The Place of Paediatric Nurses in Cardiology.pps

8/14/2019 The Place of Paediatric Nurses in Cardiology.pps

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The Place of Paediatric Nursesin

Cardiology

Iluebbey Frances


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OBJECTIVES

To enlighten and re-orientate nurses to their

roles in the management of patients with heart

disease.

To increase their alertness in identifyingchildren with heart disease.

To emphasise the importance of their roles in

ensuring optimal health for children withcardiac dysfunction.


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CLINICAL ASSESSMENT OF

CARDIOVASCULAR FUNCTION.

Much information can be gained via the

following routes:

History taking

Physical examination


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HISTORY TAKING

Prenatal period i.e maternal illness and drug

intake (e.g amphetamines)

Present illness: Its presenting complaints,severity, evidence of respiratory iii. distress,

growth pattern, feeding difficulties, activity

intolerance. Etc.

Family History: To ascertain familiar tendencies

of hereditary cardiac diseases


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PHYSICAL EXAMINATION

Conventionally, physical exam should bedone with the standard format of

Inspection/observation

Palpation

Percussion

Auscultation


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Inspection

Begins from the head

Normally during history taking

Points to note include.

General appearance for cyanosis, pallor.

Circulatory problems i.e clubbing of fingers.

Respiratory efforts i.e any difficulty, shallow, increasein respiratory rate etc.


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Feeding pattern: Restless/Fussiness duringfeeding, easily tires out etc.

Vital Signs to be observed as follows:

Heart rate may be high (tachycardia) or low(bradycardia).

Respiratory rate may be increased (tachypnoea)

Inspection of chest may reveal asymmetry

suggesting chronic heart enlargement.


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Palpation

Palpate pulses: to assess for rate, regularity,

intensity, timing etc.

Palpating the abdomen may reveal an enlargedliver (hepatomegaly)


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Auscultation

Is the most important part of cardiovascular

exam.

Assesses each portion of the cardiac cycle i.elistens to heart rate, regularity, the heart sounds,

murmurs.


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DEFINITION OF CONGESTIVE

HEART FAILURE

It is the inability of the heart to pump adequate

amount of blood at a rate commensurate to

meet the bodys metabolic demands.


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CLINICAL SIGNS AND

SYMPTOMS

These are divided into 3 groups

Impaired myocardial functionIncreased heart rate (tachycardia)

Inappropriate SweatingFatigue especially during feeds

Weakness

Restlessness

Pale, Cold extremities

Cardiomegaly (enlarged heart).

Decreased blood pressure


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PULMONARY CONGESTIONIncreased respiratory rate (tachypnoea)

Difficulty in breathing (Dypsnoea)

Sternal retractionsNasal flaring

Activity intolerance

Cough/Hoarseness (later due to laryngeal

compression)Cyanosis (Bluish discolouration of the skin

and mucous lining).

Crepitations/reduced breath sounds.


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SYSTEMIC VENOUS CONGESTION

Weight gain

Hepatomegaly (enlarged liver )

Peripheral oedema/ascites


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DIAGNOSTIC STUDIES

are done not so much to confirm the diagnosis

but more importantly to ascertain the cause,

severity and monitor response to treatment.


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Chest X-rayAssessment of extracardiac structures,the size and shape of the heart and size and positionof the pulmonary artery and aorta.

Electrocardiogram(ECG)valuable, non-invasivescreening tool. Provides information about the rate,rhythm, depolarization and repolarization of cardiaccells. Also size and wall thickness of the heatchambers.

Arterial Blood Gases (ABG)

Echocardiographyhas become the most importantnon-invasive tool in the diagnosis and management of

cardiac disease.


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Cardiac Catherization: performed on patients

who need additional anatomic information. - A

catheter is introduced into the heart then

oxygen saturation, blood pressure aremeasured in each heart chamber.

Pulse oxymetrypainless, inexpensive but

valuable tool to assess oxygen saturation.


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Other diagnostic studies include

Full Blood Count (FBC)

Erythrocyte sedimentation rate (ESR)

Blood Cultures /Electrolyte and Urea Levels etc.


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S/N NURSING

DIAGNOSIS

EXPECTED PATIENTS

OUTCOME

1 Decreased

cardiac output

related to

cardiacdysfunction

1. Child will have adequate

output as evidenced by

a. Heart rates within acceptable

limitsb. Respiratory rate within

acceptable range

c. Blood pressure normal for age

d. Lack of oedemae. Adequate urine output (1-

2mls/kg/hr


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S/N NURSING

DIAGNOSIS

EXPECTED PATIENTS OUTCOME

2 Ineffective

breathing pattern

related to

pulmonary

congestion

1. Child will have effective breathing

pattern as evidenced by:

a. Respiratory rate within acceptable

range

b. Clear and equal breath soundsc. Pink colour

d. Absence of nasal flaring/retractions

e. Unlaboured breathing

3 Fluid volume

excess related to

oedema

No evidence of fluid excess.


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Therapeutic Management

The goals of treatment are to:

Improve cardiac function

Remove accumulated fluid and sodium

Decrease cardiac demands

Improve tissue oxygenation and

decrease oxygen consumption

Children with congestive heart failure

may require intensive care until

symptoms improve

E i l i


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Essential nursing management

will include the following:

Assist in measures to improve cardiac

function

Decrease cardiac demands

Reduce respiratory distress

Maintain Nutritional Status

Assist in Measures to Promote fluid loss

Support the Child and Parents


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Assist in measures to improve cardiac function calculating and administering prescribed drugs especially

digoxin

Monitor signs of side effects

Do not give, if heart rate is below 70 for older children, 90-110 for infants.

Decrease cardiac demands:

Cares to be organized and plannedbathing,medications, procedures

Minimize disturbance

Provide adequate rest periods.

Encourage parents to cuddle/rock babies perrequired


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Reduce respiratory distress:

Gently assess babies

Ensure good positioning

Prompt oxygen administrationReport / record any abnormality in

respiration

Do clothing and diapers loosely.


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Maintain Nutritional Status:This is a serious nursing

challenge.

Individualize feeding needs.

A 3hour feeding schedule works well for most infants.

Feed in an upright position well-supported.

Diet plan specific to the individual calculated to meet caloric

needs.

Expressed Breast Milk (EBM) may be given in some case.

Feed as child can tolerate for a period of 30 minutes.

Nasogastric feeding can be done in severe and acute cases.


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Assist in Measures to Promote fluid loss

Record fluid intake and output

Monitor body weight

Monitor for signs of electrolyte imbalance

Give intravenous fluids as prescribed

Support the Child and Parents:

Communicate frequently with parent regarding

childs progress

Encourage active participation in childs care.


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Thanks for Listening

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The Place of Paediatric Nurses in Cardiology.pps