2- CONGENITAL HEART DEFECTS THAT INCREASE PULMONARY BLOOD FLOW

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Unit 4
UNIT FOUR: CONGENITAL HEART DEFECTS THAT INCREASE PULMONARY BLOOD FLOWLEARNING ACTIVITY #3

You are the paediatric critical care nurse assigned to a four month-old infant who underwent surgical repair of a ventricular septal defect (VSD). The patient’s pain is well controlled with a continuous morphine infusion and you have completed your immediate post-operative assessments. When you begin your next assessment, you notice that the infant appears pale, and his extremities are cool and mottled. You are unable to palpate a peripheral pulse. The baby’s vital signs are: P- 146, R- 66, Spo2- 80% on 35% oxygen, BP- 72/50. Upon auscultation, you hear muffled heart tones. External pacing wires are appropriately in place.

1. Which post-operative complication is this infant likely experiencing? What is the pathophysiology?

2. What are your priority nursing interventions?

3. What will you prepare the patient for?

4. How will you manage the infant’s anxious parents?

UNIT 5
Rich is an 8-year-old boy who is being seen in the pediatric cardiology office where you are a nurse. His mother and father are also present for the appointment. Rich was recently diagnosed with aortic stenosis (AS) after a history of being more tired than normal and becoming short of breath quicker than his peers when he played sports. He is scheduled on the following day for percutaneous balloon dilation via interventional cardiac catheterization. As expected, Rich’s parents are scared and anxious, and they have a lot of questions regarding the condition and the treatment. You are providing information to the parents in preparation for the procedure and anticipatory discharge teaching.
1. Rich’s parents are concerned about the risks of the procedure. What are some of the potential complications of cardiac catheterization about which you should inform his parents?
2. Rich’s parents want to know what to expect about the care he will need at home after the procedure. What will the teaching plan for Rich and his family include as he returns home after a cardiac catheterization?

UNIT 6

DEFECTS THAT INCREASE PULMONARY BLOOD FLOW, DEFECTS OF THE GREAT VESSELS, DEFECTS WITH A FUNCTIONAL SINGLE VESSELLEARNING
One-week-old Emily was born at home with the assistance of a midwife to a woman who had no prenatal ultrasounds. For the first few days, Emily breastfed well and was seemingly healthy. By day 7, Emily began to experience some difficulty breathing and became tachypneic. She was admitted to the hospital because of severe respiratory distress. Her physical examination revealed a significant murmur, hypoxia, poor peripheral circulation, and dehydration. An echocardiogram revealed the diagnosis of hypoplastic left heart syndrome. The physicians intubated Emily and prescribed Prostaglandin E1. Emily will be transported to a Level III facility that specializes in paediatric cardiac surgery later in the day. Her mother is in shock and believes that she is to blame.
1. Explain Emily’s symptoms and why her condition deteriorated at Day 7.
2. Explain the rationale behind the administration of Prostaglandin E1.
3. What treatment is Emily likely to have in the Level III facility?
4. Develop a teaching plan for Emily’s mother about hypoplastic left heart syndrome and what to expect post-operatively.

UNIT 7:
ACQUIRED HEART DISEASESLEARNING ACTIVITY #1
You are the ER nurse looking after a child who is being assessed for Infective Endocarditis. Previously this child has been healthy, with no cardiac abnormalities. She presented to the ER with lethargy, fever, & sudden onset of seizures.
1. Where is the infection likely to be situated in (the heart) with a child who has had no previous cardiac concerns?
2. Describe how a child can develop this infection. What organism is likely to be the cause?
3. Describe the signs and symptoms, lab values and diagnostic tests that used to diagnose the infection.
4. Describe the interventions for this child. If put on medications, how long would the treatment be expected to last?
5. How are you going to reassure the parents and provide teaching/education about the infection?

UNIT 8:
Fourteen-year-old Natasha has muscular dystrophy and requires a tracheostomy and mechanical ventilation for respiratory support. You are the community nurse assigned to care for Natasha during the night shift.
1. Develop a nursing care plan for Natasha that identifies two priority nursing diagnoses, 3-5 interventions with rationale, and any relevant family education.
2. Explain the nurses’ role in the event of a respiratory emergency (occlusion of the tracheostomy, mechanical failure, etc.) and any equipment that must be available at all times to ensure Natasha’s safety.