The heart and the cardiovascular system represent an object of regular concerns for physicians and nurses. According to Kusumoto (2010), cardiovascular diseases frequently become a real diagnostic and treatment challenge for physicians and nurse practitioners. Any alterations that occur in the cardiovascular system of children or adults necessitate the provision of adequate diagnostic measures to establish a correct diagnosis and minimize the risks and scope of health complications. However, the truth is that the clinical manifestations of cardiovascular pathology can be vague or confusing, which is why even the most experienced nurse practitioners may fail to detect the problem during the first visit.
Looking at the discussed scenario and considering the information provided by Huether and McCance (2015), the II/VI systolic murmurs heart loudest at the apex of the heart would become a red flag for any nurse. They would guide the direction of all diagnostic procedures. It should be noted that, in most cases, systolic murmurs are neither abnormal nor pathologic (Frank & Jacobe, 2011). II/VI systolic murmurs are “faint but can be heard immediately” (Frank & Jacobe, 2011, p. 795). In fact, grade 1 or grade 2 murmurs are also considered as normal. Other clinical symptoms being absent, it comes as no surprise that the nurse could miss the signs or features of a serious cardiovascular condition. However, the fact that murmurs are the loudest at the apex suggests that they could be a sign of cardiovascular alterations. Therefore, additional information will be necessary to confirm or rule out the diagnosis.
Medical and family history will become the foundational component of all diagnostic procedures. According to Frank and Jacobe (2011), some historical features such as poor feeding or chest pain could increase the likelihood of having congenital heart disease in the adolescent patient. A detailed physical examination would follow, covering any possible abnormalities in the patient’s gastrointestinal, cardiovascular, or respiratory systems (Frank & Jacobe, 2011). Chest X-ray, electrocardiography, and a complete blood count could provide relevant information to assist in making the correct diagnosis (Frank & Jacobe, 2011). The nurse could also ask for a permission to invite the patient’s mother and ask questions relevant to the patient’s family and medical history. The patient may not possess sufficient knowledge of the genetic, family, or environmental factors that could have increased the risks of pathophysiological alterations in his cardiovascular system.
The treatment will be prescribed, based on the diagnosis. The overall picture of the patient suggests that the mitral valve prolapse could be the problem. Huether and McCance (2015) confirm that many symptoms of the disease are either vague or non-specific. Although most patients have a perfect prognosis, some of them may be at risk for developing cardiovascular complications, including sudden death (Huether & McCance, 2015). This being said, the treatment strategy will depend on the severity of the problem and the health risks facing the patient. Genetic and environmental triggers of the disease will also need to be considered. It should be noted that genetics could impact the diagnosis and prescribed treatment. Genetic and familial factors have proved to increase the risks of cardiovascular alterations such as mitral valve prolapse (Padang, Bagnall, & Semsarian, 2012).
If any of the patient’s family members or significant others faced sudden death or had cardiovascular disease, the probability of diagnosing a cardiovascular abnormality in the 16-year-old patient will increase. The prognosis, progression, and outcomes of the cardiovascular disease in the patient’s family will also be reviewed to estimate the risks of developing health complications. Ultimately, this information will predetermine the scope and complexity of the treatment modalities required to cure the disease or at least stabilize it.
- Frank, J.E., & Jacobe, K.M. (2011). Evaluation and management of heart murmurs in children. American Family Physician, 84(7), 793-800.
- Huether, S.E., & McCance, K.L. (2015). Understanding pathophysiology. Elsevier Health Sciences.
- Kusumoto, F.E. (2010). Cardiovascular disorders: heart disease. In S.J. McPhee and G.D. Hammer (eds.), Pathophysiology of disease: An introduction to clinical medicine, 289-298. McGraw-Hill.
- Padang, R., Bagnall, R.D., & Semsarian, C. (2012). Genetic basis of familial valvular heart disease. Circulation: Cardiovascular Genetics, 5, 569-580.