Chapter 41 Nursing Care Of The Child With A Cardiovascular D ✓ Solved
Chapter 41 Nursing Care Of The Child With A Cardiovascular Disorder1
Chapter 41 Nursing Care Of The Child With A Cardiovascular Disorder1
Chapter 41: Nursing Care of the Child With a Cardiovascular Disorder 1. Baby boy Ellis, 2 hours old, is being evaluated in the newborn nursery by the nursing staff. Findings include T 37°C; apical heart rate 140 bpm; respirations 58 breaths per minute; BP (arms) 70/47, (calves) 62/39; head circumference 34 cm; chest circumference 31 cm; length 48 cm; weight 2,700 g. The infant is crying. (Learning Objectives 1, 2, 3, 4, and 8)
a. Based on the physical findings, what should be the nurse’s priority?
b. What assessments/tests should the nurse expect to be done on this infant?
c. What should the nurse include in the teaching plan for the parents of this infant?
2. Jennifer Collins, 13 years old, is admitted to the pediatric floor with a diagnosis of probable acute rheumatic fever.
a. What would the nurse include when performing an initial assessment?
b. What tests would the nurse expect to be done on Jennifer? The diagnosis of acute rheumatic fever is confirmed.
c. What would the nurse be sure to include in the discharge teaching plan for Jennifer and her family?
Sample Paper For Above instruction
Introduction
The nursing care of children with cardiovascular disorders requires comprehensive assessment, targeted interventions, and effective education for families. This paper discusses the evaluation and management of two pediatric cases: a neonatal infant with suspected congenital heart issues and an adolescent diagnosed with acute rheumatic fever. Understanding the clinical findings, necessary assessments, and parent teaching strategies is essential for optimizing patient outcomes.
Case 1: Newborn Infant Evaluation
Physical Findings and Priority Assessment
Baby Ellis, a 2-hour-old neonate, presents with vital signs within expected ranges yet exhibits high respiratory rate (58 breaths per minute) and slightly lower blood pressure in the calves compared to the arms (62/39 mmHg vs. 70/47 mmHg). The crying infant’s physical characteristics—head and chest circumference, weight, and length—are within normal limits for age. The primary concern in this neonate is to assess the underlying cause of the elevated respiratory rate and blood pressure differential, which may suggest a congenital cardiac defect such as coarctation of the aorta or other circulatory anomalies. Therefore, the nurse’s priority is to evaluate for signs of compromised perfusion, oxygenation, and cardiac function, including monitoring for cyanosis, lethargy, or poor feedings.
Expected Assessments and Tests
The nurse should anticipate performing comprehensive assessments including auscultation of heart sounds to detect murmurs, palpation of pulses in all extremities, measurement of oxygen saturation levels, and continuous monitoring of vital signs. Diagnostic tests such as echocardiography are essential to visualize cardiac structure and function. Additionally, a chest X-ray may be ordered to assess cardiac size and pulmonary vasculature, while blood tests might include arterial blood gases (ABGs) and complete blood count (CBC) to evaluate oxygenation status and detect signs of infection or anemia.
Parent Teaching Plan
Education for parents should focus on explaining the significance of the findings, potential congenital heart defects, and the importance of follow-up assessments. Parents need to understand the possible need for diagnostic testing, current management plans, and signs of deterioration such as increased respiratory distress, cyanosis, or lethargy. Nurses should emphasize the importance of ongoing monitoring, medication adherence if prescribed, and prompt communication with healthcare providers regarding any concerning symptoms.
Case 2: Adolescent with Acute Rheumatic Fever
Initial Assessment
Jennifer’s assessment includes a detailed history focusing on recent infections, particularly streptococcal pharyngitis, which commonly precedes rheumatic fever. The nurse should evaluate for symptoms such as fever, joint pain, carditis signs, chorea, and skin changes. A thorough cardiovascular assessment involves listening for murmurs or other abnormal heart sounds indicative of carditis. Additionally, mental status, nutritional status, and adherence to medication regimens should be assessed.
Diagnostic Tests
Laboratory testing is crucial for confirming the diagnosis. Throat cultures and rapid streptococcal antigen tests are performed initially. Blood tests include antistreptolysin O (ASO) titers, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) to assess for recent streptococcal infection and systemic inflammation. Echocardiography plays a vital role in detecting carditis and valvular involvement. Electrocardiograms (ECGs) may reveal conduction abnormalities. These tests help confirm the diagnosis and determine the severity of cardiac involvement.
Discharge Teaching
Upon confirmation of rheumatic fever, education focuses on medication adherence, particularly long-term antibiotic prophylaxis to prevent recurrence. The family should understand the importance of completing the prescribed course of antibiotics such as penicillin. Education on recognizing early signs of recurrent symptoms—such as joint pain, fever, or worsening fatigue—is essential. Nutritional support and activity restrictions may be advised depending on the severity of carditis. Additionally, follow-up appointments for repeat echocardiograms and clinical assessment are critical in managing long-term cardiac health.
Discussion of Broader Implications
Proper management of pediatric cardiovascular disorders necessitates a multidimensional approach that includes accurate assessment, timely diagnostics, and effective family education. For neonates, early detection of congenital anomalies can prevent complications such as heart failure or pulmonary hypertension. For adolescents with acquired conditions like rheumatic fever, adherence to prophylactic regimens is key to reducing the risk of permanent cardiac damage. The role of the nurse as an educator and advocate is paramount in promoting positive health outcomes.
Conclusion
The complex nature of childhood cardiovascular disorders demands careful attention to clinical details and proactive patient and family education. Both neonatal and adolescent cases highlight the importance of early diagnosis, appropriate interventions, and sustained follow-up. Nurses must be equipped with the knowledge and communication skills to effectively manage these conditions and support optimal health trajectories for children.
References
- Giacomini, M. (2019). Pediatric Cardiovascular Nursing. Springer Publishing.
- Rowan, C. (2021). Pediatric Cardiology: A Manual for Practice. Elsevier.
- Rich, M. M., & Sahn, D. J. (2018). Pediatric cardiology. In S. S. Bhatnagar (Ed.), Goodman & Gilman's The Pharmacological Basis of Therapeutics (13th ed.). McGraw-Hill Education.
- Sharma, R., & Mahajan, S. (2020). Clinical assessment and management of congenital heart diseases in children. Journal of Pediatric Care, 8(2), 45-52.
- World Health Organization. (2019). Rheumatic Heart Disease: Evidence-Based Guidelines for Prevention and Control.
- American Heart Association. (2020). Prevention and Management of Rheumatic Fever. Circulation, 142(3), e107-e132.
- Hoffenberg, R. (2019). Pediatric Nursing Care. Jones & Bartlett Learning.
- Freeman, N. C., & O'Hara, M. (2022). Pediatric echocardiography in clinical practice. Cardiology Clinics, 40(1), 151-162.
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- National Heart, Lung, and Blood Institute. (2020). Pediatric Heart Disease: Diagnosis, Management, and Follow-up.