FAQ W Ans (Pott 25-FAQ)

Frequently Asked Questions

Carl, a 4-year-old, has just had surgery to repair his heart defect. His parents, Mr. and Mrs. Carlson, are preparing for his discharge. Mr. Carlson is quiet and somewhat reserved. After providing information regarding Carl’s medications, diet, and developmental safety ideas, you provide an opportunity for them to ask questions or to share concerns. Mr. Carlson begins to fidget and finally speaks, “Will Carl ever be normal? Will he be able to go to school? Should we tell the school that he can’t participate in any of activities? Should we bring him to the emergency department if he gets sick? Should we limit his contact with other children?” You recognize that Mr. Carlson is experiencing some anxiety regarding taking Carl home, where they will be the major caregivers. Why do you think he is raising these questions?

Parents who have children with severe health concerns, like heart disease, worry about the physical needs and cares of their children. In addition, they are faced with many psychological and social concerns. Some of their concerns include worry about future health status, caring for the child when ill, concern about the effect of discipline, knowing what they should consider to be normal as the child grows and develops, social interaction for the child with peers, and how to share personal information. More concerns may surface later, when other experiences and life events occur. Now is the time to provide assistance to help the Carlson family determine what is “normal” for them; how to monitor and promote Carl’s health, safety, and growth and development; and how to identify local support and resources assistance.

You are caring for a child in the pediatric intensive care unit (ICU) who has distributive shock. You are mentoring a new graduate nurse, and she asks, “Why does distributive shock happen? What makes it different from the common cause of shock, which is due to loss of intravascular volume?”

As the expert nurse, you know that hypovolemic (loss of intravascular volume) shock is the most common form of shock in children. Distributive shock is caused in the presence of or secondary to sepsis. The child being cared for was playing in a construction site, and while climbing a cement block wall, he pulled it down on himself. He was under the cement blocks for several hours, which caused compartmental syndrome to occur. As a result, he developed severe circulatory compromise and infection from the dirty environment he was in. While hospitalized, with various invasive lines in place, he developed sepsis. Already immunocompromised, he developed distributive shock.

Today you are caring for Mark Tsumaki, who prior to being hospitalized was healthy until he developed a high fever. Although his temperature would go down temporarily with acetaminophen, his fever was quick to return. After 3 days, his eyes became bright red and his feet and hands began to swell and also redden. Additional complaints included a rash and joint pain. Mark was vacationing with his family in a wilderness area, and it was at least a week later before Mark was evaluated by his health care provider. Mark has been in the hospital for about 10 days with a diagnosis of Kawasaki disease and has been receiving treatment with gamma globulin for almost a week. While completing his morning assessment, you note that his heart rate is tachycardiac at 140 bpm and his urine output has decreased to 0.1 cc/kg/hr. Should you be concerned, or is he just experiencing anxiety?

The most serious complication of Kawasaki disease is cardiac involvement. Some children develop congestive heart failure and others coronary artery aneurysms if treatment is not started. Mark is demonstrating signs of congestive heart failure. You should contact his health care provider and closely monitor his cardiac status, including administration of oxygen if necessary until further medical orders are received.

Two months ago, Judy was treated for a strep throat. She has returned to the clinic today because she has developed a temperature again, is complaining that all of her joints ache, and she feels fatigued all the time.She exclaims, “I feel awful!” Judy is diagnosed with rheumatic fever. What are the initial nursing care considerations?

Children with rheumatic fever are most often treated at home today. Medical treatment usually includes oral penicillin to eradicate the infective organism (group A strep), aspirin (acetaminophen and ibuprofen are ineffective) to reduce the inflammatory response, and bedrest. Nursing management will most likely focus on education and parental support. The education should include information on the importance of consistent administration of medications, information about possible side effects (bleeding, bruising), nutritional support, the importance of restricting activity and offering diversional activities, and the importance of looking for signs and symptoms of infection. Additionally, you may want to discuss the option of homeschooling, as bed rest may last a few weeks or a few months and activity may be restricted even longer.

As a new graduate nurse, you have chosen to work on a pediatric surgical unit. You have noticed that several infants and children have undergone cardiac surgery in the past 6 months. What are the statistics on the number of children with cardiac defects?

Approximately 8 out of 1,000 newborns will have a heart defect. Heart defects range from mild, easily corrected defects, or defects that don’t require correction, to very serious and complex defects requiring more than one surgery. Some infants may also have a combination of defects. As a nurse, it is important for you to understand the challenge parents face when heart disease or a heart defect is diagnosed. Families’ responses and concerns may vary, but your support and help will be very important.