MATERNAL AND CHILD HEALTH NURSING LECTURE

CONGENITAL HEART ANOMALIES A. DEFECTS WITH INCREASED PULMONARY BLOOD

A. CONGENITAL HEART DISEASES FLOW
Review the Fetal Circulation
• Ductus venosus: carries oxygenated blood from PATENT DUCTUS ARTERIOSUS (PDA)
the placenta to the inferior vena cava; it by passes n This is the failure of the ductus arteriosus to close;
the liver; it closes at 8-weeks of life characterized by machinery murmurs and wide
• Ductus Arteriosus: bypasses flow of blood pulse pressure
through lungs by shunting oxygenated blood from n This allows a portion of oxygenated blood from
pulmonary artery to aorta; it closes at 7-10 days the left heart to flow back to the lungs by flowing
after birth from the aorta, which has a higher pressure, to
• Foramen ovale: connects right and left atria; the pulmonary artery
allows blood flow from right atrium (RA) to left n It causes congestive heart failure (CHF)
atrium (LA); bypasses the right ventricle (RV) and n Acyanotic
pulmonary circuit; closes by 2 to 3 months n Pulmonary vascular congestion is the risk.
Indomethacin is the drug of choice for closing
THE NORMAL HUMAN CIRCULATION the PDA
• superior vena cava and inferior vena cava
• Right Atrium VEBTRICULAR SEPTAL DEFECT (VSD)
• Tricuspid valve n Most common CHD characterized by abnormal
• Right Ventricle opening between the left and the right ventricles.
• Pulmonary valve n This results to right sided CHF because the blood
• Pulmonary Artery shunts from the left side of the heart (higher
• Lungs for oxygenation pressure) to the right side of the heart (lower
• Pulmonary veins pressure).
• Left Atrium n This results failure to thrive (FTT) due to
• Mitral valves decreased oxygenation and metabolism
• Left ventricle S&SX
• Aortic valve o Patient will have an increased RR; dyspnea;
• Aorta easy fatigability- these are signs that patient is
• To different parts of the body developing CHF
Failure to thrive
Organic: the body cannot cope up with the normal G&D;
poor nutrition
Nonorganic: caused by a certain disease; ventricular
septal defect

ATRIAL SEPATAL DEFECT (ASD)

n This is characterized by abnormal opening
between the left atria and right atria
n This results to right-sided CHF (shunting of blood
from the left to the right side of the heart
n Prepare child for x-ray and echocardiogram-
these are generally performed to demonstrate if
there is an increase in the size and location and
size of the defect

1 CONGENITAL HEART DISEASE

 MATERNAL AND CHILD HEALTH NURSING LECTURE

B. OBSTRUCTIVE DEFECTS TRANSPOSITION OF THE GREAT VESSELS

n This is characterized by exchange of position of
COARCTATION OF AORTA the aorta and the pulmonary artery the aorta is
n This is presence of narrowing in the aorta located in the right ventricle, and the pulmonary
artery is located in the left ventricle. This is a
S&SX mixed defect
o HPN in the upper extremities; lower BP in the n Two- non communicating circulations
lower extremities; weak or absent pulse in the n There is severe cyanosis upon birth
lower extremities
o acyanotic COLLABORATIVE MANAGEMENT FOR CHILDREN
Surgical treatment: WITH CARDIOVASCULAR DEFECTS
o removal of the coarctation or balloon angioplasty o Monitor VS, respiratory status, I and O , and
weight
AORTIC STENOSIS o Administer O2 therapy (100% oxygen by face
n This is the narrowing of the aortic valve mask) to improve tissue oxygenation
n It leads to left side congestive heart failure o During hypercyanotic spells, place the infant in
knee-chest position
PULMONIC STENOSIS o Administer morphine sulfate as prescribed to
n this narrowing of pulmonic valve. It leads to reduce cardiac workload
right-sided congestive heart failure o Indomethacin to close PDA as prescribed
o Provide adequate nutrition. Malnutrition occurs
C. DEFECT WITH DECREASED PULMONARY BLOOD due to decreased metabolism that results from
FLOW inadequate tissue oxygenation
o Administer IV fluids as prescribed
TETRALOGY OF FALLOT: o Provide adequate rest. To reduce oxygen
4 defects namely: demands of tissues
1. pulmonic stenosis o Poor feeding and activity intolerance are
2. ventricular septal defect common in children with congenital heart disease
3. overriding aorta (the aorta is located in the right o Surgery to correct the defects. This is the most
ventricle together with the pulmonary artery. The definitive treatment
aorta transports a combination of oxygenated
and unoxygenated blood CARE OF CHILD BEFORE CARDIAC SURGERY
4. right ventricular hypertrophy: the right ventricle ² VS for baseline values
enlarges to accommodate increased workload ² Accurate height and weight are also recorded
caused by shunting of blood from the left to the ² Laboratory values must be checked specially
right ventricle due to the presence of VSD chemistry hematology and coagulation values
² Blood products must be typed and
² The child with TOF experiences “Tet spell” or cross-matched
hypoxic episode. This child should be put into ² Pregnancy test for girls who are menstruating
“knee-chest” position to improve return f blood ² Informed consent must be secured for
from lower extremities to the heart-thereby anesthesia and surgery
improving the cardiac output and tissue ² Prepare parents for the amount of equipment that
oxygenation. To older children the “squatting” will surround the child after the surgery such as
position is typical to compensate for hypoxemia cardiac monitor Oxygen tanks, IV equipment,
² Primary clinical manifestation of acute cyanosis chest tube, ventilator and the noise these
or tet spell in TOF is anxiousness and irritability machines may bring.

