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Nursing Care of Child with Altered Cardiovascular Function MSN. Khetam OUTLINE 1. introduction 2. general preparation for child 3. nursing care for child with cardiac problem 4. cardiac catheterization 5. cardiac surgery 6. nursing care for uncomplicated surgery General Preparations General appearance Weight and general physical exam History taken ( intrauterine life, prenatal /antinatal/postnatal ) Temperature and * pulse , RR , & BP Color ( cynosis with crying or not ) Coughing…. Wheezing…. Runny nose…. Ear discharge…. Diarrhea…. Vomiting…. Activity level Digoxin: stopped after evening dose Diuretics: stopped 8-12 hours preoperatively Propranolol & antiarrhythmics: continued till just before surgery Nonsteroidal anti-inflammatory drugs: stopped 7 or more days prior to surgery Nursing role …. 1. Education 2. psych support 3.comfort measurement 4. O2 therapy 5. comfortable position 6. preparation for different procedure LABORATORY INVESTIGATIONS Complete Blood Count PT, PTT, INR KFT Serum Glucose & Electrolytes * LFT Hepatitis screening * HIV Urinalysis and Chest X-Ray ECG and Echo Blood grouping & Cross matching (Packed cells/whole blood, FFP)- amount depends on type of surgery PHSICAL EXAM CYANOTIC CHILD ECG Echo Echo CXR EMOTIONAL PREPARATION For older children Visit the ICU, and explain things Explain things to the family Show other post cardiac surgery patients to them Always insist that the surgeon meet the family and the patient Good sleep the night before surgery Child H.R < 6 months 110-190 6-12 months 100-170 1-3 years 90-160 > 3 years 80-150 NPO & INFUSION NPO 6 hours prior to surgery only some research recommended just 4 hour Always start iv maintenance (usually 0.18G/S from the time of NPO) Nursing care Heart Valve Cardiac catheterization Preparation phase • Procedure phase • Post cath care NDx… Hypothermia r/t cooling during procedure Nursing intervention …. • Check V/S • Warm the baby • IVF • Cardiac Catheterization CARDIC CATHETER Cardiac Surgery Heart surgery first began in 1938 when the first person (a child) was operated on and a patent ductus arteriosus closed by a surgeon called Gross in Boston. Open heart surgery became possible in the 1950's with the invention of a heart lung machine by Gibbon. There are different types of heart surgery. Operation Room Type of heart surgery Closed Heart Surgery This is undertaken while the heart is still beating. This type, strictly speaking, is not a heart operation as it is usually used for operations on the main blood vessels outside the heart eg. coarctation repair or shunts. The scar is usually on the side of the chest. Closed Heart Surgery Open Heart Surgery Open Heart Surgery This is undertaken when the heart has been stopped. The function of the heart and lungs is taken over by a machine. It is sometimes known as a bypass operation. This type of surgery is utilized for repairing defects within the heart itself E.g. holes or valve narrowing. The scar is usually down the breastbone but for some operations it is possible to make the scar under the breast and less visible. Post Open Heart Surgery Care after uncomplicated operation General Care Fluid replacement: type & amount Adequate sedation Prevention of pulmonary hypertensive crisis ( paralysis, vasodilators, longer ventilation) Prevention of infection?? Prevention of stress ulceration Blood loss replacement Care after uncomplicated operation Pulmonary System No signs of distress after extubation: Fio2 0.5,frequent pulmonary physiotherapy In intubated patients: CXR Extubation as early as possible Closed monitoring to V/S and O2 sat Care after uncomplicated operation Cardiovascular System Inadequate cardiac output: - Cold extremities & weak pulses - Oliguria & rising potassium level * FEEDING: Not in the first 24 hours Always check bowel sounds before Gradual ?? Nasogastric feeding Care after uncomplicated operation MEDICATIONS: Oral when oral feeding is established Usually diuretics for 6 weeks & digoxin for 6 months ?? Antibiotics CHEST PHYSIOTHERAPY BY THERAPIST, NURSE & MOTHER NURSING CARE Care after uncomplicated operation FEVER!!! A sign of an infection till proven otherwise Always should be taken seriously & not only treated by antipyretics & cold compressors Medication used post/op 1.Cephalosporins 2.Gentamycin 3.Vancomycin BEFORE DISCHARGE: Lab tests CXR ECG & removing pacing wires Do not forget discharge medications CHILD IN PICU post open heart surgery THANK YOU