Questions and Answers
What characterized the sinus arrhythmia often seen in children?
A fluctuation in heart rate that corresponds to the respiratory cycle.
To assess an apical pulse rate in an infant, how should the nurse proceed?
What is a potential significance of syncope and palpitations in a child?
Decreased cardiac output.
What is the most appropriate nursing action before taking an apical pulse on a child?
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What statement by the family member indicates that the teaching on checking a pulse was effective?
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What should a nurse do if the apical pulse measurement of a child differs significantly from previous measurements?
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What question is appropriate to ask an adolescent with a low heart rate during assessment?
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What does an increasing HR during inhalation and a decreasing HR during exhalation suggest?
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When is the best time to obtain an accurate apical pulse rate for a tearful child due to fear of shots?
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What does the S2 heart sound indicate?
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What is an appropriate action before listening to the heart of an anxious child?
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Study Notes
Apical Pulse Assessment in Children
- Sinus arrhythmia is common in children, characterized by fluctuations in heart rate in sync with breathing; increases with inspiration, decreases with expiration.
- Irregular heart rates not associated with breathing require investigation and documentation, as they may indicate underlying rhythm issues.
- Confirm abnormal or irregular apical pulse rates with a repeat measurement, as initial findings may be inaccurate.
Measuring Apical Pulse in Infants
- Place the diaphragm of the stethoscope at the point of maximal impulse (PMI), usually located at the third or fourth intercostal space (ICS) near the left sternal border.
- In older children, the PMI is typically found at the left fifth ICS in the midclavicular line (MCL).
- High-pitched heart sounds are best heard with the diaphragm, while the bell is used for low-pitched sounds.
Implications of Syncope and Palpitations
- Syncope and palpitations in a child may indicate decreased cardiac output (CO), which can lower blood pressure and lead to fainting.
- Rapid heart rates can result in decreased stroke volume (SV) and consequently decreased CO, often felt as palpitations by the child.
Environmental Considerations for Apical Pulse Assessment
- Prior to assessment, reduce background noise (e.g., lower television sound) to improve the clarity of heart sounds.
- Clothing may be moved aside rather than fully removed, and assessments should not be influenced by changes in position right before measurement.
Educating Families on Pulse Checks
- Effective teaching is reflected in a statement emphasizing that counting heartbeats at the apex is more reliable than assessing the wrist pulse.
- For children on digoxin, monitoring the apical pulse for a full minute is vital before medication administration, with immediate reporting of any changes.
Documentation of Pulse Measurements
- If a new apical pulse measurement diverges significantly from previous ones, immediate reassessment is warranted to confirm findings before reporting.
- Variability in heart rates can be influenced by factors like activity and emotional state, necessitating careful monitoring.
Athletic Influences on Heart Rate
- Athletes may have resting pulse rates as low as 40-50 bpm due to fitness levels, where the heart pumps more efficiently.
- Consumption of energy drinks or caffeine can augment heart rates; medications for attention deficit disorders may also raise pulse rates.
Recognizing Sinus Arrhythmia
- An apical pulse with increased rates during inhalation and decreased rates during exhalation indicates sinus arrhythmia and should not be mistaken for other cardiac dysrhythmias.
Timing for Accurate Apical Pulse Assessment
- Obtain an accurate apical pulse rate after calming a fearful child, as anxiety from upcoming procedures can falsely elevate heart rates.
Understanding Heart Sounds
- The S2 sound occurs due to the closure of the aortic and pulmonic valves at the end of ventricular systole, while S1 indicates closure of the mitral and tricuspid valves at the end of ventricular diastole.
Preparing to Assess an Apical Pulse
- Prior to assessment, warming the stethoscope diaphragm on the child's chest can enhance comfort and promote accurate auscultation.
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Description
Test your knowledge on apical pulse assessment in pediatrics with these informative flashcards. Learn about sinus arrhythmia in children and the importance of documenting irregular heart rates. Enhance your skills in recognizing normal and abnormal heart rates to ensure proper pediatric care.
