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Nursing Home’s Focus: Rehabilitation

admin — Thu, 23 Feb 2012 05:38:53 +0000

Soon to rise on Springfield’s west side is a nursing home with a 75-bed capacity. This facility will concentrate more on short-term rehabilitation while providing the services as well as hospitality a fashionable hotel. This statement was from the developers of the projects.

Brian Levinson, partner of Platinum Healthcare, stated that this is for those whose independence is dominant during the ceremonial groundbreaking for the facility called The Bridge Care Suites, which is said to be well worth $12.9 million.

He stated that the facility has cutting-edge care model which is expected to magnet adults who are 50 years and older who require intense rehabilitative therapy as they are getting better from conditions which range from heart problems, hip/knee replacements to falls, strokes, and sports injuries.

A lot of these people, at least for those in the Springfield locality, are at the moment recovering at their homes and are receiving home health care services or are going to outpatient rehab centers, continued Levinson. They are not so attracted to the idea of traditional nursing homes which mainly house patients who have chronic conditions, he stated.

The Bridge Care Suites is anticipated to be functioning by January 2013 located at 3089 Jacksonville Road. This facility will primarily provide services to those who are covered by Medicare as well as private health insurance for stays that are short-lived. The facility shall also accept Medicaid patients, said Levinson.

Platinum and Mainstreet Property Group is behind this facility. They are a real-estate development company based in Skokie from suburban Indianapolis. Platinum shall hold the nursing-home license as well as manage the facility.

The structure’s constructions will produce around 375 jobs, based on Platinum. The general contractor shall be Walsh Construction. Also, around 150 people shall be taken on by Bridge Care Suites the moment it starts to function, Levinson said.

Almost every room is a private one. The facility shall also have a café, a business center, home-like furnishings and wireless Internet, Levinson continued.

Bridge Care Suites “hospitality” care shall cost Platinum beyond what conventional nursing-home models do, however, Levinson said that Platinum anticipates to gain profit. Platinum also manages Springfield’s Capitol Care Center.

Bridge Care Suites, according to Levinson, belongs to a much particular niche which at the moment is not being served.

The patient population at Capitol Care, 555 W. Carpenter is not projected to go down when the fresh facility starts to function, he stated.

Mike Houston, Mayor of Springfield, stated at a ceremony held Tuesday that being a senior citizen, he is happy to see Springfield’s Bridge Care Suites, yet he hopes that he will never have to use it.

The mayor said it will definitely have a huge impact on the economy.

The site is five acres and is located just a couple of blocks from the Orthopedic Center of Illinois, Physicians Group Associates, Gailey Eye Clinic, and Memorial Health System’s Koke Mill Medical Center.

Houston said that they are really producing a west side medical location in Springfield

Drug Addicted Nurse Allowed to Work by the State

admin — Wed, 22 Feb 2012 05:37:56 +0000

The state was aware that nurse Jerold L. Mullins has been taking drugs from hospitals and other employers he had, yet he was never given any type of punishment from state regulators.

For about 15 years, Mullins has jeopardized patient safety and well-being by providing care for them even though he was high on drugs. He took these drugs at the time he was on duty as a nurse anesthetist, based on a consent order which was just made known to the public by the Minnesota Board of Nursing.

Mullins’ addiction had turned so menacing that while he was on duty, he gave more than the required drugs needed for the patients because this would entail there will be more for him to reroute, based on state records.

The report also showed that people told him his patients were much calmer as opposed to everybody else’s patients. It is unclear where Mullins was employed because the report did not make known any of them. 59-year-old Mullins lives in Princeton.

Mullins’ inappropriate behavior weren’t fully examined by state regulators until the year 2010, when he informed the board voluntarily regarding his past drug abuse, work problems, and ongoing efforts to get treatment in license renewal forms.

Mullins’ is on his third trip to a treatment sponsor which is backed by the state via the Health Professionals Services Program. This program flaunts itself as being another method to board discipline. Under the state regulation, health practitioners as well as their employers should report drug abuse to the program or their licensing board, based on the HPSP’s website.

