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Nursing Care of Child with
Altered Cardiovascular Function
MSN. Khetam
OUTLINE
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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
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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
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Diuretics: stopped 8-12 hours preoperatively
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Propranolol & antiarrhythmics: continued till
just before surgery
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Nonsteroidal anti-inflammatory drugs: stopped
7 or more days prior to surgery
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Nursing role ….
1. Education 2. psych support 3.comfort
measurement 4. O2 therapy
5. comfortable position
6. preparation for different procedure
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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
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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
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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
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Procedure phase
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Post cath care
NDx…
Hypothermia r/t cooling during procedure
Nursing intervention ….
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Check V/S
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Warm the baby
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IVF
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Cardiac Catheterization
CARDIC CATHETER
Cardiac Surgery
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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
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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
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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
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Care after uncomplicated operation
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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
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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
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CHILD IN PICU post open heart surgery
THANK YOU