2 CONGENITAL HEART DISEASE

 MATERNAL AND CHILD HEALTH NURSING LECTURE
² Discuss the surgical procedure to parents and
with the child to lessen worries and answer
misconceptions
² Discuss coughing and deep breathing exercise
and use of spiromentry during post op should be
discussed preoperatively
² Take parents and older children to the ICU where
they will return after surgery and show the
equipment that will surround them
CARE OF CHILD AFTER CARDIAC SURGERY
² Taking accurate vital signs is essential in the
immediate post-operative period
² Continuous cardiac monitoring and assisted
ventilation with endotracheal intubation
frequently necessary
² Hemodynamic monitoring through the central
venous catheter to carefully evaluate the preload
will help determine which type of therapy is
necessary
² IV fluids monitored
NURSING INTERVENTION
o Endotracheal suctioning is necessary to prevent
obstruction of the tube
o Assist with the chest physiotherapy to help lung
secretion mobile
o As soon as the ET tube and ventilator are
removed encourage the child to cough and
breathe deeply and use and incentive spirometer
at hourly interval to mobilize secretions.
o Coughing and Deep breathing may be painful
post-op so pain relievers are given as prescribed
o Teach children how to use pillow as splint while
coughing and deep breathing
o Be certain parents understand that games
blowing cotton or bubbles using the incentive
spirometer as important exercises to help
achieve lung expansion
o Chest tube drainage is attached to allow the
drainage and collection of fluid or air from the
chest but also to prevent air or fluid from
returning to the chest
• Keep the system closed and below
chest level
3 CONGENITAL HEART DISEASE
• Ensuring the suction control chambers
are filled or set for the ordered amount of
suctioning. If a fluid filled system, ensure
bubble are in the chamber
• Ensure the water seal chamber is filled
to manufacturer’s recommended level
• Monitoring for bubbles in the water seal
chamber which can indicate either a leak
in the drainage system or an air leak
from the patient’s lungs.
• Assessing and documenting the amount
color and consistency in the drainage
system routinely and as ordered. Report
any drainage that changes in volume
is color or bloodiness
• Keep tubes freely draining, do NOT milk
or rub the tubes
• Ensure adequate pain control that
allows the child to be awake and
interactive
NURSING INTERVENTIONS WHEN INFANT IS IN THE
ROUTINE CARE UNIT
• Watch out for blood loss
• Prevent infection
• Maintain lung expansion
• Encourage mobility
• Encourage healthy eating
• Include family in care
NURSING INTERVENTION
a. PREVENT INFECTION
– Antibiotic therapy for 24 to 48 hours after
chest closure
– Check the surgical incision site and the
points of insertion for possible beginning
infection
– Let infant wear shirts and bibs when feeding
to prevent formula from dropping into the
incision site
b. MANAGE PARENTAL ANXIETY
– Encourage child to be out of bed and
ambulate once they are hemodynamically
stable and free from cumbersome equipment
– Encourage parents to participate in the care
of their child (feeding breathing exercises
and ambulating)
 MATERNAL AND CHILD HEALTH NURSING LECTURE

