Circulation Concerns of Pediatric Clients Student 3 Slide PDF

12/3/2024 Circulation Concerns of a Pediatric Client 1 Learning Outcomes Apply core principles of family centered care, and relational care into pediatric nursing care practice and teachings to promote health and facilitate client learning. Apply evidence-...

12/3/2024 Circulation Concerns of a Pediatric Client 1 Learning Outcomes Apply core principles of family centered care, and relational care into pediatric nursing care practice and teachings to promote health and facilitate client learning. Apply evidence-informed knowledge, critical inquiry, and clinical judgment to the pediatric client and their family. Describe a holistic approach to assessments, planning, implementation, and evaluation during pediatric care. Discuss common political, ethical and economic issues that arise when caring for pediatric clients. 2 Goals of the Class Describe the immediate interventions in the care of children experiencing circulatory concerns Explore the nursing roles and responsibilities in the care of children experiencing shock, a congenital heart disease, PDA or Tetralogy of Fallot Discuss the role of the Pediatric Cardiac inquest and its impact on nursing today 3 1  12/3/2024 Shock in Children Shock or circulatory failure is a complex clinical presentation Inadequate tissue perfusion to meet the metabolic demands Resulting in cellular dysfunction and eventual organ failure Circulation failure in children because of: Hypovolemia Altered peripheral vascular resistance Pump failure 4 Types of Shock Compensated Shock Decompensated Shock Irreversible or Terminal Shock 5 Compensated Shock Vital organ function is maintained by compensatory mechanism Blood flow is normal or increased and fluids may be shifted Apprehensive Irritability Unexplained tachycardia Normal Blood Pressure 6 2  12/3/2024 Compensated Shock Continued Thirst Pale Pallor Diminished Urine Output Reduced Perfusion to extremities 7 Decompensated Shock Marked by: Tissue hypoxia Metabolic acidosis Eventually dysfunction of all organ systems Confusion and Somnolence Tachypnea 8 Decompensated Shock Continued Oliguria Cool pale extremities Decreased Skin Turgor Poor Capillary Refill 9 3  12/3/2024 Irreversible/Terminal Shock Thready weak pulse Hypotension Periodic breathing or apnea Anuria Stupor or coma 10 Therapeutic Management Ventilation Establish airway/intubation Administer oxygen Fluid Administration Obtain vascular access/intraosseous in emergency Restore fluid volume 11 Therapeutic Management Cardiovascular Support Administer Vasopressors (Epinephrine) General Support Provide continuous electro cardio monitoring Monitor pulse oximetry Keep child flat/legs raised Keep child calm and warm 12 4  12/3/2024 Review of the Heart Structures 13 Screening for Critical Congenital Heart Disease Prenatal Ultrasound Physical Examination Oximetry screening (right hand and one foot) 14 Congenital Heart Conditions in Children 15 5  12/3/2024 Congenital Heart Disease Fig. 47.3 1.Increased Pulmonary Blood Flow 2.Decreased Pulmonary Blood Flow 3.Obstruction of Blood Flow out of the Heart 4.Mixed Blood Flow 16 PDA Patent Ductus Arteriosus Box 47.2 Fig 47.2 Defect with increased pulmonary blood flow Failure of the fetal ductus arteriosus (artery connecting the aorta and the pulmonary artery) to properly close Should close within the first few weeks of life Patency causes blood to flow from high pressure aorta to lower pressure pulmonary artery 17 Pathophysiology of PDA Hemodynamic implications are related to the size of the PDA Blood is returned to the lungs It results in increased workload to the left side of the heart which increases pulmonary congestion and right ventricle pressure. 18 6  12/3/2024 Presentation of PDA Patients may be symptomatic or may progress to heart failure Characterized by a machinery like murmur Widening pulse pressure Bounding pulses Patients are at risk for endocarditis later in life and pulmonary vascular obstructive disease 19 Management and Treatment Intravenous Administration of Prostaglandins Surgical division of ligation of the parent vessel Surgical Coils can be placed to occlude the PDA Surgical and non-surgical procedures have a 0% mortality rate 20 Tetralogy of Fallot Decreased Pulmonary Blood Flow 21 7  12/3/2024 Tetralogy of Fallot Box 47.4 There are four heart anomalies Pulmonic stenosis Right ventricular hypertrophy Ventricular septal defect Overriding aorta 22 Side by Side Heart Comparison 23 Structure of Heart Abnormality Preload Afterload Cardiac Output Contractility 24 8  12/3/2024 Preload Preload is the end diastolic volume that stretches the right or left ventricle of the heart to its greatest dimensions under variable physiologic demand. Increase in preload = Increased fluid in the ventricle after the end of diastole Common causes Shunting of blood from one ventricle to another Fluid retention Fluid overload 25 Afterload Afterload is the pressure against which the heart must work to eject blood during systole. It is the end load against which the heart contracts to eject blood. It is the squeeze Stenosis of arteries =Increased AFTERLOAD Common causes Increased blood pressure Hypertension Constriction of the arteries 26 Cardiac Output Cardiac output: The amount of blood the heart pumps through the circulatory system in a minute. The amount of blood put out by the left ventricle of the heart in one contraction is called the stroke volume. The stroke volume and the heart rate determine the cardiac output. 