Several go for HPSP for the reason that it is non-disciplinary and supportive, based on a quote from Monica Feider, who supervises the program. Feider did not give back a call for remark Tuesday.

Executive director of the Board of Nursing Shirley Brekken stated that it is indeed a concern that Mullins was not reported to the board previously. Mullins has reported to the board when he was asked. It is significant that the board get details so as to have an investigation and be able to take action.

As soon as the board learned of Mullins’ issues, it reexamined his cased as well as revoked his license. But he can always reapply for his license in five years’ time provided he can submit proof for being drug-free for a course of 24 consecutive months, based on the final consent order last October.

Nursing Interventions for Stable Angina

admin — Tue, 14 Feb 2012 07:01:53 +0000

Stable angina is a common situation in the emergency department. It may be described to be asudden chest pain in which there are patterns that can be observed. Physiologically, the chest pain occurs when the heart pumps more blood due to more oxygen demand. Among both sexes, men and women have equal chances of experiencing stable angina.

Stable angina as a sign can be very helpful in evaluating patients who have the tendency to have a heart attack. Chest pain as complained by patients must also be screened out in order to point out on what it is the true state. Some chest pain is due to a pulmonary infection, embolism that blocks a lung artery or narrowing of arteries. Psychological factors may also start chest pain as presenting sign panic attacks.

A successful evaluation whether a patient has suffered a stable angina is a good step in helping the patient to function on a moderate level of activity. He or she can function properly without reaching the maximum activity level thereby preventing future episodes of angina and eventually heart problems.

Characteristics of a stable angina:

Onset is predictable
The pain can be relieved with rest
Glyceryl trinitrate is sometimes used in order to relieve chest pain
The pain can be described to be reaching up to the jaw, shoulders and chest

Diagnostic Methods:

The patient must undergo electrocardiography in order to trace the electrical impulse of the heart.
Evaluation of the pain elicit so that it will be the determining factor of the severity of thecoronary heart disease.

Nursing Management:

Assist the patient to explore his feelings when the pain affects his daily functioning, mood as well as his lifestyle.
Encourage the patient to take medications prescribed such as beta-blockers which is considered as the drug of choice for the initial therapy. There is another part of treatment that involves aspirin. This must be well observed as it entitles the patient to a long-term therapy.
Explore the feelings as well as knowledge of the patient about stable angina. Clear out some of the misconceptions about this as early as possible.
Allow the folks of the patient to know about the information as well as set up a plan of action that will save the life of the patient whenever stable angina attacks.
Assist the patient as well as the family when surgical intervention is needed. A surgical revascularisation will be done in order to pave way normal blood circulation to the heart. Secure the consent as well as the full acceptance of the operation before the patient is sedated.
Assist as well as refer community services that would help the patient adjust after the surgery.

More Nursing Interventions

Nursing Facility Steers Black Nurses from the Homes of White Clients

admin — Wed, 08 Feb 2012 00:42:18 +0000

One company that offers in-home nursing services got accused of driving black nurses away from white clients’ home.

Previous staffers at Accord Services stated that the agency would describe some nurses as being too ethnic, too black, too ghetto or too old when it comes to choosing to send them to a house, based on a federal lawsuit.

The lawsuit said that defendants purposely held discriminations to applicants and employees alike who are black, which includes African Americans and Africans, and were more in favor of employees and applicants who are Caucasian and Hispanic. The lawsuit seeks monetary damages.

The four plaintiffs explained that the negative stereotyping of blacks produced a working place that is leaking with hostility towards blacks.

But a company’s spokesman said that the plaintiffs are just discontented previous employees who were either fired or had resigned.

Freddy Allen, administrator, said to Channel 2 Action News that he has read the allegation which he finds totally untrue. He noted that the agency has black nurses who have been employed in Accord Services for nearly ten years.

The plaintiffs included Tracee Goldman, Erika Arnold, Christine Muchene, and Debra Trawick, who assert disobedience of the U.S. Civil Rights Act.

