a nurse is assessing an infant who has a ventricular septal defect This is a topic that many people are looking for. bluevelvetrestaurant.com is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, bluevelvetrestaurant.com would like to introduce to you Ventricular Septal Defect Nursing | NCLEX Pediatric Congenital Heart Defects. Following along are instructions in the video below:
Hi. There well you just saw us. Practicing for the airway management.
Can actually stop stop now were just practicing yeah. But were practicing airway management techniques during crisis and so one of the things that we thought wed show you first is the correct way to manage an airway when you have time and its not a crisis. This is not the way to do it and then after that we can kind of see compare and contrast.
How area management and differs. I mean when youre in a crisis. And youre doing chest compressions and in this module.
Were not only going to learn about airway management. Were also going to learn about access whether thats intravenous access or even interosseous access to the patient. Which is also very important during crisis because of course.
Thats the way that you give most of your drugs. So lets get started. Lets take a look at how you can handle airway management in a non crisis situation.
So lets talk a little bit about airway management in a non arrest. Setting. Now this is very different.
The first thing youre going to notice. Is that the bed is of high its almost here at my my bellybutton level. This is because the bed height at this level.
Really helps facilitate and a tracheal intubation for the operator. Obviously. If youre in a code.
Situation compression takes the priority and the bed has to be much lower in order to facilitate the compressor performing chest compressions as you can see kyle demonstrating. Here thats really not possible when the bed is this high. The other thing is youll notice the patient position much more towards the head of the bed in this non arrest situation.
Which you might find you know an elective intubation in the icu for instance is one of these situations. Where the patient is not in arrest is human definitely stable. What requires intubation for some reason also youll notice that the patient is in a sniffing position the flexion and extension of the neck to facilitate an irregular meishan now.
Im not actually gonna take you through all the steps of an a tracheal intubation. Because you know what we know is that if you dont regularly perform endotracheal intubation. You shouldnt be doing it in a code situation.
And there are other techniques that you can use such as laryngeal mask. Airway. X.
or even mask ventilation. Now. Lets actually talk about massive intonation.
This is a very useful technique that can often give you time and bridge the period between apnea and when you can secure the airway. So what we want to do here is to apply the the mask to the patients face starting at the nose and and continue down and tilt down and then with your two finger your fingers here lift up on the jaw and create a seal and sometimes you might have to walk back and forth to get a good seal and then you can go ahead and give a breath. And what you want to do is watch the patients chest rise and fall with each breath.
So that you are confirming that you can ventilate the patient. If you have difficulty there are things that you can do to help facilitate masculine to latian of a patient one of the most common things is insertion of an oral airway you can take an oral airway here and you can insert it into the patients mouth upside down. And then turn it around properly.
And then go ahead and try mask ventilation again and see if that can help you now there are other airways that you can insert as well you can also insert nasal airways. If you insert an oral airway and youre not still getting good ventilation. You can go ahead and lubricate.
A nasal airway and insert that into the patient okay so now. When youre ready you can perform at a tracheal intubation as i mentioned the height of the bed facilitates this were not going to go into all the steps of it today. Thats really beyond the scope of this tutorial.
The key. Though is to really open the mouth widely start from the side and then sweep the tongue out of thewe. Tell people what youre seeing i agreed one view and when you have the great one view dont look up to see where the tube is someone will hand it to you and keep that visualization on the glottic opening and then once that in shriek youll chew is in place.
And the cuff is past the cords. Then you can now remove the stylet you can inflate the cuff and you can have an assistant ventilate. The lungs now how do you confirm and a tracheal intubation.
What you can do is watch for chest rise you can also auscultate the lungs to confirm bilateral breath sounds and most importantly you should check for end tidal carbon dioxide using continuous co2 monitoring and that is airway management in a non rs situation. So now we have the bed set up for optimizing conditions for the compressor during a cardiac arrest situation as you can see the bed position is markedly different than the previous situation where we tried to optimize everything for airway management. And as you can see the beds much lower.
This is so that you can aid the compressor. If you want to demonstrate kyle. How the bed position is now much more optimal for the compressor providing compressions for our resuscitation.
