A nurse is auscultating an older patient's heart and notes a systolic murmur (heard between the S1 and S2 heart sounds. The first action by the nurse is to:
a. question the patient about the presence of the murmur.
b. note it in the chart as this is always a nor-mal finding for an older adult.
c. contact the medical provider as this is an abnormal finding.
d. immediately implement emergency inter-ventions.
ANS: A
In normal aging, the heart valves separating the chambers thicken and stiffen as a result of lipid deposits and collagen cross-linking. Mild systolic murmurs (between S1 and S2) are expected findings in the older adult. Aortic and mitral valves are those most commonly affected. If the nurse auscultates a systolic murmur in an asymptomatic older adult, he or she should ask about it. Most older adults will reply that they have had it for a while. If this is not the case, the person is referred to a cardiologist. If the new finding is accompanied by any significant signs or symp-toms of distress, it is a medical emergency. Diastolic murmurs (heard between S2 and S1) are al-ways indicative of a serious problem in cardiac hemodynamics and these persons are followed closely by a cardiologist.
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