Arnold, former human resources manager, said in the lawsuit that statements can be heard which ranged from a nurse can’t be used due to being too ghetto or that a client wouldn’t prefer foreigners or that black women are not skilled professionals. Arnold was taken on by the company in June 2007 and was fired back in April 2009.

Also a previous HR staffer, Goodman, who has worked at the company from October 2006 and December 2008, had the same allegations in the suit of 63 pages.

Prior to putting someone in a particular position, Goodman said questions like what color or what age were asked first. Goodman confirmed applications and made background checks.

Race-based comments, said Goodman, were usually made at staffing meetings, in which Accord would convey inclination to employ white and Hispanic applicants for nurse’s aide and nurse positions.

A white office manager, Trawick, who functioned at Accord from June and August 2009, stated that the company was open to discussion on the preferences of clients for white or younger nurse’s aides and nurses.

Trawick recalled statements such as “You have to staff him with a WG, he does not want a black person” or “She can’t be used because she lacks a tooth and she is too ghetto” during meetings.

Certified nurse’s aide, Muchene, who is a Kenyan, stated that she applied to Accord first in 2007 and each year she was told that her application is still active, and she would be contacted should a position be available. She stated that not a single call was made to her even after she saw that postings for vacancies would be filled later.

While Trawick was still office manager, she said when she asked regarding Muchene’s application, the company would tell her they favored younger or non-African applicants.

Muchene is a permanent U.S. resident. She filed a complaint with the Equal Employment Opportunity Commission. It gave her a “notice of right to sue”.

However, Allen dismissed such claims. He told Channel 2 that every allegation was made by a couple of discontented employees who were either fired or had resigned.

Also black himself, Allen said that if a likely client asks for a nurse or a different race, such request was denied and that the client is referred somewhere else.

A lawyer for the plaintiffs states that the group would like a jury come to a decision for monetary damages.

Low Medicaid Reimbursement Rates in Iowa

admin — Wed, 08 Feb 2012 00:33:03 +0000

In Mason City, low reimbursement rates for several assisted living centers in Iowa is pushing people who are not in need of 24-hour care into care centers that are more expensive, said a state health care official to North Iowa caregivers, seniors and care center officials.

Executive director Steve Ackerson of the Iowa Health Care Association and Iowa Center for Assisted Living said to a group consisting of 45 area care center officials along with employees in Mason City that if nothing is done about cost containment, patients with low acuity shall go into nursing homes.

Ackerson tackled on various long-term care problems during a legislative forum at Good Shepherd Health Center. He went on to say that assisted living is a chief emphasis of his efforts in advocacy this year. He said the theme is care, and not cut.

Financially supporting home as well as community based amenities such as assisted living lets people stay there, he stated. It is less expensive for that state, and it is what people want as well.

However, in Iowa, Medicaid reimbursement is almost non-existed for residents in assisted living facilities.

Director of assisted living Jean Palmer at Good Shepherd Health Care Inc. pointed to statistics given by Ackerson that just 5% of the residents of Iowa’s assisted living facilities are on Medicaid. The rest are privately paying.

This is because of the low Medicaid reimbursement rate, said Palmer.

She said that in most nursing homes, the Department of Human Resources has to pay more in order to keep them there.

Director Mike Svejda of Good Shepherd Health Center Inc. stated that living in a nursing home was twice to thrice more expensive as opposed to assisted living.

Svejda went on to say that the state has to use the assisted living program more and this is through paying the assisted living program more in order for it to be more affordable for those people who have low earnings.

One way to do so is by putting in more money into the Home and Community Based Services waiver program in order to enable a lot more people to stay in assisted living, recommended Svejda.

In an associated issue, Palmer reported that those persons who are in assisted living who get benefits from the Veterans Administration are now obliged by the state to take away those benefits from the total that they get from the HCBS waiver.

Palmer stated that it acted as a disservice to the nation’s veterans.

