Congenital Heart Disease: The Nursing Care Handbook

302 Pages·2019·5.92 MB·English

by  Serena Francesca Flocco

Congenital Heart
Disease
The Nursing Care Handbook
Serena Francesca Flocco
Angelo Lillo
Federica Dellafi ore
Eva Goossens
Editors
123
Congenital Heart Disease
Serena Francesca Flocco • Angelo Lillo
Federica Dellafiore • Eva Goossens
Editors
Congenital Heart Disease
The Nursing Care Handbook
Editors
Serena Francesca Flocco Angelo Lillo
Pediatric and Adult Congenital Heart Policlinico S.Orsola-Malpighi
Disease Center Bologna
IRCCS Policlinico San Donato University Italy
Hospital
San Donato Milanese (MI) Eva Goossens
Italy Department of Public Health and Primary Care
Academic Center for Nursing and
Federica Dellafiore Midwifery, KU Leuven
Health Professions Research and Leuven
Development Unit Belgium
IRCCS Policlinico San Donato
Research Foundation Flanders (FWO)
San Donato Milanese (MI)
Brussels
Italy
Belgium
ISBN 978-3-319-78421-2 ISBN 978-3-319-78423-6 (eBook)
https://doi.org/10.1007/978-3-319-78423-6
Library of Congress Control Number: 2018960933
© Springer International Publishing AG, part of Springer Nature 2019
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Foreword
It is our great delight and distinct honor to write the foreword to this book dedi-
cated to the nursing care of the patient with congenital heart disease. To the best
of our knowledge, this is the first book that is dedicated to nursing for the emer-
gent population of patients with congenital heart disease. Indeed, advances in
medicine have resulted in increased life expectancy, which yields a growing
number of patients in need for lifelong care. In addition to the numerous medical
issues that are associated with the management of people with congenital heart
disease, these patients and families also face a lot of nonmedical problems.
Nurses typically play an important role on the verge of both areas and are com-
plementary to other healthcare professionals involved in the care for these
patients.
The authors are to be congratulated for their prescience in editing this
important contribution to the body of knowledge. This book assembles a large
panel of authors with expertise in the different aspects of nursing care for
patients with congenital heart disease. Doing so, well-known topics are cov-
ered, but also issues that are sometimes underestimated are addressed. The
importance of this book is that it tries to make sure that such aspects are not
ignored in the care of our patients.
Some chapters in this book pertain to technical aspects in nursing care for
afflicted patients. They address the different paths of a daily clinical work-up. Other
chapters focus on nonmedical aspects. Not surprisingly, a chapter on transfer and
transition is included. Indeed, nurses play a key role in the transition of young
patients and their families and in the preparation for the transfer to adult care. The
book concludes with a chapter on nursing research and quality improvement initia-
tives, showing how deeply involved nurses are in the improvement of care to patients
with congenital heart disease.
v
vi Foreword
Never before has such a concentrated effort been made to provide the reader with
a state-of-the-art review of nursing care in congenital heart disease. It is our plea-
sure and privilege to warmly recommend this textbook to all nurses who want to
improve their skills in managing the problems of these patients.
Massimo Chessa
Pediatric and Adult Congenital Heart Centre
I.R.C.S.S.-Policlinico San Donato-University Hospital
Milan, Italy
Philip Moons
Department of Public Health and Primary Care
KU Leuven—University of Leuven
Leuven, Belgium
Institute of Health and Care Science
University of Gothenburg
Gothenburg, Sweden
Contents
1 Congenital Heart Disease Classification, Epidemiology,
Diagnosis, Treatment, and Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Angelo Micheletti
2 Routine and Emergency Bedside Equipment Setup . . . . . . . . . . . . . . . 69
Samantha Scolari
3 Vital Signs: Parameters, Frequency, and Pediatric and
Cardiac Early Warning Scores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Veronica Mattioli
4 Acid-Base Balance in Pediatric Congenital Heart Patients . . . . . . . . . 97
Marco Ranucci
5 Cardiac Medications: Dosages, Preparation and Administration . . . . 105
Grandi Nadia
6 Fluid and Electrolyte Balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Alessandra Rizza and Zaccaria Ricci
7 Nutrition Management: Parenteral and Enteral Nutrition
and Oral Intake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Piyagarnt Vichayavilas and Laura Kashtan
8 Respiratory Physiotherapy After Paediatric Cardiac Surgery:
The Interaction between Physiotherapist, Nurse and Parent . . . . . . . . 149
Davide Girelli
9 Respiratory System and Mechanical Ventilation in
Patients with CHD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Giuseppe Isgrò and Simona Silvetti
10 Cardiac Arrhythmias and Their Non-Pharmacological Treatment:
An Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Vincenzo Pazzano, Fabio Anselmo Saputo, Letizia Verticelli, Ilaria
Tamburri, and Antonio Longoni
vii
viii Contents
11 Nursing Care at the Pediatric Cardiology Ward . . . . . . . . . . . . . . . . . . 193
Mary C. McLellan
12 Nursing Care for Patients with CHD in the Operating Theater . . . . . . 205
Christina Sillman and Marilynne Ngo
13 Nursing Care in Cath Lab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Eliana Zarlenga
14 Nursing Care in ICU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Michele Sannino and Giulia P. Pisani
15 Nursing Care for Patient with Heart Failure . . . . . . . . . . . . . . . . . . . . . 247
Mauro Cotza and Giovanni Carboni
16 Nursing Care for Patients with Congenital Heart Disease During
Follow-Up: Transfer and Transition . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Serena Francesca Flocco and Eva Goossens
17 Perspectives From Well-Being to Organizational Health
in Congenital Heart Disease’s Nursing Care . . . . . . . . . . . . . . . . . . . . . 281
Adelaide Orlando
