Nursing Interventions

Welcome back! This week we will focus on nursing interventions for pediatric patients with Long QT Syndrome (LQTS). Nursing interventions generally include everything from readjusting a patient into a certain therapeutic position to administering medication. During the acute treatment of a new child diagnosed with LQTS nurses will follow protocols such as the one below.

This first section discusses immediate assessment of a cardiac patient. The second section discusses administering therapeutic interventions to help a cardiac patient. I've copied and pasted the section from this very helpful educational website: http://www1.us.elsevierhealth.com/MERLIN/Gulanick/archive/Constructor/gulanick10.html

*The website uses some medical jargon—I'll put some translation in parentheses. *


• Assess mentation (how a person is acting).
  • Restlessness is noted in the early stages; severe anxiety and confusion are seen in later stages.
• Assess heart rate and blood pressure.
• Assess skin color and temperature.
  • Cold, clammy skin is secondary to compensatory increase in sympathetic nervous system stimulation and low cardiac output and desaturation.
• Assess peripheral pulses (feeling pulses in hands/feet/extremities).
  • Pulses are weak with reduced cardiac output.
• Assess fluid balance and weight gain.
  • Compromised regulatory mechanisms may result in fluid and sodium retention. Body weight is a more sensitive indicator of fluid or sodium retention than intake and output.
• Assess heart sounds, noting gallops, S3, S4 (this means listening for any abnormal extra heart sounds).
  • S3 denotes reduced left ventricular ejection and is a classic sign of left ventricular failure. S4 occurs with reduced compliance of the left ventricle, which impairs diastolic filling.
• Assess lung sounds
• Assess Hemodynamic Monitoring (looking at lab work for abnormalities)
• Monitor continuous ECG as appropriate
• Monitor ECG for rate, rhythm, ectopy, and change in PR, QRS, and QT intervals.
• Assess response to increased activity.
  • Physical activity increases the demands placed on the heart; fatigue and exertional dyspnea are common problems with low cardiac output states. Close monitoring of patient's response serves as a guide for optimal progression of activity.
• Assess urine output. Determine how often the patient urinates.
• Assess for chest pain.
  • Indicates an imbalance between oxygen supply and demand.
• Assess contributing factors so appropriate plan of care can be initiated. 
  Examples of treatment interventions include:
  
  Administer medication as prescribed, noting response and watching for side effects and toxicity. Clarify with physician parameters for withholding medications.
  
• Maintain optimal fluid balance (don't want too much fluid or too little fluid)
• Maintain hemodynamic parameters at prescribed levels.
• Maintain adequate ventilation and perfusion (maintain breathing and blood circulation by repositioning patient in bed):
  • Place patient in semi- to high-Fowler's position
    • To reduce preload and ventricular filling.
  • Place in supine position
    • To increase venous return, promote diuresis.
  • Administer humidified O2 as ordered.
    • The failing heart may not be able to respond to increased O2 demands.
      
• Maintain physical and emotional rest, as in the following:
  • Restrict activity
    • To reduce O2 demands.
  • Provide quiet, relaxed environment.
    • Emotional stress increases cardiac demands.
  • Organize nursing and medical care
    • To allow rest periods.
  • Monitor progressive activity within limits of cardiac function.
• Administer stool softeners as needed.
  • Straining for a bowel movement further impairs cardiac output.
• Monitor sleep patterns; administer sedative.
  • Rest is important for conserving energy.
• If arrhythmia occurs, determine patient response, document, and report if significant or symptomatic.
  • Both tachyarrhythmias (heart beating too fast) and bradyarrhythmias (heart beating too slow) can reduce cardiac output and myocardial tissue perfusion.
  • Have antiarrhythmic drugs readily available.
  • Treat arrhythmias according to medical orders or protocol and evaluate response.
• If invasive adjunct therapies are indicated (e.g., intra-aortic balloon pump, pacemaker), maintain within prescribed protocol.

In conclusion, there are many manuals that help organize the flow of responsibilities for a nurse. However, one of the most important jobs for the nurse to accomplish is establishing rapport and trust with the patient and family/caregivers. Through describing interventions at an age appropriate level, nurses can help make the patient and family feel more included in their care.

Sources:

Gulanick, M. (2012, January 1). EHS: Nursing Diagnosis Care Plans, 4/e - Cardiac Output, Decreased. Retrieved February 22, 2015, from http://www1.us.elsevierhealth.com/MERLIN/Gulanick/archive/Constructor/gulanick10.html