Still another area that raised concern was the shortage of collaboration between the Department of Human Services and the Department of Inspections and Appeals in keeping an eye on the state’s long-term care facilities. Palmer said that they need to report to both bodies.

Ackerson stated that among the aims of his advocacy groups is to bring together DIA required reporting and DHS incident reporting so that assisted living facilities would be able to finish a single reporting process that would please the two bodies and decrease unneeded repetition of documentation efforts.

State Senator Amanda Ragan of D-Mason City stated that one of the key matters she got from Ackerson’s report is the fact that Iowa is performing a great job of working with a lot of seniors which is not an easy feat.

But according to Ragan, what is an alarming fact is the federal effect of the decrease in reimbursement for both Medicaid and Medicare, and that it is affecting the most vulnerable group of people, the elderly.

Pediatric Shock

admin — Wed, 01 Feb 2012 05:28:07 +0000

It has been noted that shock in children can be easily managed if early recognition of the condition is achieved and if timely intervention and treatment is initiated. Nurses have a big role in such through proper patient assessment, family education, and proper management.

Assessment

It is crucial for the health team to come up with the most detailed and frequent assessment of a child with shock. It is in this stage that the prognosis and survival can be projected to either a positive or a negative outcome.

Parameters that greatly matters in assessing a child with shock are the following:

Pulses (proximal and peripheral pulses)
Perfusion
Skin color
Skin temperature
Vital signs
Urine output
Level of consciousness
Respiratory functions

Ongoing assessment is also critical; therefore as the disease progresses or improves, indicators to predict survival have been noted:

Heart rate
Arterial blood pressure
Serum lactate levels
Degree of acidosis

Nursing Diagnosis

Decreased cardiac output related to inadequate intravascular volume
- As evidenced by:
  - Hypotension
  - Deprived perfusion
  - Lethargy
  - Increased Cardiac rate
  - Deficient urine output
  - Ineffective peripheral tissue perfusion related to vasodilation and coagulopathy
    - As evidenced by:
      - Decreased urine output
      - Metabolic acidosis
      - Altered neurologic status
      - Decreased cardiac output related to decreased cardiac function
        
        As evidenced by:
        
        Decreased blood pressure
        
        Poor perfusion
        
        Lethargy
        
        Tachycardia
        
        Lesser urine output

Outcome Identification

Patient will be able to restore normal volume status, heart rate, urine output, blood pressure, and level of consciousness within twenty four to forty eight (24 – 48) hours.
Patient will be able to exhibit restoration of normal vascular tone (septic – induced distributive shock).
Patient will be able to obtain normal blood cultures and without indication of any bleeding alterations and disorders.
Patient will be able to obtain blood cultures negative of sepsis.

Planning and Implementation

Vital signs monitoring
Perfusion assessment and monitoring
Carrying out orders for administration of both intravenous fluids and medications (such as inotropics and antibiotics)
Strict monitoring of intake and output (diarrhea, vomiting, etc.)
Respiratory status monitoring (includes assessment, oxygen supplementation and if indicated, endotracheal intubation)
On-going neurological assessment noting consciousness and lethargic episodes (airway support should be ready at hand)
If coagulopathies are present, blood transfusions (fresh frozen plasmas) might be indicated, or Vitamin K is administered as ordered.
Antibiotics are given as ordered foe septic induced shocks.
Febrile episodes may be common which can be treated with antipyretics.

Evaluation

After proper and adequate interventions, the child will be stable with good respiratory, circulatory, cardiac and neurologic functions.
There will be no more evidence of sepsis and coagulopathies, all laboratory works will be normal.
Fever will subside and white blood count will be within normal limits.

Newborn Procedures

admin — Wed, 11 Jan 2012 07:49:07 +0000

An impending birth of a child can be exciting and yet crucial. Being one of the health care workers witnessing the birth of a child is a unique role. You will be able to witness life as it unfolds. With the responsibility placed upon nurses during the delivery of a baby, baby care is an important part of making sure that the infant is clinically stable. In the long run, the steps instituted in the first hours of life can be detrimental for the normal growth and development of the infant.

