Nursing plan of care and congenital heart disorders

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Nursing plan of care and congenital heart disorders

Nursing plan of care and congenital heart disorders


ASSESSMENT
Congenital heart defects, is the second highest cause of infant mortality, as a result of abnormal cardiovascular development during fetal life in the form obtruksi or interruption of blood flow patterns. Abnormalities were classified as asianotik or sianotik.
In asianotik disorders, the oxygenated blood that flowed from left to right side of the heart but does not mix with oxygenated blood in the systemic circulation. The disorder is primarily a mepengaruhi asianotik children included below:

Ventricular septal defect (VSD), the most frequent of all congenital heart defects, aimed at an abnormal opening in the ventricular septum that allows oxygenated blood from the left ventricle mixes with oxygenated blood in the right ventricle. Usually the surgery is to improve these kelaianan.
Coarctation of the aorta, aimed at narrowing the aorta close to the former fetal ductus arteriosus. This disorder usually take place by way of surgical repair.
Atrial septal defect (ASD) is aimed at the opening in the septum from the atria that allows blood to flow from left to right. If ASD is not closed spontaneously, then surgery is required.
Patent ductus arteriosus (PDA) is a permanent opening between the aorta and pulmonary artery which failed to close at birth. Although the PDA is especially true in premature infants, can be closed spontaneously, surgery may also be required.

Against kelaianan sianotik, blood flowing from right to left side of the heart, where the oxygenated blood flow from left ventricle to all parts of the body, resulting in cyanosis. Kelaianan nature emmpengaruhi sianotik which mainly include the following children:
· Transposition of the great vessels is Uatu condition where the pulmonary artery and aorta alternately: arriving at the aortic right ventricle, and pulmonary artery in the left ventricle. The occurrence of two parts of the circulatory system that can not support kkehidupan. Surgery is necessary actions to correct abnormalities.
· Tetralogy of Fallot consists of four parts aberration-VSD, overriding aorta, pulmonary stenosis, and right ventricular hypertrophy. Performed repair surgically.
ASSESSMENT

VSD
Cardiovascular

Lightweight: holosistolik murmur at the left sternal border carry.
Medium and heavy: murmur holosistolik (same as mild kelaianan), signs of heart failure (Tachypnoea, tachycardia, anxiety, increased central venous pressure, weight gain, decreased urine output, berkewringat), failure occurs rapidly, liver enlargement, reduction energy, difficulty eating, and weight-enhancing effect of fluid retention.


Lungs

Weight: pulmonary edema.

Aortic Coarctation
Cardiovascular

Lightweight: 1 + or loss of denytu femoral, popliteal pulse, and pulse dorsalis pedis; mild hypertension (elevated bilaterally on the arms and a decrease in the limbs).
Medium: loss of pulse femoral, popliteal, and dorsalis pedis; moderate and severe hypertension (detected bilaterally in the arm: a reduction in the limbs).
Weight: kelaianan same medium, plus signs of heart failure.

ASD
Cardiovascular

Systolic ejection murmur clearly (either partner heard by training high-level practitioners).
Heart enlargement.

Breathing

Increased incidence of upper respiratory tract infection.

Musculoskeletal

Activity intolerance.

PDA
Cardiovascular

Light: 4 + bilateral peripheral pulses, pulse pressure is widespread, and murmurs that continues over time on the front of the left or on midklavikula thorax.
Medium: signs of heart failure
Weight: left heart enlargement.


Breathing

Lightweight: frequent upper respiratory tract infection

Transposition of the great vessels
Cardiovascular

Heart murmur (in case of VSD)
Heart-shaped egg on chest radiograph
3 + or 4 + pulse (depending on whether the ductus arteriosus settled).
No increase in oxygen saturation, although given oxygen.


Integumentary

Severe cyanosis.

Tetralogy of Fallot
Cardiovascular

Systolic murmur along the left upper sternal border
Heart-shaped shoes on chest radiograph
Normal peripheral pulses
The possibility to attack cyanosis (dyspnea, respiratory complaints in, brtadikardia, fpusing, seizures, and loss of consciousness).
Thrill along the left upper sternal border

Neurological

Loss of consciousness

Musculoskeletal

Intolerance aktiiftas
Squatting position (if the patient is a child of the baby).