– Show to parents how to pick up child properly is snug and intact and no bleeding is present.
by placing hand behind the neck and n Reassess site after first ambulation and then a
scooping under the buttocks. minimum of 4 hourly prior to discharge.
– To prevent pain, do not pull the child’s arms n Patients should be kept lying flat for several
when attempting to carry an older child hours after the procedure so that any serious
– Use seatbelts at car seats to ensure safety bleeding can be avoided and that the artery can
– Do not place child on prone heal.
n It is advised that diagnostic catheterisation
CARE OF THE CHILD AFTER CARDIAC SURGERY patients are kept on bed rest for four hours, and
² The child should avoid the following: interventional catheterisation patients stay on
– Outside play or activities for 6 weeks. To bed rest for six hours.
prevent trauma and healing of the incision.
– Crowd for 2 weeks. To prevent development NURSING INTERVENTION
of infections a. Priority nursing intervention here is to prevent
– Activities that could cause fall (e.g. bleeding at the puncture site. Apply direct
bike-riding) for 4 to 6 weeks pressure to the catheterization site for at least 15
– Creams, lotions, or powders on the incision minutes, IF bleeding should occur at the insertion
until healed. To prevent infection site.
– Submersion underwater in tub or pool b. Distal pulses will be checked to ensure peripheral
– The child usually allowed to return to tissue perfusion. If a pulse cannot be palpated a
school after 3 weeks Doppler should be used. Notify physician for
– Advise parents to discipline child any loss of pulses
normally and avoid over protectiveness. c. An anticoagulant maybe initiated as ordered
This allows normal growth and d. Provide detailed education regarding the
development of the child. symptoms of an infection to the family.
– Dental visit should be done every 3 months e. Sponge bath is recommended or quick shower.
after age 3 years. To prevent dental caries Submersion to tub baths or pools are strictly
which may harbor microorganisms prohibited.
especially streptococcus (Group A
beta-hemolitic streptococcus may trigger CONGESTIVE HEART FAILURE (CHF)
autoimmune response that causes n Congestive heart failure (CHF) is a condition in
rheumatic heart disease which the heart does not pump as well as it
– Emphasize to parents the importance of should. The most common symptoms in
regular follow-up care for the child young children are difficulty feeding,
– Assistance with dressing and bathing for sweating and poor weight gain. Older children
several weeks buti will soon independent may present with fatigue and exercise
again. intolerance
n Clinical manifestations of CHF is tachypnea,
CARDIAC CATHETERIZATION dyspnea, fatigue
n is a procedure used to diagnose and treat certain n Edema due to poor circulation of blood
cardiovascular conditions secondary to heart failure, edema increases
n A long thin tube called a catheter is inserted in an weight
artery or vein in groin, neck or arm and threaded
through blood vessels to heart
n Assess puncture site 30 minutely for 4 hours then
hourly until ambulation. Ensure that the dressing

4 CONGENITAL HEART DISEASE

 MATERNAL AND CHILD HEALTH NURSING LECTURE

confusion, anxiety, or hallucinations,

halos around bright objects; (fast,
forceful heartbeats in an irregular
rhythm) weakness
n Instruction of cardiopulmonary resuscitation (cpr)
increases parental confidenc and prapare thento
handle emergency