18 Self-Care in Congenital Heart Disease Patients . . . . . . . . . . . . . . . . . . . 289
Rosario Caruso
19 Nursing Research and Quality Improvement Initiatives
for Patients with Congenital Heart Disease . . . . . . . . . . . . . . . . . . . . . . 295
Federica Dellafiore and Eva Goossens
Congenital Heart Disease Classification, 1
Epidemiology, Diagnosis, Treatment,
and Outcome
Angelo Micheletti
Abstract
Congenital heart disease (CHD) is a problem in the structure of the heart that is
present at birth. CHD is still the most common inborn defect with an approxi-
mate prevalence at birth of 5–11 per 1000 live births and incidence of 1%. The
aim of this chapter is to give both a general overview on CHD and to address just
a few specific issues for each type of structural disease. Congenital cardiac mal-
formations may be classified in different ways; to highlight the underlying anat-
omy and pathophysiology, the diseases could be grouped as follows: (a) CHD
with shunt between systemic and pulmonary circulation, (b) left heart CHD, (c)
right heart CHD, (d) CHD with anomalous origin of great arteries, and (e)
miscellanea.
1.1 Introduction
Congenital heart disease (CHD) is still the most common inborn defect with an
approximate prevalence at birth of 5–11 per 1000 live births and incidence of 1%
[1]. By definition, CHD means a disease that has been present since birth but not
necessary “clinically” evident since birth: this is the case, for example, of moderate
size atrial septal defect of unobstructive subaortic stenosis.
Taking into account the pathophysiology and diagnosis of CHD, it is helpful to
highlight three key points: (1) the presence of shunt between arterial and venous
blood, (2) the presence of cyanosis, and (3) the changes in circulation after birth [2].
A shunt consists of an abnormal communication between two cardiac chambers or
vessels allowing blood to go from one side to the other. Shunting may be described
A. Micheletti
Department of Paediatric Cardiology and Cardiac Surgery, Adult with Congenital Heart
Disease, IRCCS—San Donato University Hospital, Milan, Italy
e-mail: [email protected]
© Springer International Publishing AG, part of Springer Nature 2019 1
S. F. Flocco et al. (eds.), Congenital Heart Disease,
https://doi.org/10.1007/978-3-319-78423-6_1
2 A. Micheletti
as left-to-right, right-to-left, or bidirectional. The direction is strictly dependent on
pressure gradient across the shunt; most commonly blood goes from high-pressure
left-sided heart to low-pressure right-sided heart. Therefore shunt direction affects
the status of pulmonary blood flow which can vary from normal, increased, or
decreased. Any large left-to-right (L-R) shunt results in increased blood flow into the
lungs associated with shortness of breath and prominent vascular markings on chest
x-ray, volume overload of left ventricle (LV) associated with chamber dilatation, and
subsequently heart failure; if untreated, it will eventually result in pulmonary artery
(PA) pressure overload which, by time, will cause irreversible structural arterial wall
changes ending up with pulmonary hypertension (PH), with increased pulmonary
vascular resistance (PVR), and, later on, in pulmonary vascular obstructive disease
(PVOD). High and fixed PVR is the feature of pulmonary vascular obstructive dis-
ease. When PVR approaches or even exceeds systemic vascular resistance, direction
of the shunting becomes bidirectional or mainly right-to-left (R-L), condition known
as Eisenmenger syndrome. Generally, in presence of right-to-left shunt, venous poor-
oxygenated blood mixes with arterial high-oxygenated blood, causing cyanosis.
Cyanosis is a bluish discoloration of the skin and mucous membranes resulting from
presence of 5.0 g/dL or greater of deoxyhemoglobin in the blood.
Presence of shunts is crucial during fetal life when the placenta provides the
exchange of gases and nutrients and lungs receive only about 15% of combined ven-
tricular output. Fetal circulation is characterized by four sites of shunting: the pla-
centa, ductus venosus through which umbilical vein drains into inferior vena cava,
foramen ovale within the interatrial septum, and the arterial duct through which blood
in the PA flows into descending aorta. Just after birth, placental circulation disappears
and pulmonary circulation is established. Interruption of the umbilical cord results in
an increase in systemic vascular resistance and closure of the ductus venosus.
Concomitant lung expansion results in reduction of pulmonary artery pressure and
PVR, an increase in pulmonary blood flow, functional closure of the foramen ovale,
and closure of patent arterial duct due to increased arterial oxygen saturation.
With lung expansion and the resulting increase of alveolar oxygen tension, an ini-
tial significant rapid fall in PVR occurs mainly due to the vasodilating oxygen effect
on pulmonary vasculature. Later on, between 4 and 8 weeks after birth, there is
another slower fall in the PVR and PA pressure secondary to wall changes in pulmo-
nary arterioles. Many neonatal conditions associated with different forms of CHD,
causing inadequate oxygenation, may interfere with the normal pulmonary arteriole
maturation, resulting in persistent pulmonary hypertension or delay in usual PVR fall.
Ductus arteriosus usually closes spontaneously within the first 48 h after birth,
by constriction of the medial smooth muscle; after this functional closure, an ana-
tomical closure occurs, by 2–3 weeks of age, by permanent changes in the endothe-
lium and subintimal layers. Many factors may interfere with ductal closure such as
oxygen, maturity of the newborn, prostaglandin E levels, and acidosis [3].
2
To achieve a precise diagnosis of CHD, even in very complex cases, along with
an accurate physical examination, many both noninvasive and invasive tools are cur-
rently available. Transthoracic echocardiography (TTE) is the first-line diagnostic
technique in terms of anatomical and functional information in all CHD, whereas
cardiac catheterization still constitutes the final definitive diagnostic test for many