Hematology

Polycythemia
Increased hemoglobin and hematocrit values.

Integumentary
· Cyanosis
· Finger clubbing

Psychosocial

Worry

Clinical Flow
OPEN HEART SURGERY
Today I / Preop / Room
Consul

Heart Services
Anesthesia


Examination

Complete blood count, platelets, blood chemistry, coagulation, fdibrinogen degrees.
Type and cross
Electrocardiogram (ECG), chest radiograph, echokardiogram
Examination of urine

Handling

Pulse oximetry
Vital signs (VS) every 4 hours
Bathroom with antiseptic
Infusion if necessary, intake and output (I & O)
Provision of appropriate development interventions


Treatment

Aspirin was stopped during the previous 2 weeks in the hospital when needed.


Diet

Customize with age, according to instructions
Fasted after midnight


Activities

In accordance with age, according to instructions.


Process Team

The format of patient history / assessment at admission.
Assessment system
Handling the growth by a physician
Completeness check list prabedah.

Teaching
C = class
H = handout
R = reference
V = video.

Orient to the routine activities in the room
start teaching prabedah
visits to the intensive care unit (ICU)
Review of nursing plan


Follow-up plan

Kaji support networks
Strengthening the length of stay


Needs and results

Paien / parents express about the surgery and hospitalization.
Patients maintain the level of development
Paien / parents express his understanding of routine space activities and policies.
Paien / parents expressed an understanding of teaching prabedah.

Day ke-2/OR/PICU
Consultation

Respiratory Medicine


Examination

Laboratory activities as directed.


Handling

Monitor cardiac / respiratory (CR), neurological checks, pulse oximetry.
Vital signs every 15 minutes to 1 hour.
Keep the pressure flow, hypothermia blankets, infusion, pacing wires (closed and six), pleural chest tube from bottom-emptying kedinding sucker, ventilator support (not used if if there is a hose left atrium), pulmonary care every 2 hours and as needed.
Restrictions on the 4 parts.
Listing of strict intake and output every hour, the eye care
Transfusion if necessary
Permanent catheter urine.
Weigh the body weight every day (not done when mounted hose LA).
Nasogastric 9NG) tube for low gomco, check pH and guaiac.

Treatment:

I.V vasoactive drug, pain management
IV sedation, IV antibiotics, histamine-2 blockers, diuretics.

Diet;

Age-appropriate, as directed.

Activity:

Age-appropriate, as directed.

Process teams:

Assessment system.


Teaching
C = Class
H = handout
R = reference
V = video

Orient routine ICU
Postoperative care instructions: intervention, treatment
Flowsheet education about the heart.

Follow-up plan:

Kaji support networks

Needs and outcomes:

Penampilanm patients, there was no hint of rtimia
Adequate perfusion is characterized by limb palpable pulse, warm, and urine output.
Gas exchange is maintained through the support ventilator characterized by arterial blood gas (AGD) and oxygen saturation within acceptable parameters.
Patients control the pain adequately characterized by non-verbal communication, ability to rest, and vital signs.
Patients free from interference.
Patients / parents support the development of appropriate services.
Parents expressed understanding of the activities and policies ritun in the room and post-surgical care instructions.

Day ke-3/POD # 1/PICU
Consultation:

Respiratory Medicine

Inspection:

ECG, chest radiograph
Assessing blood work as often as possible.

Handling:

Monitor cardiac / respiratory, neurological checks, pulse oksimetry.
Vital signs every hour.
Keep the pressure hose, pacing wares (closed and secure), pleural chest tube dati bottom-emptying into the wall suction, discontinue ventilator support
Disposal of lung every 2 hours and if diperlaukan.
Permanent catheter urine.
Weigh the body weight every day (not to be done if an interval of LA).
NG tube to low gomco, check pH and guaiac
Skinfold measurements every hour intake and output
Infusion.

Treatment:

Sedative I.V.
Pain management
Stop the vasoactive drug
I.V. antibiotics, histamine-2 blockers
Diuretics, digitalis

Diet;

Age-appropriate, as directed.

