERS **✔✔- No radiation

- Systolic
- Grade <III
- Does not interfere with S1 & S2
- Decreases with sitting and standing
- Equal femoral and radial pulses

,- Normal PMI
- Normal history and physical exam


innocent murmurs herard in what % of children and if unsure do
what? - ** VERIFIED ANSWERS **✔✔• 50%
refer


Grade </=2 intensity* - ** VERIFIED ANSWERS **✔✔- Short systolic
duration. Minimal radiation. Musical or vibratory quality. Softer
intensity when the patient is sitting compared with when the
patient is supine. Not present when standing.


• Pathologic Murmursrefer to pediatric cardiologist when a child
has? - ** VERIFIED ANSWERS **✔✔o A murmur in a child with a
syndrome associated with Congenital Heart Defect (trisomy 21)
o Any diastolic murmur
o Any systolic murmur associated with a thrill
o Pansystolic murmurs Continuous murmurs that cannot be
suppressed
o Systolic clicks
o Opening snaps
o Fixed splitting of the second heart sound not associated with
bundle branch block
o An accentuated S2 S4 gallops
o Not positional Grade III/ VI or higher
o Harsh quality
o Atrial septal defect: May have a soft, mid systolic murmur at ULSB
with wide-split heart sounds


• Diagnostic Studies for murmurs - ** VERIFIED ANSWERS **✔✔o Chest
xray; ECG, ECHO, CBC

, ASD - ** VERIFIED ANSWERS **✔✔• Increased pulmonary blood flow
• Opening in septum between atria, between left and right atria
• Foramen ovale
• Results in right venticular hypertrophy
• Fatigue, delayed growth, CHF
• Soft, mid systolic murmur
• Diagnosis: echo, chest x-ray (mild cardiomegaly), ECG
and corrected by surgical closure or patch


PDA (patent ductus arteriosus) - ** VERIFIED ANSWERS **✔✔• Ductucs
arteriosus fails to close
• Blood flows from aorta to pulmonary artery
• Increased blood flow to lungs
• Causes right VH
• Same diagnosis and treatment as ASD


VSD (ventricular septal defect) - ** VERIFIED ANSWERS **✔✔• Opening
between ventricles
• May be asymptomatic, dyspnea, tachypnea, delayed growth, CHF
• Holosystolic murmur
• May resolve spontaneously, may need permanent closure


Tetralogy of Fallot (TOF) - ** VERIFIED ANSWERS **✔✔• Cyanosis,
hypoxia, delayed growth, polycythemia, metabolic acidosis
• Exercise intolerance, clubbing of fingers
• Systolic murmur at 2nd left ICS with holosystolic murmur at LLSB
• Diagnosis: chest x-ray, ECG, echo, cardiac cath
• Treatment: Perform surgical correction