However that comes at the expense of obviously the person managing the airway because theyre now much lower to the floor. The patients not necessarily in the sniffing position not necessarily towards the head of the bed. Lets talk a little bit kyle about optimizing conditions for airway management is it reasonable to pause cpr.
So that we can get the patient into the optimal position for airway management. So we can intubate the patient. It is not this is a big difference from before you should never interrupt compressions to secure an airway.
Let me emphasize this strongly compressions are the priority airway management comes secondary either you you achieve adequate ventilation with bag mask inhalation or you attempt to intubate in the condition that you find the patient or you place a laryngeal mask airway. If you get the patient back. And you get a return a circulation.
Then you can secure the patient airway.
The studies show that when people fixate on airway management. They neglect compressions. They have compressions stopped they reposition the patient they do things that limit and inhibit effective chest compressions now.
But i always hear people say abcs. Its airway. Breathing and then circulation isnt that the same dont those things hold true for cardiopulmonary resuscitation ca b.
Now compressions airway breathing. So it has chain thats changed. Okay and youre often able to get at least marginal ventilation.
Which is all you really need is to get a little oxygen in youre not going to try. And really ventilate these patients aggressively. We already went over that aggressive inhalation is actually detrimental long title.
Large tidal volumes. Long and satori holds high respirator eights. All caused negative performance with your compressions.
So less is more do what you can we do have some techniques that we can quickly show you on on how you can improve. Things you can try and bundle a direct laryngoscopy with a pulse check. But like i said we wont do anything thats not a compressing event to be less than 10 seconds.
Its actually pretty hard to intubate someone in less than 10 seconds. And then they got to start they cant wait for you they got to start compressions again as soon as they can so get away from this idea that youre gonna intubate over one in an arrest just figure out how to effectively ventilate the patient so when over bag mask ventilation. Before and we talked about learned yo mask airway.
So i think that thats something to discuss so lets lets recap. A little bit. If if youre coming to a situation.
Where the patient is having a cardiac arrest and compressions are occurring. You should try in terms of managing. The airway to do bag valve mask bag valve mask mentally.
If you can establish ventilation through that method. Then you dont necessarily need to move immediately to a nutricula intubation. Now.
However if you are somebody who does any tracheal intubation on a routine basis. If youre an and the arteries that feed the lungs are going to become damaged and theyre actually going to narrow so youre going to get a condition called pulmonary. Hypertension and this is going to cause that infant that child a lot of issues a lot of breathing issues and its going to cause issues on their heart.
Because the right ventricle is already exhausted from having to pump extra blood volume now when this pulmonary hypertension occurs. We have narrowing of arteries this heart this heart has to pump even harder to squeeze that blood to the lungs so its like the same concept with a water hose you narrow that water hose in order for that water to get it through the water hose to the other end its really going to increase its exertion and its pressure to get that water through that narrow little hose and thats whats happening. So thats going to cause even more problems and thats going to stress the heart out and were going to get heart failure.
So you hear you have this infant who has heart failure and the parent usually will notice signs and symptoms about one to three months after birth and theyll have difficulty feeding because it takes a lot of energy to eat that because they have to suck on that bottle and their energy is expiring because their heart cant keep up because its so weak. So they dont finish those feedings and it burns a lot of energy having to breathe having to pump this heart so theyre burning extra calories. Theyre not feeding to take in that caloric intake.
So they start to lose weight and their growth is affected in addition they can start to get a lot of lung infections because you are getting all this congestion. Where fluid is back flowing into the lungs from where this heart is weak the heart failure and theyre at risk for more infections in addition they can start to have dysrhythmias where atrial fibrillation. Where their heart electrical activity is not working right and theyre at risk for valve issues like i said earlier regurgitation of those valves and they can have endocarditis.
Theyre at risk for developing infection within the heart because the lining in the heart can be disrupted. Because of whats going on and bacteria can stick in there and cause infection. Now what if this vsd is never repaired and they have this continuous left right shunting.