Activity:

Age-appropriate, as directed.

Process teams:

Assessment system


Teaching
C = class
H = handout
R = reference
V = video

Strengthening post-surgical care instructions.

Follow-up plan;
Needs and results;

The patient showed no signs of bleeding is characterized by chest tube drainage; CBC and vital signs within acceptable parameters.
Patients mendemosntrasikan perfusiyang adequately characterized by tolerance to drug discontinuation vasiactive.
Patients maintain skin integrity.
Patient's pain adequately mengonrol ditandfai by non-verbal communication, ability to rest, and vital signs.

Day ke-4/POD # 2/PICU
Consultation:

Children living
Social Work

Peemriksaan;
Handling:

Monitor cardiac / respiratory, neurological checks, pulse oksimetry
Vital signs every 1 hour, lung disposal every 2 hours and, if necessary.
Keep the pressure hose, indfus, stop hose LA.
Chest tube of the pleura - emptying into the wall suction.
Oxygen extubation, sternal lift the bandage.
Skinfold measurements intake and output every 1 hour, eye care
Permanent catheter urine
Weigh the body weight every day
Stop the NG tube

Treatment:

Stop the vasoactive drug
Pain management
I.V antibiotics, histamine-2 blockers
Diuretics
Keep Lanoxin

Diet

Appropriate age, according to the instructions


Activities

Appropriate age, according to the instructions


Process team

Assessment system


Teaching
C = class
H = handout
R = reference
V = video

Strengthening post-surgical care instructions

Follow-up plan
Needs and results

Patients receiving vasoactive treatment termination is characterized by maintaining perfusion.
Patients are not hot
Patients tolerate extubation marked AGD and oxygen saturation; upya breathe within acceptable parameters.
The incision is performed on patients showed no swelling or effusion.
Patients did not vomit after eating
Patients control the pain adequately characterized by the expression / using pain scale.
Patients / parents express pemahamannnya against the patient's condition today and change interventions.

Day ke-5/POD # 3/PICU
Consultation
Examination

Chest radiograph after the chest tube is stopped.


Handling

Stop oxygen bilamungkin
Expenditure lung every 2 hours and when necessary
Pulse oksimetry
Monitor cardiac / respiratory, vital signs every 2 hours
Infusion
Weigh the body weight every day
Stop the chest tube.
Measure intake and output

Treatment

Handlers pain
Keep Lanoxin and diuretics
Stop antibiotics after a chest tube removed.
Stop histamnie-2 blockers


Diet

In accordance with age, according to the instructions.


Activities

Age-appropriate, as directed.


Process team

Assessment system.

Teaching
C = class
H = handout
R = reference
V = video

Started teaching about treatment using medication instruction sheets.

Follow-up plan
Needs and results

The patient tolerated the removal of chest tubes with no marked by pneumothorax or bleeding.
Hemodynamic stable patients ditandfai by rhythm, perfusion, and vital signs.
Styatus respiratory patients characterized by unstable oxygen saturation, breath sounds, and efforts to breathe within acceptable parameters.
Location Chet hose tube without redness, swelling, or fluid flow.
Pasienkemih spontaneously after the catheter is withdrawn.
Patients menstoleransi increased activity.
Patients / parents expressed an understanding of basic explanation of treatment.

ari ke-6/POD # 4/Dipindahkan into space Pediatrics
Consultation
Examination
Handling

Expenditure change every 2 hours and when necessary
Pulse oksimetry every 4 hours
Vital signs every 4 hours
Disconnect infusion
Weigh the body weight every day
Lift pacing wares


Treatment

Pain management
Keep Lanoxin and diuretics.


Diet

Age-appropriate, within their instructions


Activities

Age-appropriate, as directed.


Process team

Assessment system


Teaching
C = class
H = handout
R = reference
V = video

Orient in the pediatric
Explanation of treatment using medication instruction sheets.

Follow-up plan
Needs and results

Respiratory status of patients characterized by unstable oxygen saturation in an acceptable parameters; filling the lungs fully, clearly both.
Patients tolerate the increased activity
Patients / parents expressed an understanding of the treatment, intervention, and treatment.

