The Nurse's Role
Children with cardiovascular disorders may present unique challenges in the health care environment. As measures are taken to learn more about heart conditions and how they effect circulation, health care providers can better care for children and their families
The nurse needs to identify children with signs and symptoms of heart conditions and make referrals for immediate medical evaluation through providing a thorough assessment. Provide supportive care and education for the family about caring for the child at home. Know the interventions that may be necessary for children with heart disorders.
The nurse needs to identify children with signs and symptoms of heart conditions and make referrals for immediate medical evaluation through providing a thorough assessment. Provide supportive care and education for the family about caring for the child at home. Know the interventions that may be necessary for children with heart disorders.
The main signs and symptoms of heart problems to watch for include:
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Common Nursing Interventions and Considerations
These should be tailored to the heart condition that the child may have. It is important to understand the condition and know how the circulation may be affected. Remember to always include the family in care decisions.
- Signs of depletion include tachycardia, poor perfusion, hypotension, and poor pulses.
These should be tailored to the heart condition that the child may have. It is important to understand the condition and know how the circulation may be affected. Remember to always include the family in care decisions.
- Cardiac arrhythmias: Patients with congenital heart disease are at lifelong risk for the development of arrhythmias. This can be due to fibrosis and scarring of cardiac tissue from previous surgical procedures or as a result of chamber enlargement from abnormal pressure and volume loads. Though these are rarely a problem in children, nurses should recognize types of arrhythmias and understand the diagnostic testing needed for follow-up.
- Fluid balance: The fluid balance is very delicate in cardiac patients. Those with cyanotic heart conditions often develop polycythemia which makes them more susceptible to dehydration. The patients with cardiac shunts may have such viscous blood due to dehydration that the shunt is occluded, this may cause sudden death. Also, cardiovascular emergencies caused by electrolyte imbalances may occur. Because of this, it is imperative to know and watch for the signs of fluid volume overload and depletion.
- Signs of depletion include tachycardia, poor perfusion, hypotension, and poor pulses.
- Airway considerations: The use of intubation and ventilator support is not uncommon in children affected by cardiovascular disorders. This causes an increased risk of laryngeal anomalies, especially among Down's syndrome patients who may have tracheal shortening or stenosis. They may require an increase in airway attention and respiratory effort.
- Oxygenation: The pulse oximetry readings of those with cardiac disorders is often less than that of healthy individuals. Oxygen should be administered with caution. An increase in oxygen in the lungs may cause an increase of pulmonary blood through the dilation of pulmonary arteries. This may result in pulmonary edema and poor systemic perfusion. When the patient is administered oxygen, their regular pulse oximetry levels should be monitored and retained.
- Venous access: The cardiac patient may have previously had numerous peripheral and central line insertions. This may result in scarred or damaged veins which also may decrease peripheral perfusion and volume distribution. This makes veins less visible and more fragile which causes venous access to be more difficult, especially among infants and young children. Prepare to have additional assistance and time to obtain venous access among cardiac patients.
- Current medications: Know the common medications and side effects for children with cardiac disorders. This includes furosemide, digoxin, and lisinopril. These also affect the fluid volume distribution. Assess the risks and benefits of these medications. Most acquired heart conditions may require additional antibiotics and anti-inflammatory medication administration as well. Most Heart disorders require prophylactic medication for dental care and surgeries.
References
Hanash, C. & Crosson, J. (2010). Emergency diagnosis and management of pediatric arrhythmias. Journal of Emergencies, Trauma and Shock, 3(3), 251-260. doi: 10.4103/0974-2700.66525
Hawk, B. M. (2013). Perioperative care of the pediatric cardiac patient undergoing noncardiac surgery. Association of Operating Room Nurses Journal, 97(6), 728-735. doi: 10.1016/j.aorn.2013.04.014
Photo Credits
https://www.youtube.com/watch?v=OizGCnnIMxs
http://www.myicucare.org/SiteCollectionImages/Patient-Family-EXPECT-Figure.jpg
http://childrenshospitalblog.org/wp-content/uploads/2010/05/Parker-medical-smile-300x225.jpg
http://adoptionnutrition.org/wp-content/uploads/2013/01/elisyn.jpg
Hanash, C. & Crosson, J. (2010). Emergency diagnosis and management of pediatric arrhythmias. Journal of Emergencies, Trauma and Shock, 3(3), 251-260. doi: 10.4103/0974-2700.66525
Hawk, B. M. (2013). Perioperative care of the pediatric cardiac patient undergoing noncardiac surgery. Association of Operating Room Nurses Journal, 97(6), 728-735. doi: 10.1016/j.aorn.2013.04.014
Photo Credits
https://www.youtube.com/watch?v=OizGCnnIMxs
http://www.myicucare.org/SiteCollectionImages/Patient-Family-EXPECT-Figure.jpg
http://childrenshospitalblog.org/wp-content/uploads/2010/05/Parker-medical-smile-300x225.jpg
http://adoptionnutrition.org/wp-content/uploads/2013/01/elisyn.jpg