HYDROCEPHALUS
n It is caused by an imbalance in the production
and absorption of CSF in the ventricular
PRIORITY NURSING DIAGNOSIS system. When production is greater than the
o Decreased Cardiac Output: Inadequate blood absorption, CSF accumulates within the
pumped by the heart to meet metabolic demands ventricular system, usually under increased
of the body pressure producing passive dilatation of the
§ Administer Digoxin (Lanoxin) ventricles. It is detected through prenatal
Increases contractility of the heart sonogram
and force of contraction Two types:
§ provide optimum rest and good 1. COMMUNICATING hydrocephalus
Oxygenation (Extraventricular)
o The child may tire easily: n This is due to impaired absorption of CSF
§ Provide nipples of their bottles with within the subarachnoid space (due to
easy-to suck nipples malformations, tumors, hemorrhage, infection,
§ Eating may tire the child easily, so it trauma) .
should be not more than 45 minutes n Ventricles communicate
§ Do not give large meals at feeding time
§ Organize nursing interventions in such a 2. NON-COMMUNICATING hydrocephalus
way that the child will have an (Intraventricular)
uninterrupted rest and sleep periods n This is due to obstruction of CSF flow within the
to reduce cardiac demands and ventricular system.
workloads n The ventricles do not communicate
§ Diet is low sodium, high calorie
3 MAIN REASONS WHY CSF ACCUMULATES:
DIGOXIN THERAPY 1. Overproduction of fluid by the choroid plexus in
n stronger heart contraction, edema is gradually the first or second ventricle as could occur from a
resolved because of better circulation growing tumor (rare).
n Digoxin increases the force of contraction of the 2. Obstruction of the passage of fluid in the
muscle of the heart by inhibiting the activity of narrow aqueduct of Sylvius (most common) or
an enzyme (ATPase) that controls movement of the foramina of Magendie and Luschka, the
calcium, sodium, and potassium into heart openings that allow fluid to leave the 4th ventricle.
muscle. Inhibiting ATPase increases calcium 3. Interference with the absorption of CSF from
in heart muscle and therefore increases the the subarachnoid space if a portion of the
force of heart contractions. subarachnoid membrane has been removed (like
n Digoxin toxicity: surgery of meningocele or extensive
o Early signs: lack of appetite, nausea, subarachnoid hemorrhage)
vomiting, or diarrhea; headache,

5 CONGENITAL HEART DISEASE

 MATERNAL AND CHILD HEALTH NURSING LECTURE

ASSESSMENT OF HYDROCEPHALUS motor function becomes impaired because of

• Rapid head growth both neurologic impairment and atrophy caused
• Bulging fontanels by the inability to move such a heavy head.
• Dilated scalp veins n Skull x-ray will reveal the separating sutures and
• Separated sutures thinning of the skull
• MacEwan sign (cracked pot sound on n Transillumination will reveal that the skull is filled
percussion with fluid rather than solid brain tissue
• Thinning of skull bones
• Frontal enlargement (bossing) THERAPEUTIC MANAGEMENT
• “sunset eyes” o IF CAUSED BY OVERPRODUCTION OF CSF:
• Child shows signs of increased intracranial – Acetazolamide (Diamox) a diuretic may
pressure such as decrease pulse and respiration, be prescribed to promote the excretion
increased temperature and blood pressure, of the excess fluid
hyperactive reflexes, strabismus and optic – Destruction of a portion of the choroid
atrophy plexus may be attempted by ventricular
• Irritable or lethargic with typical shrill, high pitched endoscopy; if a tumor is responsible for
cry the overproduction of CSF the tumor
should be removed
MACEWEN'S SIGN OR MACEWEN SIGN o IF CAUSED BY OBSTRUCTION
n is a sign used to help to diagnose hydrocephalus] – Shunting procedure
(accumulation of excess cerebrospinal fluid) and
brain abscesses. Tapping (percussion) the skull NURSING INTERVENTION PRE-OPERATIVELY
near the junction of the frontal, temporal and a. Assess if infant is able to turn freely because of
parietal bones will produce cracked pot sound. increased head size
Positive test is indication of separated sutures. b. Provide an environment for child that is
This is due to raised intracranial tension. stimulating yet not tiring
n The “setting sun” sign is an ophthalmologic c. Arrange for consultation for mother with
phenomenon where the eyes appear driven neurosurgeon to discuss surgery and child’s
downward bilaterally. The inferior border of the prognosis
pupil is often covered by the lower eyelid,
creating the “sunset” appearance. This finding VENTRICULOPERITONEAL SHUNT (VP SHUNT)
is classically associated with hydrocephalus in INSERTION
infants and children n Involves threading a thin polyethylene catheter
under the skin from the ventricles to the
PAPILLEDEMA peritoneum. Fluid drains by this route from the
n a serious medical condition where the optic nerve ventricles to the peritoneum where it is absorbed
at the back of the eye becomes swollen. across the peritoneal membrane into the body
Symptoms can include visual disturbances, circulation--eventually reduces intracranial
headaches, and nausea. Papilledema occurs pressure.
when there is a build-up of pressure in or around n After VP shunt insertion, place the child in supine
the brain, which causes the optic nerve to swell; position with head of bed flat for the first 24 hours
Late sign of increased ICP to prevent too rapid reduction in CSF pressure.
n If surgery is anticipated, IV infusion should A rapid decrease in the size of the ventricles may
not be placed in a scalp vein in a child with cause subdural hematoma
hydrocephalus. n After 24 hours, the child may be turned to the
n As the head continues to enlarge the child’s unaffected side; may be put in semi-fowler’s