From ke-7/POD # 5/Ruang pediatric
Consultation
Examination

Handling

Disposal of lung every 4 hours
Pulse oksimetry every 4 hours
Vital signs every 4 hours
Weigh the body weight every day
Lift the chest tube dressing.


Treatment

Pain management
Keep Lanoxin and diuretics


Diet

Appropriate age, according to the instructions


Activities

Age-appropriate, as directed.


Process team

Assessment system


Teaching
C = class
H = handout
R = reference
V = video

Review / reinforcement all subsequent explanations

Follow-up plan
Needs and results

Patients / parents expressed an understanding of the treatment, intervention, and treatment ditanbdai by actively participating.

Day ke-8/POD # 6/Ruang Pediatrics
Consultation
Examination

Chest radiograph, ECG, echocardiogram


Handling

Disposal of lung every 4 hours
Pulse oksimetry every 4 hours
Vital signs every 4 hours
Weigh the body weight every day.


Treatment

Pain management
Keep Lanoxin and diuretics


Diet

Appropriate age, according to the instructions


Activities

Appropriate age, according to the instructions

Process team

Penglajian system

Teaching
C = class
H = handout
R = reference
V = video

Strengthening all subsequent explanations.


Follow the plan

Writing within 24 hours tindfak information provided.

Needs and results
Patients / parents express and show confidence and readiness for change.
Day ke-9/POD # 7/Ruang child
Consultation

Examination
Handling

Pulmonary toilet every 4 hours
Pulse oksimetter every 4 hours
Vital signs every 4 hours
Tyimbang body weight per day
Check / lift stitches.


Treatment

Pain management
Keep Lanoxin and diuretics


Diet

Age-appropriate, as directed.


Activities

Appropriate age, according oetunjuk.


Process team

Assessment system


Teaching
C = class
H = handout
R = reference
V = video

Give strengthening before teaching home plans


Home plans

Further instruction sheet
Follow-up with agreements by Koter
Home at 11:00


Needs and results

Patients / parents express and show confidence and readiness to go home today.
Patients / parents express and pemahami to the next instruction.


Nursing Diagnosis
Anxiety (parents) are associated with congenital heart defects in children.

Expected results
Parents will experience a decrease in anxiety is characterized by its ability to express feelings, to answer correctly questions about the Events of children, and interacting with children.

Intervention
1. Describe cardiac abnormalities by using illustrations, and answer the questions parents, if possible, discuss the various components kelaianan heart.
2. Give regular information about the child's condition.
1. Allow parents raised or mengendong baby as soon as possible and as often as possible whenever possible.
Rational
1. Explanation of heart failure and provide answers to questions parents will help reduce anxiety by allowing revealing and well about kelaianan memahamin heart, and some abnormalities as a result of genetic factors.
2. Provide regular information mengungkinkan parents to maintain contact with children, reducing anxiety

Lifting and mengendong children will increase bonding and feelings of security, will mengurango anxiety.


Nursing Diagnosis
Lack of knowledge related to the surgery to be faced.

Expected results
Parents, son of funds (if possible) will mendemisntrasikan pemahamnan against surgery that would be characterized by its ability to explain the reason for the surgery and answer the questions correctly.

Intervention
1. Assess the knowledge of parents and children to the surgery to be faced and tinfkat child development (see appendix A, the normal growth).
2. Instruct children and elderly oprang of perioperative events that will allow direct participation, including

Bathing children using providone-iodine solution (betadine) or hexachlorophene (pHsoHex) at night before surgery
Oriented to the intensive care unit (ICU) before surgery.
Set for fasting prior to surgery (the exact time will depend on the child's age)
Following education about post-surgical equipment and procedures, such as chest tubes, oxygen maker, incentive spirometer, a bandage, endotracheal tubes, intravenous lines, central venous pressure monitoring and blood vessels, monitoring electrocardiogram (ECG), and postural drainage.

