that occurs in systole may be innocent or indicative of a problem, but a diastolic murmur is always indicative of heart disease. It is very important to keep an open mind about the murmur you hear, and take step by step process to identify key characteristics in order to accurately diagnose the murmur. When you hear an abnormal heart sound, do not forget that a very important aspect of the patient assessment is the patient history. A thorough history is first and foremost of importance when assessing a murmur (Miller, 2016). First, when you hear a murmur, identify if it is heard in systole or diastole. In order to do this, you can listen to the murmur with your stethoscope (where you hear the murmur the loudest) and simultaneously palpate the carotid pulse only on one side. If the murmur you hear times up with the pulse of the carotid artery this indicates a systolic murmur. Second, identify where you hear the murmur the loudest; this will help indicate where the murmur is originating. The loudness of the murmur is noted in order to “grade” the murmur, based on a scale out of 6 options of grade. Grade 1 is the lowest and grade 6 represents the loudest (Jarvis, 2016). A very common systolic murmur is mitral valve prolapse murmur; this murmur presents an audible “click,” and may be the easiest one to identify. Other systolic murmurs include: mitral regurgitation murmur, physiological murmur and aortic stenosis murmur. A change in patient position can expose a murmur as well. When a patient lies on the left side, an S3, S4, and murmur of mitral stenosis may be heard that was not otherwise noted. Leaning forward and sitting upright on the exam table is a good position for the patient to be in for the NP to assess for a soft diastolic murmur of aortic or pulmonic regurgitation. Diagnostic test such as an ECG and echocardiogram will establish an accurate diagnosis of innocent murmur (Jarvis, 2016). References: Jarvis, Carolyn. (2016). Physical examination & health assessment (7th ed.). St. Louis, MO: Elsevier. Miller, B. A. (2016). A 31-year-old female with a systolic heart murmur. Medicine Morning Report: Beyond the Pearls E-Book , 277. o Kara Flatt Kara Flatt Jul 23, 2017Jul 23 at 8:06pm Manage Discussion Entry Jade-
Thank you so much for your post! I was interested to read the variety of differential diagnosis’ you used. As nurse practitioners it is important that we look for a variety of issues, however, I think it is equally important that we be able to hone in to what may be the culprit instead of casting a large net and seeing what we get. While I could identify with common cold and a tension headache, I am having trouble with your diagnosis of kidney stones and Chiari malformation. I know that kidney stones can be characterized by back pain, but not so much with headache or a cough. Could you explain to me your reasoning for picking this diagnosis?
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