-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
1/28
The Place of Paediatric Nursesin
Cardiology
Iluebbey Frances
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
2/28
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
3/28
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.
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
4/28
CLINICAL ASSESSMENT OF
CARDIOVASCULAR FUNCTION.
Much information can be gained via the
following routes:
History taking
Physical examination
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
5/28
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
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
6/28
PHYSICAL EXAMINATION
Conventionally, physical exam should bedone with the standard format of
Inspection/observation
Palpation
Percussion
Auscultation
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
7/28
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.
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
8/28
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.
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
9/28
Palpation
Palpate pulses: to assess for rate, regularity,
intensity, timing etc.
Palpating the abdomen may reveal an enlargedliver (hepatomegaly)
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
10/28
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.
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
11/28
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.
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
12/28
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
13/28
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
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
14/28
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.
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
15/28
SYSTEMIC VENOUS CONGESTION
Weight gain
Hepatomegaly (enlarged liver )
Peripheral oedema/ascites
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
16/28
DIAGNOSTIC STUDIES
are done not so much to confirm the diagnosis
but more importantly to ascertain the cause,
severity and monitor response to treatment.
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
17/28
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.
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
18/28
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.
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
19/28
Other diagnostic studies include
Full Blood Count (FBC)
Erythrocyte sedimentation rate (ESR)
Blood Cultures /Electrolyte and Urea Levels etc.
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
20/28
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
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
21/28
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.
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
22/28
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
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
23/28
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
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
24/28
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
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
25/28
Reduce respiratory distress:
Gently assess babies
Ensure good positioning
Prompt oxygen administrationReport / record any abnormality in
respiration
Do clothing and diapers loosely.
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
26/28
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.
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
27/28
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.
-
8/14/2019 The Place of Paediatric Nurses in Cardiology.pps
28/28
Thanks for Listening