Nursing Care of the Family and Child with Congenital Heart Disease

How do parents feel initially after learning that their child has a congenital heart defect?

Shock and anxiety and fear that the child will die

How should parent-infant attachment be supported for the family of a child with a congenital heart defect?

Encourage parents to hold, touch, and look at their child

How may the father or siblings negatively react to a mother spending a disproportionate amount of time with a child with a congenital heart defect?

Neglected, resentful, jealous

What is a negative effect from a parent not feeling like they can trust others with their child's care?

They are locked into caring for their child with no relief

What is a negative effect from a parent's fear that their child may die?

Overdependency

How should information about a child's congenital heart defect be communicated to the child?

In an age-appropriate way

Parents of children with a cyanotic heart defect should be educated about:

Management of fluid balance and hypercyanotic spells

What kind of information should parents share with other caregivers of a child with a congenital heart defect?

The child's diagnosis, the medications they are taking, the surgeries they have had, who the doctors are

Should parents restrict the activity level of a child with a congenital heart defect?

Generally, no, children self-regulate just fine.

How should nutrition be adjusted for a child with a congenital heart defect?

Calories should be increased. Breastfeeding is generally okay, but may need to be supplemented with high-calorie formula or given through a bottle with a special nipple in order to achieve the proper caloric intake

Should infants with congenital heart defects be immunized?

Yes. Their schedule may need to be adjusted around times of surgery or acute illness, and those with severe defects should receive RSV prophylaxis (palivizumab) during their first RSV season.

What are the expected outcomes of preparing a child for a procedure?

Reduced anxiety, improved cooperation, enhanced recovery, stronger trust with caregivers, improved long-term emotional and behavioral adjustment after procedures

How should the age of a child affect the timing for preparation for a procedure?

The younger a child is, the closer the explanation should come to a procedure. For example, a toddler might only hear an explanation the moment before a painful procedure, but an adolescent might appreciate an explanation weeks ahead of time.

Should children be allowed to bring a comfort object from home to a procedure?

Yes. Generally, children will be allowed to have it until they are anesthetized, and the object is returned to the patient before the child wakes up.

How long should a nurse take to record heart rate and respirations for a child after a procedure for a congenital heart defect?

60 seconds

What should the nurse monitor for when caring for a child after a procedure for a congenital heart defect?

Dysrhythmias, vital sign changes (possibly through an arterial line), adventitious lung sounds, maybe CVP

Why are chest tubes commonly placed in a child after a procedure for a congenital heart defect?

To drain blood and air from the pleural or mediastinal space, to allow the lungs to expand fully

What is the normal pattern of drainage from a chest tube that is placed in a child after a procedure for a congenital heart defect?

Largest volume of drainage in first 12-24 hours, first sanguineous but later serous

How should the nurse monitor for renal failure for a child after a procedure for a congenital heart defect?

Make sure urine output is greater than 1 ml/kg/hr, track levels of BUN and creatinine, and take strict intake and output measurements

What is the best way to detect fluid retention for a child after a procedure for a congenital heart defect?

Daily weights

How should a nurse encourage activity for a child after a procedure for a congenital heart defect?

Gradually, starting with sitting, standing, walking, etc.

How should the nurse splint the chest of a child after a procedure for a congenital heart defect, to minimize pain?

Have the child hold a favorite stuffed animal or pillow against incision site

How can nurses promote the emotional health of a child after a procedure for a congenital heart defect?

Allow the child to express feelings

What information should be provided to the family of a child after a procedure for a congenital heart defect?

Instructions on medication, nutrition, activity restrictions, return to school, wound care, signs and symptoms of complications like infection, when to seek medical care