1. Suctioning Secretions – As the head of the infant comes out, the nurse or medical intern responsible for the baby care must be able to establish the basic ABC’s – Airway, Breathing and Circulation. A rubber bulb syringe is used to clear out the nasal openings as well as the buccal area of the baby. Secretions should be gently taken out of these areas in order to give a patent airway. The baby is placed on his or her side in order to prevent aspiration. Suctioning of the oral secretions can be further being done after that. Circulation must also be assessed especially when there is a cord coil. It is essential to untangle the cord first so that the baby won’t be strangled.

2. Cord Cutting and Clamping – Cutting and clamping the cord is the official end of the support of the mother’s blood circulation, the neonate is on its own in terms of the circulatory system. Some agencies would also allow the father to cut the cord for memorable reasons. This procedure must be done aseptically by the nurse. In this part, it is important to assess the completeness of the two veins and one artery. Any anomalies must be reported to the paediatrician.

3. APGAR Score – As the baby is taken out of the womb, the doctor will examine the baby in the first minute of life as well as on the next five minutes. The APGAR score has been widely used in order to assess the infant in its first hours of life. Developed by Dr. Virgina Apgar in 1952, it measures the heart rate, breathing, muscle tone, skin colour and reflex irritability of the infant. A perfect score of 10 means that the baby is normal while a score of zero to 3 may mean resuscitation measures. Assisting during the scoring may mean being present during the resuscitation of the baby.

4. Immunization – Initial dose of vitamin K is given in order to avoid bleeding after the birth. Antibiotic ointment is applied to both eyes of the baby also.

Keeping the baby warm is a very important part of the initial management. Since babies have less fat, it is a must to thermoregulate them. The first hour is also an important to give a chance for the mother to see her child when everything is stabilized.

Nursing Management for Guillain-Barre Syndrome

admin — Wed, 11 Jan 2012 07:39:37 +0000

Guillain-Barre Syndrome is also known as Infectious Ployneuritis as well as Polyradiculitis. It characterized by paresthesias of the extremities and muscle weakness or paralysis. It is a rare disorder that the cause was thought to be of allergic or immunologic reaction. Another theory would state that it is preceded by an infection. The most common cause of this paralysis can due to the effect of polio, although polio is controlled already worldwide.

Medically known to be called as GBS, its rarity may account 2 in 100,000 people. The prognosis is good but despite that, GBS is still a life-alternating event. Many patients suffer from fast loss of control of their muscular function, vital functions may also breathing and swallowing. These symptoms can make patients feel that they are terminal. A patient with GBS will complain of sudden feeling of weakness in the legs and progresses up to the body.

Stages of GBS:

Acute – the symptoms show between one to three weeks.
Plateau – the symptoms show between several days to 2 weeks.
Recovery – This is the stage wherein there is remyelination which may last up to 2 years.

Signs and Symptoms:

Paresthesia – tingling and numbness of the lower extremities
Muscle weakness of legs – progress rapidly ascending paralysis involving the trunk, upper extremities and facial muscles which may mean complete paralysis.
Difficulty in chewing, swallowing and talking. The cranial nerves are now involved.
Loss of sensation and sphincter disturbances of bladder and rectum.
Areflexia or absence of reflexes is also observed.
Respiratory failure is the respiratory muscle function is affected.

Diagnosis

The clinical manifestation is the basis of the diagnosis. The viral infection as well as motor and sensory deficits is used in determining the severity.

Nursing Management:

It is important to prevent complication such as immobility as well as infection. Placing the patient in a comfortable and clean environment is a must.
Plasmapheresis or exchanging plasma through a machine can also decrease the severity of GBS.
For patients that have difficulty in breathing due to the involvement of respiratory muscle function, ventilator support is needed. Proper turning from time to time must be done in order to prevent accumulation of moisture on the back of the patient.
Surgically, some patients must undergo tracheostomy along with mechanical ventilation.
Encourage to comply with steroids such as adrenocorticotropic hormone (ACTH) and prednisone. Cytoxan or cyclophosphamide can also slow down the progress of GBS. At times, anticoagulants are given in times of thrombophlebitis.
Food intake is also necessary to support the patient. A balanced diet must also be served in order to prevent tissue and muscle breakdown. Some of the patients may require gastrostomy tube in order to by support nutritionally.