6 CONGENITAL HEART DISEASE

 MATERNAL AND CHILD HEALTH NURSING LECTURE

position 10-20degree angle if there is sustained – Observe mother’s interaction with infant
increase in ICP and remind her that congenital disorders
occur in a proportion of all births for
Ventriculoperitoneal (VP) shunt complications unknown reasons
• include blockage and infection – early and – Review care of child and assure parents
prompt detection of shunt dysfunction is vital as healthcare providers can be contacted
delay can lead to markedly raised intracranial anytime if they have questions.
pressure, which may result to death. – Establish a convenient follow up care
• signs of shunt malfunction: (there is decreased appointment
absorption of CSF—due to blockage of VP or – Make referral for home care if needed.
infection/swelling Also refer parents to support group of
– Headaches. other parents of children with
– Vomiting. hydrocephalus
– Lethargy (sleepiness)
– Irritability. SPINAL CORD ANOMALIES
– Swelling or redness along the shunt • It is the failure of the neural tube to close
tract. • detected through amniocentesis and prenatal
– Decreased school performance. sonogram; characterized by elevated alpha-feto
– Periods of confusion. protein (AFP).
– Seizures • Degrees of Spinal cord anomalies: 1) Spina
• Monitor abdominal girth, enlargement of Bifida, 2) Meningocele , and 3)
abdominal girth signifies that the CSF is NOT Meningomyelocele
adequately absorbed in the abdominal cavity
1. SPINA BIFIDA OCCULTA
NURSING INTERVENTION POSTOPERATIVELY n The posterior portion of the lamina failed to close
a. Assess infant’s neurologic status postoperatively but the spinal cord or the meninges do NOT
including response to sound pupillary response protrude through the defect. The defect is not
increasing irritability or lethargy visible externally. It is characterized by skin
b. Position infant with head of bed slightly elevated; depression or dimple; port-wine angiomatous
prevent flexion or rotation of the head. Record nevi, dark tufts of hair, soft subcutaneous lipomas.
cerebral perfusion pressure as prescribed. It is simply a surface of bone is missing, and the
c. Assess head circumference and anterior spinal cord is intact
fontanelles for tenseness every 4 hours as
prescribed.
d. Document head circumference and appearance
of anterior fontanelles.
e. Observe how mother feeds the baby. Assist
mother and teach how to position the baby during
feeding
f. Monitor intake and output closely
g. Administer osmotic diuretic and corticosteroid as
prescribed

NURSING INTERVENTION
a. Psychosocial/Spiritual/ Emotional Need
2. MENINGOCELE– THE EXTERNAL SAC

