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Heart Murmers...

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Hello Everyone, I just finished my new grad orientation and am officially on my own after this Friday ... However, I just have a question for you experienced nurses.. One thing I struggle with is hearing heart murmers.. My preceptor brought me to every baby on the unit who has a heart murmer for me to listen to.. I just still dont hear the difference.. Does anyone know any tips or good websites who may be able to help me distinguish heart murmers from normal neonatal heart tones.. I know its hard to describe in words but I thought I would try... Thank you again for your all your help in advance.. I am officially one of you guys Friday!! Scary and exciting at the same time.. :):balloons:

~Nursecheryl81

prmenrs, RN

Specializes in NICU, Infection Control. Has 42 years experience.

It just takes time. The first one you will probably hear will a "washing machine" type. Practice. Listen to every kid identified as a heart. You WILL get it!

Heart murmur: swerrrrrrsh... switsh. Swerrrrrsh... switsh. Swerrrrrrsh.... switsh. Well, I tried.... doesn't translate in writing.

Just keep listening as a previous poster advised. I couldn't pick up anything as a new grad. But every chance I had with a patient with a known murmur I would listen to it. Just remember though, the really minor anomolies often make really loud noises, while the major defects often make no noise at all.

prmenrs, RN

Specializes in NICU, Infection Control. Has 42 years experience.

Murmurs are caused by turbulence in flow thru the heart--the smaller the defect, the louder the noise---usually. Sometimes a murmur has a swish or whoosh quality, sometimes it has a harsher, sort of click sound. Sometimes, it sounds like an extra sound sneaking in there.

Mimi2RN, ASN, RN

Specializes in NICU. Has 27 years experience.

I think of hearing a heart murmer as listening on a different level. If you can concentrate on the normal heart sounds, then listen below that level, it's easier to hear a murmer. It will sometimes take a few minutes, as some murmers are softer.

Listen as often as you can, it'll get easier. :)

BittyBabyGrower, MSN, RN

Specializes in NICU, PICU, educator.

I teach the gals I precept to say LubDub in their head and eventually they will hear the "odd" noise outside of the LubDub. Also remember, some murmurs are better heard thru the back! :)

KRVRN, BSN, RN

Specializes in NICU.

It sort of sounds like a breath sound to me (at least on tiny babies). Kinda sounds like a very fast shallow respiration, but then you realize that it's far too fast to be a RR and it coincides with the HR. That's how hearing and identifying them clicked for me. I heard what sounded like a fast RR over the top of the heart sounds and then I suddenly realized that it wasn't a RR but actually a murmur! Then when you know what you're listening for you can pick up quiet ones on all sizes of babies.

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

I learned to hear murmurs on myself, of all people........I have a fairly distinctive one that makes a sort of "lubSWOOSHdub" sound, like a washing machine, as one poster said above. Now I can pick 'em up on almost anyone, including patients whose DOCTORS haven't noticed them. :)

I've always had better luck using the bell side of the stethoscope very lightly placed on the baby's chest. Also, try to move the stethoscope around to the different areas on the chest which correspond to the different heart areas because sometimes a murmur can be heard in one area and not in another. It helps if the baby is resting quietly too. I agree that the more you listen, the more you will get a chance to hear one so use your stethoscope often and count for the full minute when you check heart rate. I first learned to hear murmurs in the well baby nursery where I learned to hear the murmur as the PDA was closing. As one poster said, when the PDA is wide open we often can not hear it, but as it begins to close and the hole gets smaller and smaller, the turbulence of the pressure of the blood going through it makes the murmur much louder. I can remember admitting new, term babies just after being born who had no murmur and then a few hours later they had a murmur. The next day I'd listen and there would be no murmur at all. In these cases the PDA was wide open at first, then getting close to closing and then the next day had completely closed so the murmur was gone. Once we had a baby who turned blue and quit breathing in his mom's room (on a mother-baby unit). He was about a day old and his PDA had closed. Unfortunately he had a heart defect which was fine as long as his PDA was open. He was coded, transferred to our NICU, given prostaglandins to reopen and keep open the PDA and transferred to a hospital where surgery could be performed. I don't remember which heart defect it was because it happened on the day shift and he was just being transported as I came on shift. From that time on, I've realized the importance of being able to hear murmurs and keep a close eye on those babies in case something should go wrong. Another tip I can think of is that to me the murmurs I learned to hear first often sounded like a squishy sound, sort of like when you are standing in a mud puddle and squishing your toes through the mud. We used to do this a children and had a great time doing it. After time you will begin to hear some that sound like clicks and some that sound like a blowing sound. I believe it's the PPS murmur that can be heard very well through the baby's back. Sometimes babies with PDAs have bounding pulses in their palms too. I can't think of anything else to say other than to listen, listen, listen and ask your co-workers to let you hear any murmurs they hear as time goes by. When orienting nurses I will find the murmur, leave the stethoscope exactly on the chest and have the orientee take the earpieces and place them to their ears. If we are lucky and move very gently the stethoscope bell will remain in the correct place and the orientee can hear the murmur. Good luck and listen as often as you can. This is one of those things that comes with time. Oh yes, if you are giving Indocin to a baby you sould listen a lot because as the PDA hopefully closes you will be able to hear a murmur slowly getting lounder and then hopefully disappearing.

Hope you had a Happy Thanksgiving!

Tiki

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