3. Teach your child cough, breath deeply, and splinting techniques, if possible.

Rational

The assessment will provide a basis to begin teaching.
Children and parents need to anticipate the circumstances surrounding the surgery. The surgeon will explain the procedure and significantly associated with risk in the elderly.
Coughing, breath in, and the splinting helps eliminate and remove secretions from the airway and increase oxygen. Proceeds from this technique will peningktkan setelahpembedahan lung development.


Nursing Diagnosis
Risk of injury related to the setting position, an electrical appliance dugunakan, blood loss, and surgical procedures.

Expected results
Children will not experience injury during surgical procedures.
Intervention

Assess the depressed area on the child every hour during surgical procedures that result in skin damage. See the reddish, pale skin, tears, and open wounds.
calculate the fluid volume shavings children, based on fluid intake and blood loss occurs.
If the child has surgery to repair coarctatio of the aorta, blood pressure monitors on the leg during surgery.
Monitor cardiac rhythm anak.pemasangan temporary pacing wires and installation of a temporary pacemaker can be provided in case of emergency.
Check the electrical grounding pad and the location of ECG electrodes that can cause burns.


Rational

skin damage, which can occur in 1 hour at the start of surgery, the child was at risk of infection.
Addition of liquid needed to maintain adequate cardiac output.
During surgery improve their coarctatio, given through the aortic clamp. Monitoring blood pressure in the legs to help ensure the necessary blood flow back to the lower body.
Monitoring heart rhythm is important because surgical procedures can be temporary or permanent is decided normal conduction of the heart.
Electrical graunding in place can cause burns eprtama level.


Nursing Diagnosis
Decrease in cardiac output associated with surgical procedures.
Expected results
Children will maintain adequate cardiac output after cardiac surgery characterized by frekuesnsi and pernafasdan according to age; strong, regular pulse, and capillary filling time of 3 to 5 seconds.

Intervention

After surgery, review the state of the heart every hour, as where the following:
Measure and record the child monittor hemodynamic (arterial hose, hose central venous pressure (CVP), intracardiac catheters, cardiac output and thermistor). Normal left atrial pressure is 0 to 8 mm Hg; Normal CVP is 0 to 5 mm Hg.
Monitor blood laboratory tests, including prothrombin time, measurement analysis of fresh blood (AGD), and complete blood count (see appendix E, normal laboratory values).
Review the signs of heart failure in children, such as shortness of breath, cracles, tachycardia; see the edema around the eyes and weight gain in infants.
Assess heart sounds in children in additional noise and the sound of friction.
Assess renal function apda children through;

Measuring and recording fluid intake and output (normal lebh discharge greater than 1 ml / h)
Monitor urine specific gravity every time you urinate or every 2 to 4 hours if the child is fitted with a catheter.
Monitrot blood urea nitrogen (BUN) and serum levels of kretinin.

Assess the state of fluid and electrolytes in children through:

Tiungkat electrolyte monitoring (see appendix E, normal laboratory values).
Measure and record fluid intake and output every hour.
See any signs of edema and poor skin turgor.
Weigh the body weight every day.

Assess respiratory conditions in children through:

Monitoring and record the pattern and frequency of child breath, wheezing, skin color, capillary oengisian time; also monitor ventilator equipment, and read intracardiac catheter oximeter, and the level of CO2.
Check if there endotracheal tube (ET) that the security tape and record the installation of hose through the X-ray tube in order to mengakji accuracy ET.
Monitoring and record the amount of chest tube fluid emlalui setisap hours (normal expenditure of less than 3 ml / h); well chest tubes, and signs of infection in the area of ​​installation.
Monitrong AGD level every 4 to 8 hours.
Ventilation children with 100% oxygen for 1 minute before and after penmgisapan via ET.
Assess the child's neurological condition, cata pupillary reactions, muscle tone, and reflex (cengkrman, sucking, and swallowing).


Rational
1. Surgery and causing severe trauma to the child's body.