Nursing Interventions for Guillain-Barre Syndrome
Nursing Interventions: Guillain-Barre Syndrome Turn and reposition the patient, and encoura...

Fetal Blood Circulation

admin — Wed, 11 Jan 2012 07:34:01 +0000

Importance

It is necessary in serving the fetus and to prepare the circulatory system to function after birth

Three Important Parts of the Fetal Circulation

Ductus Venosus
- shunts a significant majority (80%) of the blood flow of the umbilical vein directly to the inferior vena cava
- it allows oxygenated blood from the placenta to bypass the liver
- in conjunction with the other fetal shunts, tit plays a critical role in preferentially shunting oxygenated blood to the fetal brain
- Foramen Ovale
  - it is one of two fetal cardiac shunts
  - allows blood to enter the left atrium from the right atrium, thereby allowing oxygenated blood to bypass the pulmonary system
  - Ductus Arteriosus
    - is a cardiac shunt connecting the pulmonary artery to the aortic arch
    - it allows most of the blood from the right ventricle to bypass the fetus’ fluid-filled lungs, protecting the lungs from being overworked and allowing the left ventricle to strengthen

The Fetal Circulation

Oxygen from the placenta travels to the umbilical vein bringing oxygen and nutrients.
Some of the blood flows to the hepatic circulation, others bypass the liver and pass through the ductus venosus.
The blood from the lower parts of the body together with the blood in the ductus venosus flows towards the inferior vena cava.
Then it goes to the right atrium
Some of the blood from the right atrium goes to the right ventricle via the tricuspid valve while others pass the foramen ovale leading to the left atrium.
From the left atrium, it goes towards the left ventricle, mixing with the poorly oxygenated blood from the lungs and then pumped towards the ascending aorta.
From the ascending aorta, the blood is pumped to the upper parts of the body like the heart, neck, head and upper limbs.
Then perfuse to the placenta via the two umbilical arteries.
Meanwhile the blood that enters the right ventricle (from No. 5) together with the poorly oxygenated blood from the head and upper extremities returns to the right side of the heart by the way of the superior venacava then, passes through the pulmonary artery wherein 10% enters the lungs, most of the blood bypasses the lungs which is then pumped to the ductus arteriosus going to the descending aorta.
The blood is the pumped and perfused to other parts of the fetus.
The blood then returns to the placenta via the two umbilical arteries.

Transition after Birth

The infant takes first breath, causing the mechanical expansion of the lungs. (Increasing uptake of oxygen by lungs induces a vasoconstriction of ductus venosus and ductus arteriosis.)
Rapid decrease in pulmonary vascular resistance (pulmonary vasodilation that is produced by initiation of ventilation) occurs.
The pressure in the pulmonary circulation and the right side of the heart fall as the fetal lung fluid is replaced by air and as lung expansion decreases the pressure transmitted to the pulmonary blood vessels.
With lung inflation, the alveolar oxygen tension increases, causing reversal of the hypoxemia-induced pulmonary vasoconstriction of the fetal circulation.
Clamping of the umbilical cord causes removal of the low-resistance placental circulation and produces an increase in systemic vascular resistance and left ventrical pressure, which further closes the ductus venosus.
The resultant decrease in right atrial pressure and increase in left atrial pressure produce closure of the foramen ovale.
A decrease in pulmonary vascular resistance and an increase in systemic vascular resistance causes a left to right shunting and increasing PO2 (constricts ductal smooth muscle) which further closes the ductus arteriosus.

