This is the process of rendering care to a child with anatomical and physiological heart defect(s) that is/are present at birth. These defects can lead to heart failure and anoxic spells. The paediatric nurse is expected to understand clearly the cardiac structure, pathophysiology and major complications in order to provide holistic care to the child/caregiver.
Aims
· Provide and maintain adequate oxygenation
· Provide care during hypercyanotic spells
· Maintain adequate tissue perfusion
· Ensure adequate nutrition
· Explore treatment options for children
· Provide psychological support to child/caregiver
· Prevent complications
Requirements
1. Emergency tray containing the following:
· Padded spatula
· Nasal prongs/oxygen mask
· Ambu bag/self inflating bag
· IV cannula and giving set (age appropriate)
· IV fluid (Ringer’s lactate, 0.9% normal saline, 1/5 normal saline in 10% dextrose, 1/5 normal saline in 4.3% dextrose)
· Syringes and needles (various sizes)
· NG tube (various sizes)
· Urethral catheter (various sizes)
· Paediatric stethoscope
· Water soluble lubricant
· Emergency medications e.g. morphine, IV propranolol
· Glucometer and strips
· Pulse oximeter
· Sterile and examination gloves
· Sterile swabs
2. Cardiac bed
3. Warm incubator
4. Bed linen
5. Drip stand with infusion pump
6. Adhesive tape
7. Oxygen source
8. Cardiac monitor
9. Suction apparatus with catheters (age appropriate suction catheters)
Steps
1. Establish rapport with child/caregiver (Refer to steps)
2. Explain procedure to child/caregiver (Refer to steps)
3. Ensure privacy
4. Perform five moments of hand hygiene
5. Encourage bed rest
6. Nurse child in a cardiac bed/warm incubator with head end of the incubator propped up
7. Assess airway, breathing and circulation
8. Call for help if child is unconscious
9. Recognize hypercyanotic spells and manage accordingly
10. Suction any secretions in the airway
11. Administer oxygen via face mask or nasal prongs
12. Assess skin colour for cyanosis and capillary refill time > 3 seconds
13. Monitor vital signs (temperature, pulse, respiration, blood pressure, pain and SPO2)
14. Observe the electrical activities of the heart with cardiac monitor
15. Establish IV access to administer IV fluids e.g. Ringer’s lactate
16. Administer prescribed emergency medication e.g. morphine, propranolol
17. Position child with knees flexed towards the chest in tetralogy of Fallot
18. Ensure continuous monitoring with pulse oximetry
19. Pass an NG tube for feeding
20. Ensure diagnostic investigations e.g. echocardiogram has been done
21. Educate family on child’s condition and the treatment options available which is mainly surgical intervention
22. Inform family that, surgery may be performed between 3 months to 3 years as some of the condition may resolve spontaneously depending on the type
23. Educate caregiver on the need for follow-up and report during emergency situations
24. Provide family with continuous psychological support
25. Inform family not to allow child to perform strenuous activities
26. Express appreciation to child/caregiver
27. Dispose off, decontaminate and clean used items
28. Remove examination gloves
29. Document findings manually or electronically
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