Hemodynamic instability due to trauma surgery. In lkhusus, changes in CVP may indicate right heart failure, changes in arterial pressure as an indication of p [erubahan blood pressure, and changes in cardiac output may indicate heart failure.
Heart bypass and damage blood cells and causes hemolysis of red blood cells, the possibility of anemia. Anticoagulants can be recommended to prevent clotting. AGD measurements indicated eprfusi oxygen levels in the blood.
Due to the stress of surgery, the child may pose a risk of heart failure as a result of increased cardiac workload and increased sodium and water retention.
Bleeding can occur at Katong pericardial and the limited ability of cardiac function. Kelainanan heart sound can indicate cardiac tamponade. The sound of friction can be indicated postpericardiotomy syndrome (pericardial constraint or pleural reaction characterized by fever, chest pain, and signs of pericardial or pleural inflammation 0tanda).

2. Surgery is dangerous to normal kidney function.

Measure and record fluid intake and output will help determine kedaan fluids and kidney function.
Urine specific gravity measurements indicate the state of hydration and the ability of kidneys to concentrate urine.
Decrease in BUN and kretinin level can indicate kidney failure.

3. Surgery causes an imbalance of fluid and hydration elekrolit help determine the child's circumstances and level of potassium. (A decrease in potassium can cause arrhythmias).
· Intake and output measurements help determine the state of fluids and kidney function and memantu prevent excess fluid.
· The signs of edema and poor skin turgor may indicate poor hydration and heart failure.
§ Increasing weight merupana early signs of heart failure.
4. Surgery can membahyakan pwernafasan situation of children.

Immobility, pain, and the use of anesthetic gases will disrupt the normal functioning of the lungs.
ET tube position are not supposed to inhibit the function of breathing.
Excessive secretion of fluid through the chest tube to indicate the occurrence of bleeding; stress of infection in the immune system of children.
AGD Level efektfitas directly measure respiratory condition.
Ventilation with 100% oxygen relaxes the alveoli and prevent severe hypoxia and stoppage of breath.

5. Neuroligs state interference and occurs as a result of decreased cardiac output, hypoxia, acidosis, electrolyte imbalance, or thrombosis of the brain.

Nursing Diagnosis
The risk of infection associated with immobilitas and place made an incision.

Expected results
Children will show no signs of infection characterized by a body temperature of 97.6 º to 99 º F (36.4 º to 37.2 º C), white blood cell count is stable, and the signs vitak accordance with the child's age.

Intervention
1. Review the incision area and infusion every hour of signs of bleeding, erythema, infiltration, and drainage of excess fluid from the wound drain.
2. monitor the child's temperature and check the lekositosis.
3. Assess the depressed areas of the body every hour on the first 2 hours to 3 hours, then every 2 hours thereafter.
4. Give antibiotics as directed.
5. Gantu bandage as instructed, use the technique of sterilization.

Rational
1. Immunological system of children have been pressured by the surgery. Emphasis is also dapoat caused him infection in the incision area which can be husband's dance of septic shock. Loss of fluid emlalui infiltration or bleeding can interfere with cardiac output.
2. Perningkatan lekositosis temperature and can indicate an infection.
3. Assessment is required to penghindari skin damage.
4. Antibiotics can be given to help prevent infection.
5. Sterilization technique helps prevent the bacteria into the incision area.

Nursing Diagnosis
Risk of injury associated with indomethacin administration (in premature infants who have PDA).

Expected results
Babies will show no sign of injury 0tanda ditanbdai by the frequency of heart and pernafasdan appropriate age level and urine output of 1 to 2 ml / kg / hour.

Intervention
1. Bewrikan indomethacin (indocin) as directed. Be sure to check and double check all the drugs before the drug is given (usually 0.2 mg / kg).
2. Assess and record the child's heart condition, respiratory, renal, gastrointestinal, and state neuroligs every 4 hours. If the infant is stable, review setiap1 to 2 hours.

Rational

Indomethacin causes narrowing of the duct which increases closure. Double check the administration of drugs will help mencegfah administration of drugs that berelebihan.
The assessment takes weeks to detect a variety of possible complication (like bleeding) after administration endomethacin.


Nursing Diagnosis
Decrease in heart cvurah indfundibulum spasm associated with the lungs (in children denganm teralogi fallot0.

Expected results
Children will not show signs of attack danaya cyanosis.