Adult Derivatives of Fetal Vascular Structures

Because of certain changes in the cardiovascular system at birth, certain vessels and structures are no longer required.
Over a period of months these fetal vessels form nonfunctional ligaments, and fetal structures such as the foramen ovale persist as anatomic vestiges of the prenatal circulatory system.

Fetal Structure	Adult Structure
Foramen Ovale	Fossa Ovalis
Umbilical Vein	Ligamentum teres
Ductus Venosus	Ligamentum venosum
Umbilical Arteries and abdominal ligaments	Medial umbilical ligaments, superior vesicular artery (supplies bladder)
Ductus Arteriosum	Ligamentum arteriosum

Nursing Management of the Child with a Congenital Heart Defect

admin — Wed, 11 Jan 2012 07:24:55 +0000

I. Nursing Assessment

A. Become informed about the child’s symptomatology and plan of medical care

Obtain thorough nursing history to become familiar with the child and his family to recognize normal and abnormal patterns
Discuss with the physician the plan for medical care

B. Make a baseline Nursing Assessment of the child’s condition

Observe and record information relevant to the child’s growth and development
Observe and record child’s level of exercise tolerance
Observe child’s skin and mucous membranes for color and temperature changes
Observe for clubbing of the fingers, especially the thumb nails, with thickening and shininess of the terminal phalanges-may occur in cyanotic children by 2-3 months of age.
Observe for chest deformities
Observe for respiratory pattern
Palpate the child’s pulses in all extremities
Auscultate the child’s heart
Record vital signs

II. Nursing Diagnoses

Impaired gas exchange related to altered pulmonary blood flow or oxygen deprivation
Altered cardiac output related to specific anatomic defect
Activity intolerance related to decreased oxygenation in blood and tissues
Altered Nutrition: less than body requirements related to the excessive energy demands required by increased cardiac workload
Increased potential for infection related to poor nutritional status
Anxiety related to diagnostic procedures and hospitalization
Developmental delay related to decreased energy, inadequate nutrition, physical limitations and social isolation
Alteration in parenting related to parental perception of the child as vulnerable

III. Nursing Interventions

A. Provide adequate nutritional and fluid intake to maintain the growth and developmental needs of the child

Feed in semi-erect position
Provide small frequent feedings
Provide foods with high nutritional value
Determine child’s likes and dislikes
Strict input and output
Daily weight

B. Prevent infection

Prevent exposure to communicable diseases
Immunizations should be up-to-date
Handwashing should be observed
Be certain that the child receives prophylactic medication for infective endocarditis

C. Reduce the workload of the heart since decreased activity and expenditure of energy will decrease oxygen requirements

Uninterrupted rest
Avoid unnecessary activities
Prevent excessive crying
Provide diversional activities
Prevent constipation
Relieve the respiratory distress associated with increased pulmonary blood flow or oxygen deprivation

Determine degree of respiratory distress
Include specific information in nursing record
Position child at 45 degree angle to decrease pressure of the viscera on the diaphragm and increase lung volume
Pin diapers loosely and provide loose-fitting pajamas for older children
Feed slowly
Tilt infant’s head slightly
Suction the nose and throat if unable to cough out secretions
Provide oxygen therapy as needed
Improve oxygenation o that the body functions may be maintained
Provide effective oxygen environment
Observe response to oxygen therapy
Observe response to oxygen weaning therapy

Relieve Hypoxic spells associated with cyanotic types of Congenital heart disease
Observe for “tet” spells
Encourage fluid intake
Obtain vital signs

D. Observe child for symptoms of Congestive Heart Failure that occur frequently as a complication of Congenital Heart Disease

E. Observe for the development of symptoms of infective endocarditis that may occur as a complication of congenital heart disease

F. Observe for the development of thrombosis that may occur as a complication of congenital heart disease

G. Prepare the child for diagnostic and treatment procedures

H. Explain cardiac problems to child and parents

IV. Health Education

A. Instruct the family in necessary measures to maintain the child’s health

B. Teach the family about the defect and its treatment

C. Encourage the parents and other persons to treat child in a normal manner as possible

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