Nursing homes and plans HEART FAILURE

Nursing homes and plans HEART FAILURE

INTRODUCTION
Heart failure occurs when the heart does not dpat pump enough blood into a number of systemic siekulasi to meet work requirements. Usually divided into left and right heart failure, heart failure is usually caused by congenital heart defects during infancy.
Complications of this disorder include hemapatomegali, ascites, and cyanosis. Treatment included diuretics (treatment of edema and prevent reabsorption of salt) and digoxin (to increase cardiac contractility and slow the heart rate), low-salt diet, fluid restriction, and decreased activity and stress.
ASSESSMENT
Baby
Cardiovascular

Lightweight: resting tachycardia (above 160 denyutan/menit0
Weight: decreased peripheral pulse (1 + or 2 +; if the ductus arteriosus causing settle 4 +).


Breathing

Lightweight: resting tachycardia (above 60 pulses / min)
Compensation: Efforts excessive respiration (resting tachycardia, Substernal and intercostal retraction, nasal flaring, Crackle, dry cough, dyspnea, and Orthopnea)


Gastrointestinal

Lightweight: weight increased slowly


Genitourinary

Weight: Decreased urine output (less than 1 ml / h).


Musculoskeletal

Lightweight: tired when feeding, failed to grow, barriers to development.


Integumentary

Lightweight: Diaphoresis (head and face), pale, blackish.
Compensation: orbital edema, peripheral edema, cold extremities, edema skjrotum (male infant with severe heart failure).

Children and adolescents
Cardiovascular

Lightweight: resting tachycardia
Weight: Decrease in peripheral pulses (1 + or 2 +; if the ductus arteriosus causing settle 4 +)


Breathing

Lightweight: resting Tachypnoea, severe dyspnea
Compensation: Excessive breathing efforts (including resting Tachypnoea, Substernal and intercostal retraction, nasal flaring, creckle, and dry cough), wheezing, Orthopnea.


Gastrointestinal

Lightweight: kuirangnya appetite, rapid weight gain ("heavy liquid")
Compensation: Ederma orbita, dependent edema of the arms and legs, pale, black, cold extremities.


Nursing Diagnosis
Excess fluid volume associated with increased blood flow in the lungs (at kelainanan ventricular septum, persistent ductus arteriosus, atrioventrikuler fistula, leakage of the heart valve, kidney failure, excessive IV fluid administration).
Expected results
Children will maintain steady state jantun characterized by cardiac and respiratory frequency with age and there is no or ronchi Crackle.


Intervention

Assess and record the child's cardiovascular condition by recording the apical pulse and rhythm, peripheral pulses, blood pressure, capillary filling time, and skin changes (striated skin color, edema, increase or decrease in temperature, diaphoresis).
Use a heart monitor to assess the situation of children. Assess vital signs and notify your doctor promptly if significant changes occur.
Give digoxin (Lanoxin), this drug is the drug of choice, or other heart medications, according pertunjuk. Give half of all treatment diditalisasi in certain doses, then a quarter of the total dose in two subsequent doses.
Give the rest sesewring possible.
When handling a child, do it with a quiet manner, provide consistent care, and perform procedures considered dangerous in the space of action, not in the child's room.
monitor serum digoxin (berentang treatment from 0.5 to 2 ng / ml.
Review signs of digoxin toxicity, such as vomiting and dizzy the eyes.


Rational

Assessment of baseline data and changes of heart conditions of children, including tachycardia, bradycardia, hypotension, and irregular heart rate-all indicated a decompensated heart.
Monitoringjantung will detect immediate changes in heart rate and heart rhythm, such as tachycardia (an early sign of heart failure) and atritmia (perhaps the influence of various handling advanced heart failure).
This treatment will make a strong heart contractions and slow.
Yuang breaks must often reduce the heart's workload.
These interventions can help reduce stress and anxiety, reduce the burden of heart jerka.
monitoring is required to maintain the level of treatment.
Digoxin can cause more severe reactions.


Nursing Diagnosis
Impaired gas exchange related to pulmonary edema.

Expected results
Children will maintain adequate oxygenation is indicated by color of skin and mucous membranes angry pink color and capillary filling time of 3 to 5 seconds.

Intervention

Assess and record the state of the child's breathing through:

Noting the frequency, nature and regularity of breathing
Auscultation of breath sounds
Note the existence of cough and nature.

place the child in the semi-Fowler position
give oxygen belalui face shield, hood oxygen (for infants), or nasal kanule, as directed.
give diuretics as directed; record fluid intake and output.
Monitor serum electrolytes, especially potassium (see appendix E, normal laboratory values).
Oximeter monitor records, if the high 90s


Rational

Assessment of baseline data and changes in child respiratory conditions, such as respiratory signs (dyspnea, Crackle, Tachypnoea, retraction, and cyanosis).
Semi-Fowler position allows gravity to lower pressure occurs on the heart and lungs.
Increasing the amount of oxygen in the inspired air will help to compensate for the disruption of oxygen exchange in laveoli caused lung congestion.
Diuretics cause the release of fluids and kidney tissue release many caioran.
Electrolyte imbalance can be caused by edema or use of diuretics; decrease or increase of potassium can cause arrhythmias.
Changes in oxygenation assessment of child oximeter, which can dicuragai lung congestion and disruption of gas exchange in the alveoli.