7 CONGENITAL HEART DISEASE

 MATERNAL AND CHILD HEALTH NURSING LECTURE
n (the three layers of meninges: pia mater
arachnoid and the dura mater) protrude as a
circular mass, about the size of an orange
through the defect in the vetebral column. The
protrusion generally occurs I the lower lumbar
and lumbosacral region, although it might be
present anywhere along the spinal canal. The
protrusion is either covered y a layer of skin or
ore frequently only the clear dura mater. No
sensory or motor deficits accompany the disorder
unless the membrane sack should rupture.
MENINGOMYELOCELE
n most common birth defect affecting the central
nervous system and is viewed as the most
complicated birth defect
• Not only the meninges protrude through the
vertebrae, but the spinal cord usually ends at the
point of protrusion
• Motor and sensory function is decreased or
absent beyond this point.
• The higher the defect is along the spine, the
greater the degree of paralysis
• The child may have partial or complete paralysis,
partial or complete lack of sensation of the lower
extremities as well as loss of bowel and bladder
control
• Legs appear lax because infant cannot move
them
• Urine and stools continually dribble because of
lack of sphincter control
• Infant ay have accompanying Talipes disorder
and developmental dysplasia of the hip
• A hydrocephalus may also develop in
• Many as 90% of these infants because of the lack
of sub arachnoid membrane
ENCEPHALOCELE
n is a cranial meningocele, most often in the
occipital area of the skull but may occur as a
nasal or nasopharyngeal disorder. Generally
covered by the skin.
n Transillumination of the sac will reveal whether
brain tissue is in the sac. A CT scan MRI or
ultrasound will reveal the size of the skull
disorder and help predict the extent of surgery
8 CONGENITAL HEART DISEASE
needed.
ASSESSMENT
• Discovery of increased AFP (alpha feto-protein)
in amniotic fluid
• Observe and record whether an infant born with
neural tube disorder has spontaneous movement
of the lower extremities
• Asses the nature and pattern of voiding (whether
wet every 2-3 hours or continually wet). Infants
without motor or sphincter control void
continually. This pattern is same for defecation.
• Differentiation is further established by CT scan
ultrasound or MRI.
THERAPEUTIC MANAGEMENT
² No surgical correction for Spina bifida occulta.
Just inform parents of the defect. They should
receive patient education so that they can
recognize more serious symptoms as the child
grows such as numbness weakness or pain
which may indicate a need for reevaluation.
² Immediate surgery is needed for Meningocele
and encephalocele to replace the meninges and
to close the gap in the skin. This is done soon
after birth if possible (within 24-48 hours) to
prevent infection. Surgical risk: the child’s
cognitive potential may be impaired; and if a
large portion of the meninges have to be
removed by the surgery—this could limit the rate
of absorption of CSF which could lead to build up
of CSF and hydrocephalus.
² Children with meningomyelocele have the same
surgery to return the meninges and close the gap
in the skin surface—however complete or partial
paralysis of the lower extremities and loss of
bladder and bowel function will not be resolved
NURSING INTERVENTION
• Preoperative
– Use sterile gloves and sterile linens when
caring for infants with either meningocele or
meningomyelocele
– Use a sterile, wet, warm compress of saline,
antiseptic, or antibiotic gauze over the lesion
 MATERNAL AND CHILD HEALTH NURSING LECTURE
to keep the sac moist. Add additional warm
fluid as needed.
– Position infants carefully to prevent pressure
on the exposed meninges either in a prone
position or supported on their side. Use rolled
blankets or diapers to support the back and
prevent pressure on the lesion. Place folded
diapers between legs to prevent skin
surfaces from touching and rubbing in this
position and to prevent hips from internally
rotating.
• Position infants on their abdomen will prevent
urine and feces from flowing onto the lesion as
well as keeping the protruding meninges free
from pressure.
• Place a piece of plastic wrap below the
protruding membranes on the child’s back to
prevent feces from touching the open lesion.
• Place a folded towel under the infants abdomen
to help flex the infant’s hip while on prone position
to reduce pressure on the sac , and ensure good
leg position. Check if the infant’s leg is
comfortable in that position.
• Make certain that the child is adequately warm.
However do not put child under radiant heat
source because it may dry the lesion and cause
cracking. Use of incubator is advised for a better
heat source and allows the nurse to assess and
monitor the lesion.
• Watch out for any seepage of clear fluid from the
defect and should be reported promptly because
that is probably escaping CSF. If in doubt if fluid
is urine or CSF check it against a glucose test
strip: CSF will test positive for glucose whereas
urine or mucus will not.
• Monitor for any increase in head size, measure
head circumference as prescribed in the
preoperative to set a baseline to be used after
surgery. Mark with an indelible pen the scalp
above and below the tape measure over both
ears and on the back of the scalp.
NURSING INTERVENTION
• Post-operative.
9 CONGENITAL HEART DISEASE
– Baby is placed on cardiorespiratory monitor
and positioned on the abdomen until the
skin incision has healed (about 7 days)
– Continue same careful precautions against
allowing urine or feces to touch the incision
area
– If defect repair is large and the risk of
picking up the infant is great, the infant may
be fed while lying on the side in an
incubator or prone on a specialized bed
frame.
– Raise infant’s head slightly by slipping a
folded diaper under it.
– Do not pat/touch/stroke the incision area at
anytime.
• Continue to observe the child as well for signs of
increased intracranial pressure such as bulging
fontanelles, variations in vital signs, neurologic
signs such as pupillary changes or behavioral
changes such as irritability or lethargy
• Preserve skin integrity during preoperative and
postoperative
– Reposition patient every 2 hours to prevent
pressure ulcers
– Use paper tape or stockinette for dressing
changes or place a protective dressing
such as Stomahesive on the skin under the
area where the tape will touch.
– Change diaper frequently to prevent
excessive contact of acidic urine with skin
NURSING INTERVENTION
a. Encourage parents to take infants to the places
children normally accompany parents such as
home relatives shopping or the zoo, because
encouraging children to be as independent as
possible as they grow helps them lead an active
life as possible
b. Teach parents how to perform passive exercises
to prevent muscle atrophy and formation of
contractures if a child has impaired lower
extremity motor control.
c. Prepare parents emotionally for the possibility of
use of crutches. Provide patient education
regarding the use of crutches
d. Teach parents to do a daily inspection of child’s
 MATERNAL AND CHILD HEALTH NURSING LECTURE