Intervention

Recognize the signs and symptoms of cyanosis, including dyspnea, respiratory complaints in, bradycardia, fingsan, seizures, and even loss of consciousness.
Place the child in the prone position knee-to-chest.
Speak with a light tone and rub it on bgian belaang children.
Ventilation with 100% oksdigen children using the lid of oxygen, nasal cannula, or device a blast.
Give Morphin sulphate I.M. (0.1 to 0.2 mg / kg) or I.V. (0.5 to 0.1 mg / kg / per the instructions.
Teach parents how North intervening 1 to 4.
Teach parents how North giving beta blocker drugs, such as propranolol hydrochloride (Inderal)


Rational
1. Early introduction allows intervention before severe anoksia which can cause deterioration of consciousness.
2. This position will reduce the workload of the heart with blood menurnnnya behind the peripheral.
3. Menyjukkan tone and touch of a comfortable and helps relax the spasm.
4. Ventilation with 100% oxygen increases the amount of oxygen in the inspired air and in circulation.
5. Morphin helps relax the spasm and menyebabkankan vasodilation.
6. mewngetahui how this intervention will help parents adjust to the crisis that caused spasms and allow him to participate in child care.
7. Beta blockers will decide the mechanism that affects the infundibulum spsme lungs. Teaches parents how to provide treatment will help improve compliance with home care.

Nursing Diagnosis
Risk of infection (bacterial endocarditis), associated with an increased flow through the hole (in children with VSD).
Results diharakpan
Children will show no signs of bacterial endocarditis and bacteremia.

Intervention

Explain to parents cause bacterial endocarditis, particularly in relation to dental and surgical procedures. This explanation for the prevention of infection, particularly in children who received prophylactic antibiotic treatment.
tetrtulis give instructions to parents of special procedures in the provision of antibiotic treatment.


Rational

Understanding the causes of bacterial endocarditis will increase to meet a given antibiotic treatment.
Having a variety of information will increase to meet the provision of treatment.


Nursing Diagnosis
Anxiety (children) are associated with the ICU environment, separated from parents, parental anxiety, surgery, immobilization dasn.

Expected results
Children will be reduced his anxiety is marked by cooperation in the procedures and treatment and play according to age level.

Intervention

Encourage parents to visit children and participate in treatment as often as possible.
Explain to the children and parents each stage in the post-surgical care.
Consult the Child-life waorker or play therapy on children games and activities appropriate in accordance with developmental level.


Rational

Contact with parents will give the child a sense nayaman and safe.
Familiar with prosewdur and nursing actions will reduce anxiety and increase cooperation.
Games and akantifitas will help various children's attention on the environment and provide sitimulasi development.


Nursing Diagnosis
Lack of knowledge related to home care.

Expected results
The parents will express pemahamanan of home care instructions and will demonstrate procedures for home care.

Intervention

Teach parents signs of wound infection, including the existence of a keeluar pus from wounds, fever, and the smell that wafted from the wound.
Teach parents how to give the drug when the child is still in the hospital.
Teach parents how to monitor the pulse of children, and teach how it was reported when a deviation occurs 15 samnpai 20 pulses above or below the normal limit.
Instruct parents to feed the children a little, but often.
Teach parents the signs and symptoms of post-pericardiotomy syndrome, including fever, chest pain, and dyspnea.


Rational

Because infection can occur more than 3 weeks after surgery, parents need to know the signs to report.
The practice of increasing comfort with the procedure and meet the needs. The practice of the parents when a child is still in hospital, by examining the ability of parents to provide proper treatment.
Knowing how to monitor the pulse of the child will allow parents to detect and report a variety of significant changes which indicate the occurrence of complications.
Eat little and often will reduce the workload of the heart to maintain adequate caloric intake.
Post-pericardiotomy syndrome would potentially life-threatening, can occur over 3 weeks after cardiac surgery. Parents need to know the signs and symptoms to be reported in case of emergency.

Documentation checklist
During his stay in hospital care, notes:
The situation of children and the study by the admission
Child status change
Associated with laboratory tests and diagnostic examinations
Nutrition
Things grow and develop
Response to treatment in children
The reaction of children and parents of sick and stayed in hospital care.
Guidelines for teaching patients and families
Guidelines for home plans

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