2. Assessment, Diagnostics, Vitals

how does the heart lie in infants and children younger than 7?

more horizontally than in older children

• apex: higher in the chest, near the fourth intercostal space

what is the expected HR for an infant? *

80–150 beats/min

what is the expected HR for a toddler? *

70–120 beats/min

what is the expected HR for a preschooler? *

65–110 beats/min

what is the expected HR for a school-age child? *

60–100 beats/min

what is the expected HR for an adolescent? *

55–95 beats/min

why do infants have a higher HR than older children?

their higher metabolic rate increases their need for oxygen and nutrients

what is the expected BP for an infant? *

80/55 mmHg

what is the expected BP for a toddler? *

systolic 90–110 mmHg, diastolic 55–75 mmHg

what is the expected BP for a preschooler? *

systolic 90–110 mmHg, diastolic 55–75 mmHg

what is the expected BP for a school-age child? *

systolic 100–120 mmHg, diastolic 70–80 mmHg

what is the expected BP for an adolescent? *

systolic 100–120 mmHg, diastolic 70–80 mmHg

what symptoms in a child’s history may suggest a cardiac problem?

poor feeding or poor growth; fatigue, lethargy, or sweating; vomiting; delayed gross motor development; bluish skin or rapid breathing

what should the nurse inspect during a pediatric cardiac assessment? *

• skin color, edema, and finger clubbing

• vital signs and breathing effort

• chest shape and visible pulsations

• neck veins and abdominal swelling

where does edema usually appear first in infants with cardiac problems? (order)

1. the face

2. the presacral area near the lower back

3. the extremities

what should the nurse palpate during a pediatric cardiac assessment?

pulses and the abdomen

what can an enlarged liver suggest during a pediatric cardiac assessment?

right-sided heart failure

what should the nurse listen for during a pediatric cardiac assessment?

apical pulse, heart sounds, and murmurs

what should the nurse do when a heart murmur is newly identified in a child? *

report the finding

what are the signs and symptoms of heart failure in infants?

• poor feeding

• sweating with feeds

• poor weight gain

• rapid breathing

• crackles

• edema

what findings suggest breathing difficulty in an infant with suspected heart failure?

rapid breathing, nasal flaring, and crackles

what findings suggest fluid overload in an infant with suspected heart failure?

crackles in the lungs and edema of the face, lower back, or extremities

what findings suggest inadequate nutrition in an infant with suspected heart failure?

poor feeding, falling asleep during feeds, and poor weight gain

how should concerns be prioritized for an infant with breathing difficulty, fluid overload, and poor feeding? *

1. airway and breathing, support oxygenation

2. second, circulation and fluid overload

3. third, nutrition and weight gain

what diagnostic tests may be used to evaluate a child’s heart?

arteriogram; Holter monitor; chest x-ray; echocardiogram; EKG; cardiac catheterization; exercise stress test