lower extremities and buttocks for any area of • Otoscopic examination may show a level of fluid
irritation or possible infection behind the tympanic membrane and the malleus
e. When in use of wheelchair teach the patient to becomes prominent
press with their arms on the armrests to raise • No movement of typanic membrane (as there
their buttocks off the wheelchair seat at least would be normally)
once every hour to help provide adequate
circulation to the lower extremities. THERAPEUTIC MANAGEMENT
f. To ensure bladder emptying, an intermittent ² Analgesic, antipyretic, decongestants are
clean urinary catheterization technique may be prescribed
taught to parents (inserting a clean catheter
through the urethra into the bladder every 4
hours to drain urine) OTITIS MEDIA WITH EFFUSION
• On early school age, the child can learn to do n This occurs if Otitis Media become chronic
self-catheterization usually occurs to children 3 to 10 years old
• A drug such as oxybutynin chloride (Ditropan) n Epithelial cells of the middle ear begin to secret a
may improve bladder capacity and allow a child to thin watery mucus, becomes glue-like thick and
need less frequent catheterization tenacious
ACUTE OTITIS MEDIA n Some children claim a feeling of fullness or the
n Inflammation of the middle ear is one of the most sound of popping or ringing in the ears; partial
prevalent diseases of childhood loss of hearing 20 to 40dB because of the
n Causative organism: Streptococcus pnuemoniae; inability of the ossicles to function well
Haemophillus influezae; Streptococcus pyogens
n Occurs in children 6 to 36 months and then again THERAPEUTIC MANAGEMENT
at 4 to 6 years ² Control of allergy: antihistamine of decongestant
n Most susceptible groups: male children; Alaskan ² Tympanocentesis
and native American; those with cleft palate, and ² Tubal Myringotomy and insertion of myringotomy
infants who are formula-fed tubes for aeration
n Potentially serious disease of childhood because
permanent damage can occur to middle ear NURSING INTERVENTION
structures, leading to permanent hearing a. Suggest to mother to give prescribed
impairment antihistamine at bedtime. Urge child to sleep with
affected ear up.
ASSESSMENT b. Meet with EENT service to consult on cause of
• Child have cold or rhinitis and low grade fever for frequent otitis media
several days, the fever peaks to about 102F c. Instruct mother to administer acetaminophen
(38C) and sharp constant pain begins in one or every 4 hours or ibuprofen every 8 hours and
both ears how to instill saline nose drops
• Infant become extremely irritable and frequently d. Encourage mother to offer liquids and soft foods
tug or pull affected ear in an attempt to gain relief e. Educate the mother about the common
from pain characteristics of otitis media; reassure mother
• External ear is usually free of wax because the the infection will resolve without an antibiotic
warmth of inflammation and fever melts the wax f. Instruct mother to contact the clinic or healthcare
and moves it more readily out of the canal provider if there is no improvement within 24 to
• Tympanic membrane appears inflamed and 48 hours or if the child exhibits increased pain
reddened and may bulge forward into the external
canal

10 CONGENITAL HEART DISEASE