27 9  12/3/2024 Contractility Cardiac contractility is the tension developed and velocity of shortening (i.e., the “strength” of contraction) of myocardial fibers at a given preload and afterload. It represents a unique and intrinsic ability of cardiac muscle to generate a force that is independent of any load or stretch applied. In the early stages of hypertrophy effective perfusion is maintained. Prolonged hypertrophy leads to loss of effective myocardial contraction. 28 Diagnostic Tests Table 47.1 Chest X ray Electrocardiogram Echocardiography Cardiac Catheterization Cardiac MRI T h e P h 29 Signs of Heart Failure Fig 47.7/Box 47.6 Impaired Myocardial Function Pulmonary Congestion Systemic Venous Congestion 30 10  12/3/2024 Impaired Myocardial Function Tachycardia Sweating (inappropriate) Decreased urine output Fatigue Weakness Restlessness 31 Impaired Myocardial Function Continued Anorexia Pale cool extremities Weak peripheral pulses Decreased blood pressure Gallop rhythm Cardiomegaly 32 Pulmonary Congestion Manifestations Tachypnea Dyspnea Retractions Flared nares Exercise intolerance Orthopnea 33 11  12/3/2024 Pulmonary Congestion Manifestations Continued Cough, hoarseness Cyanosis Wheezing Grunting 34 Systemic Venous Congestion Manifestations Weight gain Hepatomegaly Peripheral edema (especially periorbital) Ascites Neck vein distention (children) 35 Therapeutic Management Improve Cardiac Function Remove accumulated fluid and sodium Decrease cardiac demands Improve tissue oxygenation and decrease oxygen consumption 36 12  12/3/2024 Medications to Improve Cardiac Function Table 47.3 Ace Inhibitors Digitalis Beta Blockers Diuretics 37 Nursing Actions and Interventions Assess the infant/child- HR, RR, blood pressure, capillary refill, additional heart sounds, distended neck veins in older children, increased fatigue and lethargy, Daily or BID weights Administer oxygen at a level to maintain the required oxygen saturation level Elevate the head of the bed 30-45⁰ Offer feeds at the first sign of hunger, high calorie feeds Encourage family participation in the care of the child Organize care to allow the infant/child uninterrupted rest periods 38 Treating Hyper Cyanotic Spells (TETS Spells) Place infant in knees/chest position Use a calm comforting approach Administer oxygen Give morphine IV/SQ Begin IV fluid replacement or volume expander Repeat morphine if needed 39 13  12/3/2024 Surgical Interventions Table 47.4 Palliative Shunt Blalock-Taussig Shunt Complete repair Elective repair 40 Care of Child Preoperatively Frequent cardiorespiratory assessments Daily weights NPO pre surgery Monitoring for changes in level of consciousness Family preparation Monitoring diagnostic tests Hemoglobin, hematocrit, echocardiogram, electrocardiogram, heart catheterization, basic metabolic panel 41 Post-Operative Care of Child Assessment of Cardiorespiratory function Improving oxygenation Positioning and moving Promote adequate nutrition and fluid volume status Prevent infection Adequate pain control 42 14  12/3/2024 Diagnosis and Complications for Tetralogy of Fallot Child born with heart anomaly or other chronic conditions Child may be healthy during the early years of child development and then diagnosis of an illness is made Diagnosis of a chronic illness Loss of “normal” routines and developmental expectations Additional family fears Children born with Tetralogy of Fallot are living into adulthood Transition from pediatric care to adult care 43 Pediatric Cardiac Inquest An Article from the Canadian Medical Association Journal 783.full.pdf (cmaj.ca) 44 The Findings The evidence suggests that because nursing occupied a subservient position within the HSC structure, issues raised by nurses were not always treated appropriately. The evidence suggests that nurses were not allowed to play a role in planning the February 1994 restart of the Pediatric Cardiac Surgery program, even though they formed an essential element of that program. 45 15  12/3/2024 Recommendations It is recommended that: The HSC restructure its Nursing Council to allow nurses to select its membership and to give it responsibility for nursing issues within the hospital. It is recommended that: The HSC establish a clear policy on how staff is to report concerns about risks for patients. It is recommended that: The Province of Manitoba consider passing 'whistle blowing' legislation to protect nurses and other professionals from reprisals stemming from their disclosure of information arising from a legitimately and reasonably held concern over the medical treatment of patients. 46 Thank you 47 16