The overflow of the blood going to the lungs stressing the lungs out stressing the ventricle out all this whats gonna happen well. This is left untreated. The patient can develop whats called eisenmengers syndrome.
And this is where you have a reversal of that shunting. So whats going to happen due to that extensive pulmonary hypertension that has happened what will happen is that you will actually have a reversal of shunting of blood that will go right to left so instead of going left to right this blood will actually start to now flow into the left ventricle. So you wont have the shunting anymore of this the oxygenated blood going into the right ventricle.
But youll have the unex ajaita blood going into the left ventricle. And thats going to cause some issues. Whats going to happen is now youre going to have this uh nossa genital blood that didnt make it to the lungs to get oxygenated go back into circulation and the patient will start having.
Cyanosis bluish tinting color of the skin low oxygen in the body. Because it didnt get oxygenated. Its going back through circulation and you can start to see clubbing of the fingers and things like that and this condition is irreversible.
They will usually need a heart or lung transplant. So really patients need to get treatment for this so that does not occur when else talking about signs and symptoms of a vsd. Okay when are you going to start to see signs and symptoms in the pediatric patient in that infant who has like a vsc like a large vsd because those are really the ones that cause our signs and well youre not really gonna see it immediately on birth you may hear like a heart murmur.
But that infant is going to start showing those signs and symptoms of the heart failure pulmonary hypertension about one to three months after birth now. Why is that okay well in utero. When the baby is in there moments belly and that pressure in the right side and the left side is equal because their lungs arent working yet.
But once they are born they start breathing on their own things are going to start changing in the heart. The pressure specifically the pressure on the right side of the heart is going to start to decrease. So if they do have this large gaping hole in their septum as that pressure starts to decrease over time which is about two to three weeks youre going to start seeing this shunting of blood.
Because the pressure will be decreasing on the right side compared to the high pressure in the left side. So around one to three months once that pressure has stabilized its decreased on the right side that left side will start shunting that blood over to the right side. And thats going to increase that blood volume going to the lungs.
Linda pulmonary. Hypertension heart failure and the parent may bring their baby in for those checkups report and babys not feeding right they get really tired fatigued easily. The weights arent really looking good for that child based on its age and they could start having frequent lung infections.
All pointing to a sign that hey this baby may have a congenital heart defect.
We need to do an echocardiogram and see whats going on so to help us remember the signs and the symptoms lets remember the word hole hole in the ventricles that is what is going on so what were gonna do is sum up everything. We went over and thats our signs and symptoms so eight is heart failure. We talked about why there is heart failure going on and the pulmonary hypertension.
So the signs and symptoms youre gonna see is theyre gonna have difficulty breathing with all the fluid congestion from where that heart is weak in there and fluids backing up theyre gonna fatigue with ease especially with any activity feeding swelling in the hands. The extremities where the fluid is building up crackles and the lungs from the congestion of fluid and they can have sweating with any type of activity like a lot of parents report while theyre feeding they may get really sweaty be cold and clammy oh for often experiences lung infections and that goes back to the congested lungs from where they have all that fluid in there and l4 a low growth weight loss of weight and that ties back to their heart and breathing burning a lot of energy to maintain life for that child that can burn a lot of energy. Theyre not eating like they should because theyre just exhausted from where their little heart is just exhausted and they cant stay awake to continue and theyre just exhausting next is eve for extra heart sounds and a heart murmur may be detected in vsd.
You may hear it at birth. It really depends. Because why are you even hearing.
A heart murmur. Whats it from well what its from is that you have this flow of blood from the left ventricle to the right ventricle. So youre hearing that turbulent gradient of that blood crossing over during systole and depending on the pressure changes thats occurring in that infant you may or may not detect it because remember the pressure changes over the next two to three weeks.
Now the term of the murmur is holosystolic or pin. Systolic murmur and this means that youre usually going to hear it starting at s1 and itll extend into s2 and it can be found in the left. Lower sternal border.