Nursing Diagnosis
Impaired nutrition: less than demand deposits associated with decreased energy.

Expected results
Children will maintain adequate nutritional intake is characterized by eating 80% of food provided and mempertahnkan weight remained stable and good skin turgor.

Intervention

Schedule a meal after a period of rest, and give a peaceful environment.
Give eat little, often (5 or 6 times per day).
Place the child on a semi-Fowler position during meals.
Give food to the child with a formula that favored or preferred food; if the child is given treatment that resulted in a decrease of potassium, give foods rich in potassium.
If specified, provide oxygen during the meal.
Increase your intake of calories through the provision of food with high calorie formula.
If the child is bored before eating enough, give food through nasogastrik, as directed.
Limit your intake of caioran in children, according to the instructions.


Rational

Children have a lot of energy after a break from activity and menalan sucked or chewed. Calm environment to help relax the child, the intake will increase.
Eat little and often helps prevent distention of the stomach caused by overeating at meals and use less energy the child at mealtime.
Semi-Fowler's position makes it easy to swallow; gravity helps reduce pressure on the heart and lungs.
Eat in children with a formula that favored or eating that can help increase the intake, lower levels of potassium that can trigger arrhythmias.
Because kangesti lung can decrease oxygen-making, increased concentration of inspired oxygen from the air can help increase energy levels when he eats children.
Children should consume more calories in order to increase metabolism as a result Tachypnoea needs, tachycardia, and respiratory disorders.
Feeding through nasogastrik allows children to receive adequate nutrition.
Fluid restriction may recommend to lower the circulating volume associated with fluid retention.


Nursing Diagnosis
Berhubuan injury risk with a dose of medication or treatment due to physiological response.

Expected results
Children will show no injury due to medication doses or physiological response due to treatment.

Intervention

monitor heart rate and heart rhythms of children through the use of cardiac monitoring.
Monitor electrolytes kladar children.
Do check back on all drug calculations accurately; make sure that the instructions already bebar and that children receive in the number of bears.


Rational

Monitorting detect heart rhythm disturbances in heart rate and heart in relation to the treatment used. Example, first-degree heart block or sinus bradycardia may berinidikasi of digoxin toxicity, and ventricular arrhythmia can be caused by hypokalemia due to the use of diuretics.
Electrolyte imbalance can be caused by drug use. Contoih, diuretics can cause dipokalemia, which could potentially influence the occurrence of poisoning due to digoxin.
Guarantee the accuracy of all children receiving medication treatment properly in the amount required for effective treatment.


Nursing Diagnosis
Anxiety (parents) are associated with children who are sick, stay patient at the hospital, and home care

Expected results
Parents will be reduced his anxiety is characterized by asking the right questions about the child's condition.

Intervention

Explain to the child's parents difat disease and reasons for hospital stay. Also explain all procedures and treatment, and start with advanced instruction that began in the hospital.
Encourage parents to participate in the care of children by helping to provide medicine and bathing, feeding, and monitoring the child.
Provide emotional support to parents.


Rational

Knowing the information will help parents understand the child's condition and treatment is expected and easy to handle anxiety.
Participating in child care would reduce parental anxiety about the treatment and care to stay at home sakit.Juga lets start practicing home care procedures under supervision.
Provide emotional support to help reduce anxiety.


Nursing Diagnosis
Lack of knowledge related to the disease process and treatment at home.

Expected results
The parents will express their understanding of illness and home care instructions.

Intervention

Teach parents about the signs and symptoms of heart failure; including Tachypnoea, tachycardia, fatigue, lack of food, restlessness, diaphoresis, rapid weight gain, dyspnea, cyanosis, wheezing, and peripheral edema.
Teach parents about the administration of drugs, including details of dosage and the possibility of further reaction, particularly digoxin, and provide information about the surveillance of poisoning.
Teach parents about the purpose and use of monitoring equipment at home.
Explain to parents the importance of high-calorie foods, low-salt diet; if the child using a treatment that can lead to decreased potassium, explain the importance of the addition of potassium in the diet in foods will.

Rational

Know your signs and symptoms of heart failure will help parents quickly find dokjter ask for help if needed.
Penjelasdan information to help ensure the provision pengoabtan correctly and meet all the treatment plan, parents need knowledge of how North gradually handle child whenever events associated with treatment.
Children need supervision at home in order to detect the occurrence bradycardia, tachycardia, or apnea.
Children will need extra calories to grow and low sodium levels in order to prevent fluid retention and hypertension; treatment resulted in a decrease of potassium will be at risk of arrhythmia due to decreasing levels of potassium. Knowing onformasi will push to meet dietary needs of children.


Pedokumentasian check list
During his stay in hospital care, notes:
Objec child and assessments during home sakt.
Changes in the situation of children
Associated with laboratory tests and diagnostic examinations
Fluid intake and output
Nutrition
Response of children to treatment
Reaction oranhg children and parents to illness and hospitalization stay in the hospital.
Guidelines for teaching patients and families
Guidelines for home plans.

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