Nursing Management for Congenital Heart Defects

Question 1

Improving Oxygenation

Answer 1

1. Assess airway patency and suction as needed
2. Position child in semi-Fowler or Fowler position to facilitate lung expansion
3. Monitor vital signs (respiratory and heart)
4. Monitor color and oxygenation status
5. Observe for respiratory distress
   > nasal flaring
   > grunting
   > retractions
6. Auscultate lungs for adventitious breath sounds
7. Provide humidified supplemental oxygen as ordered
8. Anticipate the need for assisted ventilation if the child has difficulty maintaining the airway or experiences deterioration in oxygenation capacity

Question 2

Relieving Hypercyanotic Spells

Answer 2

1. Use calm, comforting approach
2. Place the infant or child in a knee-to-chest position
3. Provide supplemental oxygen
4. Administer morphine sulfate
5. Supply IV fluids

Question 3

Nursing Intervention: Promoting Adequate Nutrition

Answer 3

1. Provide nutrition orally, enterally, or parenteral in order to foster growth and development and reduce infection
2. Newborns/Infants- nutrition via breastmilk or formula may be provided orally or via gavage feedings
3. Cut a large hole in the nipple or cross-cutting the nipple decreases the work of feeding
4. Nipple feeding should be limited to 20 mins
5. Many infants feed orally for 20 mins receiving the remainder of the feeding via orogastric or nasogastric tube
6. Offer older children, small frequent feedings to reduce the amount of energy required to feed or eat and to prevent overtiring of the child

Question 4

Nursing Intervention: Assisting the Child and Family to Cope

Answer 4

1. Support the family’s efforts to cope with the diagnosis
2. Explain all that is happening with the child (use appropriate language parent and child can understand)
3. Allow child and parents to voice their feelings, concerns or questions
4. Encourage parent to participate in child’s care
5. Newborn/Infant- encourage attachment and bonding
   > hold infant close, using kangaroo care
   > encourage parents to touch, stroke, pat and talk to the infant
   > emphasize normal aspects of the infant
6. Older children
   > have parent bring favorite toy or object from home

Question 5

Nursing Intervention: Preventing Infection

Answer 5

1. Proper hand hygiene
2. Appropriate dental care
3. Prophylaxis
4. Vaccinations

Question 6

Undergoing Cardiac Surgery: Providing Preoperative Care

Answer 6

1. Establish a baseline
   > Temperature
   > Examination of extremities
   > Auscultation of heart
   > Respiratory Assessment
2. Establish a relationship with child and family
3. Obtain any labs and diagnostics
4. Child and Family Education
   > Read book about their child’s CHD and hospitalization
   > Creating a “hospital suitcase”
   > Hospital tours
   > Instructing parents to stop fluids and food at the designated time
   > Give all medication as directed
   > Allow parent to accompany child as far as possible
   > Reinforce to the child that the parent will be present when they wake up from surgery

Question 7

Undergoing Cardiac Surgery: Providing Postoperative Care

Answer 7

1. Assess vital signs frequently
2. Assess color of the skin and mucous membranes
3. Observe cardiac rate and rhythm via cardiac monitoring
4. Auscultate lungs for adventitious breath sounds
5. Assess O2 saturation
6. Administer oxygen as needed
7. Inspect the dressing
8. Monitor intake and output hourly
9. Assess for changes in LOC
10. Administer medications
11. Encourage child to cough, deep breath, use of incentive spirometer
12. Assess child’s pain level
13. Assess daily weights
14. Administer small, frequent feedings
15. Position child into a comfortable position
16. Provide emotional and physical support to child and family