And whats interesting is that smaller vsd so small holes can actually produce a louder murmur than compared to a large one and think about it if you blow through a really small hole you can actually hear the noise. Its a lot louder than if you blow through a big large hole. So thats where thats from now lets talk about nursing interventions and treatments for a patient with a esd.
A big thing. That is done is that of course. The vst will be monitored and medications will be ordered especially for those large ones because the doctor wants to prevent that patient from developing heart failure.
Pulmonary hypertension and going into the eisenmenger syndrome. Which is irreversible. So they can give them medications and of course surgical repair.
So as a nurse. You want to be familiar with some of these meds one man they can get is called digoxin. And what does the johnson do well it helps the heart contract stronger and it slows it down.
Which is perfect for this infants heart because its exhausted and its been really just pumping away and its weak so digoxin can make it stronger. But pump slower. But you have to watch this drug and its a great drug.
But if it gets where its not in therapeutic range. It can cause toxicity and death. So what you have to do is you have to before you give it you monitor and record.
The apical pulse for one full minute and depending on what that pulse is you may or may not give the medication and youll always follow the physicians parameters for that. But the guidelines are usually this to hold the medication. If the infants heart rate is less than 90 to 110 beats per minute or for children.
If the heart rate is less than 70 or for adults. If the heart rate is less than 60 also what potassium levels a low potassium level hypokalemia can increase digoxin toxicity so a lot of times these patients may be on diuretics like lasix that wastes potassium. So youve really got to monitor those potassium levels.
Make sure theyre getting enough potassium because it can lead to digoxin. Toxicity normal level your therapeutic level is 05. To 2 nanograms per milliliter.
Well be measuring that also in your infants. You want to watch that heart rhythm. One early signs and symptoms of ditch talks.
The city in an infant is a dysrhythmia so watching that heart rhythm that ekg also watching for vomiting and the antidote for detox digoxin. Is digi buying other meds that can be prescribed or like diuretics and what diuretics do is that they will help pull fluid extra fluid thats build up from the body and the patient will urinate it out. But you have to watch because it can throw off electrolytes and if theyre on digoxin.
What do you want to monitor potassium levels. Because you can have digital sisse t. So we will be monitoring their eyes and os making sure their renal function is good theyre not taking in too much and not really putting out you want to monitor that and monitor their weights.
Because that indicates if theyre retaining fluid because again their risk for heart failure with this condition another drugs they can prescribe are ace inhibitors. And what these will do is lower the blood pressure. When you lower the blood pressure.
Thats going to lower the pressure in this left ventricle. Which is great right because if we lower the pressure in the left ventricle. Whats gonna happen were going to decrease that shunting of that blood from left to right so we can get more blood flowing up through the body.
Which is where we need it instead of going back to the lungs and congesting those lungs and stressing them out so another thing nursing wise. We wont be thinking about their nutrition. Because one of the big signs and symptoms that theyre going to have is their growth can be affected because they are just so exhausted.
They dont feel like eating so sometimes they need supplements they may have to have a feeding tube. You want to educate the parent about the importance of getting proper nutrition as a nurse. Youre gonna be doing calorie counts.
Youre going to be weighing them measuring them seeing where theyre at next you wanna be thinking about as the nurse is risk for infection their risk for lung infections. Because the pulmonary hypertension going on the congested lungs. So they need to make sure that theyre getting those preventive vaccines to prevent any type of respiratory infection their risk for and stay away from people who are sick and the endocarditis.
Sometimes they have to be prescribed antibiotic to prevent and the in dakar. Tightest and treatment surgery for the really large bsts. They can have surgery.
Where a patch is actually placed over this hole and the tissue from the heart will actually grow over the patch and keep that patch in place. And sometimes a heart calf can be performed. Where they can go in and close the hole that way okay so that wraps up this review over vsd.
Thank you so much for watching dont forget to take the free quiz and to subscribe to our channel for more videos. .
Thank you for watching all the articles on the topic Ventricular Septal Defect Nursing | NCLEX Pediatric Congenital Heart Defects. All shares of bluevelvetrestaurant.com are very good. We hope you are satisfied with the article. For any questions, please leave a comment below. Hopefully you guys support our website even more.