Exam 3 NURS 630 (cardiac, mental |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
health, MS, HA, metabolic) exam with |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
correct answers |||\\\
• Murmur grading:
|||\\\ |||\\\ |||\\\
o Grade I: - correct answersBarely audible; heard faintly after a period of attentive listening
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
• Murmur grading:
|||\\\ |||\\\ |||\\\
o Grade II: - correct answersSoft 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) - correct answersModerately loud; no thrill
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
• Murmur grading: o Grade IV: - correct answersLoud, present over widespread area; no thrill
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
• Murmur grading:
|||\\\ |||\\\ |||\\\
|||\\\ Grade V: - correct answersLoud, audible with stethoscope barely on the chest; precordial thrill
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
|||\\\ present
• Murmur grading:
|||\\\ |||\\\ |||\\\
o Grade VI: - correct answersHeard without stethoscope (rare)
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
,• Innocent murmurs
|||\\\ |||\\\ |||\\\
• Important questions to ask? - correct 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 - correct answers- Cardiac consultation
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Echocardiogram
|||\\\
- No sports participation until work-up completed
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
pathalogic murmur •Characteristics and things to ask - correct 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 - correct 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? - correct answers•
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
50%
|||\\\ refer
Grade </=2 intensity* - correct 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? - correct answerso 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 - correct answerso Chest xray; ECG, ECHO, CBC
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
ASD - correct 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) - correct 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) - correct 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) - correct 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
|||\\\ |||\\\ |||\\\ |||\\\
Coarctation of Aorta - correct answers• Obstructs systemic blood flow |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
• Narrowing of aorta
|||\\\ |||\\\ |||\\\
health, MS, HA, metabolic) exam with |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
correct answers |||\\\
• Murmur grading:
|||\\\ |||\\\ |||\\\
o Grade I: - correct answersBarely audible; heard faintly after a period of attentive listening
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
• Murmur grading:
|||\\\ |||\\\ |||\\\
o Grade II: - correct answersSoft 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) - correct answersModerately loud; no thrill
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
• Murmur grading: o Grade IV: - correct answersLoud, present over widespread area; no thrill
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
• Murmur grading:
|||\\\ |||\\\ |||\\\
|||\\\ Grade V: - correct answersLoud, audible with stethoscope barely on the chest; precordial thrill
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
|||\\\ present
• Murmur grading:
|||\\\ |||\\\ |||\\\
o Grade VI: - correct answersHeard without stethoscope (rare)
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
,• Innocent murmurs
|||\\\ |||\\\ |||\\\
• Important questions to ask? - correct 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 - correct answers- Cardiac consultation
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
- Echocardiogram
|||\\\
- No sports participation until work-up completed
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
pathalogic murmur •Characteristics and things to ask - correct 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 - correct 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? - correct answers•
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
50%
|||\\\ refer
Grade </=2 intensity* - correct 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? - correct answerso 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 - correct answerso Chest xray; ECG, ECHO, CBC
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
ASD - correct 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) - correct 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) - correct 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) - correct 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
|||\\\ |||\\\ |||\\\ |||\\\
Coarctation of Aorta - correct answers• Obstructs systemic blood flow |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
• Narrowing of aorta
|||\\\ |||\\\ |||\\\
