1. Nursing Care of Child with Altered Cardiovascular Function MSN. Khetam

2. OUTLINE 1. introduction 1. introduction 2. general preparation for child 2. general preparation for child 3. nursing care for child with cardiac problem 3. nursing care for child with cardiac problem 4. cardiac catheterization 4. cardiac catheterization 5. cardiac surgery 5. cardiac surgery 6. nursing care for uncomplicated surgery 6. nursing care for uncomplicated surgery

3. General Preparations General appearance General appearance Weight and general physical exam Weight and general physical exam History taken ( intrauterine life, prenatal /antinatal/postnatal ) History taken ( intrauterine life, prenatal /antinatal/postnatal ) Temperature and * pulse, RR, & BP Temperature and * pulse, RR, & BP Color ( cynosis with crying or not ) Color ( cynosis with crying or not ) Coughing…. Wheezing…. Runny nose…. Ear discharge…. Diarrhea…. Vomiting…. Coughing…. Wheezing…. Runny nose…. Ear discharge…. Diarrhea…. Vomiting…. Activity level Activity level

4. Digoxin: stopped after evening dose Digoxin: stopped after evening dose Diuretics: stopped 8-12 hours preoperatively Diuretics: stopped 8-12 hours preoperatively Propranolol & antiarrhythmics: continued till just before surgery Propranolol & antiarrhythmics: continued till just before surgery Nonsteroidal anti-inflammatory drugs: stopped 7 or more days prior to surgery Nonsteroidal anti-inflammatory drugs: stopped 7 or more days prior to surgery Nursing role …. Nursing role …. 1. Education 2. psych support 3.comfort measurement 4. O2 therapy 1. Education 2. psych support 3.comfort measurement 4. O2 therapy 5. comfortable position 5. comfortable position 6. preparation for different procedure 6. preparation for different procedure

5. 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

6. PHSICAL EXAM

7. CYANOTIC CHILD

8. ECG

9. Echo

10. Echo

11. CXR

12. EMOTIONAL PREPARATION For older children For older children Visit the ICU, and explain things Visit the ICU, and explain things Explain things to the family Explain things to the family Show other post cardiac surgery patients to them Show other post cardiac surgery patients to them Always insist that the surgeon meet the family and the patient Always insist that the surgeon meet the family and the patient Good sleep the night before surgery Good sleep the night before surgery

13. Child H.R < 6 months 110-190 6-12 months 100-170 1-3 years 90-160 > 3 years 80-150

14. NPO & INFUSION NPO 6 hours prior to surgery only some research recommended just 4 hour 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) Always start iv maintenance (usually 0.18G/S from the time of NPO)

15. Nursing care

17. Heart Valve

18. Cardiac catheterization Preparation phase Preparation phase Procedure phase Procedure phase Post cath care Post cath care NDx… NDx… Hypothermia r/t cooling during procedure Hypothermia r/t cooling during procedure Nursing intervention …. Check V/S Check V/S Warm the baby Warm the baby IVF IVF

19. Cardiac Catheterization

20. CARDIC CATHETER

21. 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. 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.patent ductus arteriosuspatent ductus arteriosus

22. Operation Room

23. Type of heart surgery Closed 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. 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. coarctation repair shuntscoarctation repair shunts

24. Closed Heart Surgery

25. Open 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 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. 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.

26. Post Open Heart Surgery

27. Care after uncomplicated operation General Care Fluid replacement: type & amount Fluid replacement: type & amount Adequate sedation Adequate sedation Prevention of pulmonary hypertensive crisis Prevention of pulmonary hypertensive crisis ( paralysis, vasodilators, longer ventilation) ( paralysis, vasodilators, longer ventilation) Prevention of infection?? Prevention of infection?? Prevention of stress ulceration Prevention of stress ulceration Blood loss replacement Blood loss replacement

28. Care after uncomplicated operation Pulmonary System No signs of distress after extubation: Fio2 0.5,frequent pulmonary physiotherapy No signs of distress after extubation: Fio2 0.5,frequent pulmonary physiotherapy In intubated patients: CXR In intubated patients: CXR Extubation as early as possible Extubation as early as possible Closed monitoring to V/S and O2 sat Closed monitoring to V/S and O2 sat

29. Care after uncomplicated operation Cardiovascular System Inadequate cardiac output: Inadequate cardiac output: - Cold extremities & weak pulses - Cold extremities & weak pulses - Oliguria & rising potassium level - Oliguria & rising potassium level * FEEDING: * FEEDING: Not in the first 24 hours Not in the first 24 hours Always check bowel sounds before Always check bowel sounds before Gradual Gradual ?? Nasogastric feeding ?? Nasogastric feeding

30. Care after uncomplicated operation MEDICATIONS: MEDICATIONS: Oral when oral feeding is established Oral when oral feeding is established Usually diuretics for 6 weeks & digoxin for 6 months Usually diuretics for 6 weeks & digoxin for 6 months ?? Antibiotics ?? Antibiotics CHEST PHYSIOTHERAPY BY CHEST PHYSIOTHERAPY BY THERAPIST, NURSE & MOTHER THERAPIST, NURSE & MOTHER

31. NURSING CARE

32. Care after uncomplicated operation FEVER!!! FEVER!!! A sign of an infection till proven otherwise A sign of an infection till proven otherwise Always should be taken seriously & not only treated by antipyretics & cold compressors Always should be taken seriously & not only treated by antipyretics & cold compressors Medication used post/op 1.Cephalosporins 2.Gentamycin 3.Vancomycin 1.Cephalosporins 2.Gentamycin 3.Vancomycin BEFORE DISCHARGE: BEFORE DISCHARGE: Lab tests Lab tests CXR CXR ECG & removing pacing wires ECG & removing pacing wires Do not forget discharge medications

33. CHILD IN PICU post open heart surgery

34. THANK YOU