• Institute preoperative teaching to reduce anxiety.
• Prepare child and family for postoperative procedures such as naso- gastric tube, wound care, and monitoring apparatus.
• Administer preoperative sedation.
䊋 Provide postoperative care for the child undergoing cardiac surgery:
• Make sure child is in safe position of comfort according to the physician’s order.
• Perform stat orders.
• Use proper handwashing.
• Assess wound for bleeding and signs of infection.
• Provide appropriate wound care.
• Assess breath sounds.
• Perform neurologic checks.
• Take frequent vital signs.
• Administer fluids to prevent hypotension.
• Monitor fluids losses through chest tube.
• Administer pharmacologic support as ordered.
• Monitor electrolytes and supplement with infusion as ordered.
• Administer sedatives and analgesics for comfort.
• Allow caregivers to visit as soon as possible.
• Explain procedures and equipment to caregivers.
• Encourage caregivers to ask questions.
• Involve child life specialist and social services in the care to support the child and family.
TRANSPOSITION OF GREAT ARTERIES
flow patterns. Reveals vessel transposition and septal defects and car- diomegaly.
䊋 Pulse oximetry (SpO2): Device used to evaluate the degree of oxygen saturation in the blood using a small infrared light probe. Oxygen satu- ration levels are low
䊋 Electrocardiogram: Detects electrical events normal and abnormal cardiac rhythm in the heart. May be normal for newborn and later show signs of ventricular hypertrophy
䊋 Echocardiogram: Two-dimensional Doppler evaluation to detect evidence of valve leakage, cardiac anatomy, size, and function. Will reveal vessel transposition and septal defects.
Treatment
䊋 Intravenous prostaglandin E to increase blood mixing so that oxygen saturation if ≥ 75%.
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Pulmonary artery
Aorta
FIGURE 6-10
䊋 Atrial septostomy (Rashkind procedure) performed during catheterization to increase mixing and maintain cardiac output.
䊋 Arterial switch procedure to connect the main artery to the proximal aorta and the ascending aorta to the proximal pulmonary artery.
䊋 Coronary arteries are switched from the proximal aorta to the proximal pulmonary artery, which creates a new aorta.
Nursing Interventions for Child Undergoing Cardiac Catheterization
䊋 Prepare the patient for cardiac catheterization:
• Take complete nursing history.
• Patient must be NPO for 4 to 6 hours.
• Complete assessment including calculation of body surface area.
• Check for allergies; allergies to iodine, contrast dyes, and shellfish should be relayed to the physician prior to the procedure.
• Document baseline assessment of pedal pulses and pulse oximetry.
• Utilize child life specialists to alleviate anxiety for the child and family.
• Arrange a tour of the lab with the child if age appropriate.
• Explain specific aspects of the procedure such as the placement of the IV and ECG electrodes.
• Demonstrate how the skin will be washed with brown soap and how the skin will be numbed.
• Explain how the contrast affects the patient and how sedation will make the child feel.
䊋 Care of the patient after cardiac catheterization:
• Monitor patient with cardiac monitor and pulse oximeter prior to discharge.
• Monitor the patient for
䊊Temperature and color distal to the catheter insertion site
䊊A pulse of the extremity distal to the catheter insertion site
• Take vital signs every 15 minutes for the first hour and hourly thereafter.
• Monitor for trends and assess for possible hypotension, tachycardia, and bradycardia.
• Check the pressure dressing for evidence of bleeding.
• Observe for bleeding at the insertion site or evidence of hematoma.
• Monitor intake and output for diuresis from contrast material.
• The patient and family should be provided with education upon discharge to:
䊊Observe the site for signs of inflammation and infection.
䊊Monitor for fever.
䊊Avoid strenuous activities for a few days.
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CHAPTER 6
/ Cardiovascular Conditions 119
䊊Avoid tub baths for 48 to 72 hours.
䊊Use acetaminophen or ibuprofen for discomfort.
Nursing Interventions for Child Undergoing Cardiac Surgery
䊋 Provide preoperative care of the child undergoing cardiac surgery:
• Make inquiries to parents and caregivers as to any questions they may have about the procedure.
• Orient child and family to strange surrounding prior to surgery day.
• Check chart for signed informed consent forms.
• Check identification band with surgical personnel to ensure identity.
• Ensure side rails are securely fastened.
• Use restraints for transport.
• Check laboratory values for signs of systemic alterations.
• Bathe and groom the child.
• Provide mouth care for comfort while NPO.
• Cleanse operative site with prescribed method.
• Administer antibiotics as ordered.
• Remove jewelry, makeup, and prosthetics as needed.
• Check for loose teeth.
• Institute preoperative teaching to reduce anxiety.
• Prepare child and family for postoperative procedures such as naso- gastric tube, wound care, and monitoring apparatus.
• Administer preoperative sedation.
䊋 Provide postoperative care for the child undergoing cardiac surgery:
• Make sure child is in safe position of comfort according to the physician’s order.
• Perform stat orders.
• Use proper handwashing.
• Assess wound for bleeding and signs of infection.
• Provide appropriate wound care.
• Assess breath sounds.
• Perform neurologic checks.
• Take frequent vital signs.
• Administer fluids to prevent hypotension.
• Monitor fluids losses through chest tube.
• Administer pharmacologic support as ordered.
• Monitor electrolytes and supplement with infusion as ordered.
• Administer sedatives and analgesics for comfort.
• Allow caregivers to visit as soon as possible.
• Explain procedures and equipment to caregivers.
• Encourage caregivers to ask questions.
• Involve child life specialist and social services in the care to support the child and family.
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