[solved]-Cardiac Catheterization Nursing Care Plans

Cardiac catheterization is an invasive procedure in which a small flexible catheter is inserted through a vein or artery (usually the femoral vein) into the heart for diagnostic and therapeutic purposes. It is usually done with angiography as radiopaque contrast media is injected through the catheter and visualization of the blood flow is seen on fluoroscopic monitors. Catheterization allows measurement of blood gases and pressures within the heart chambers and great vessels; measurement of cardiac output; and detection of anatomic defects such as septal defects or obstruction to blood flow.

Therapeutic, or interventional, cardiac catheterizations use balloon angioplasty to correct such defects as stenotic valves or vessels, aortic obstruction (particularly re-coarctation of the aorta), and closure of patent ductus arteriosus.
Nursing Care Plans

Nursing care planning goals for a child who will undergo cardiac catheterization include promoting adequate perfusion, alleviating fear and anxiety, providing teaching and information, and preventing injury. Close monitoring of a child post cardiac catheterization is also crucial for the early identification of complications that will minimize mortality and morbidity rates.
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Here are four (4) nursing care plans (NCP) and nursing diagnosis for cardiac catheterization:

Ineffective Peripheral Tissue Perfusion
Hyperthermia
Fear
Risk For Injury

Ineffective Peripheral Tissue Perfusion

Ineffective Tissue Perfusion: Decreased in the oxygen resulting in the failure to nourish the tissues at the capillary level.

May be related to

Clot formation at the puncture site

Possibly evidenced by

Decreased or absent pulses distal to catheterization site
Cool, mottled appearance of the affected extremity
Tingling sensation on the affected extremity
Pain

Desired Outcomes

Child’s involved extremity will be pink and warm.
Child will respond to sensation in extremities equally bilaterally.
Child’s pulses will be present distal to the catheterization site and equal bilaterally.

Nursing Interventions Rationale
Assess affected extremity, noting its color, temperature, and capillary refill; Palpate distal pulses; Use doppler every 15 minutes for 4 times, every 30 minutes for 3 hours, then every 4 hours. Formation of a clot at the puncture site and the child is at risk of the clots severely obstructing distal blood and resulting in tissue damage. Frequently assessment of the extremity for adequate perfusion enables for prompt intervention as needed.
Encourage bed rest and keep affected extremity straight or slight bend in the knee (10 degrees) for 6 hours. Bed rest and slight, or no flexion, provides improve circulation and minimizes the risk of further trauma which could promote the formation of a clot.
Provide warmth to the opposite extremity. Enhances blood flow without causing risk of increased bleeding at the site.
Inform parents and child of a need for frequent vital signs monitoring and importance of bed rest with an extension of the extremity. Promotes understanding and cooperation.
Hyperthermia

Hyperthermia: Body temperature elevated above normal range.

May be related to

Reaction to the radiopaque contrast substance utilized during catheterization

Possibly evidenced by

Increase body temperature within few hours postoperatively

Desired Outcomes

Child’s axillary temperature will be less than 100° F.

Nursing Interventions Rationale
Assess body temperature every hour for 6 hours and then routine. Provides information on which action to take.
Monitor and record intake and output hourly. Evaluates the routine adequacy of fluid intake and elimination.
Maintain IV fluids while the child is drowsy, and when fully awake, encourage fluid intake per orem. Increased fluid intake helps to flush out the dye.
Instruct parents to encourage PO fluids. Including parents in the care boosts the probability of achieving the goal.
Instruct parents to monitor child’s temperature at home and notify any elevations after discharge. Teaching empowers parents to care for the child and helps monitor for hyperthermia.
Fear

Fear: Response to perceived threat that is consciously recognized as a danger.

May be related to
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Fear of needles and fear of exposure.
Invasive, painful procedure
Separation from parents
Risk of harm

Possibly evidenced by

Expressed concern over impending procedure.
Apprehension
In children: increased motor activity
Inattention
Clinging to parent
Crying
Verbal protests
Withdrawal

Desired Outcomes

Child will not cry, cling to parents, or protest.
Parents will verbalize decreased anxiety/concern.

Nursing Interventions Rationale
Assess parents’ and child’s understanding of catheterization and any special fears. Provides information on parents’ and child’s knowledge, misunderstanding and particular concerns; sources of anxiety for the parents include fear and uncertainty over the procedure, guilt and anxiety over the child’s pain, fear of complications, and
uncertainty over the outcome; for the
child, fears may include separation from parents, fear of the unknown (if the first catheterization), fear of mutilation and death, or remembered fear and pain (if repeat catheterization).
Encourage expression of fears, clarify any misconceptions or lack of knowledge. Enables parents and child to express feelings and provides them accurate, complete information.
Prepare the child using age-appropriate guidelines; use concrete explanations just prior to an event for younger children.
Include information on what the child will experience through all senses. Age-appropriate information given to the child allows for greater understanding and reassurance; young children process information through all their senses and need to know what to expect to better cope.
Allow parents to accompany the child
and be with the child when awake postoperatively. Children in stressful events adjust well to the presence of their parents.
Suggest to parents and child to bring a familiar, comforting item such as a blanket, pillow, stuffed toy. A familiar object provides comfort and security to the child experiencing unfamiliar events and surroundings.
Provide a rationale for pre and
post-catheterization procedure. Having knowledge and awareness of reason for each procedure promotes better understanding and acceptance.
Inform parents that the child may
momentarily act differently at home: may need to stay close to parents, have unpleasant dreams, and be less self-sufficient; encourage parents to comfort and reassure the child, to allow the child to “re-live” the experience through stories or play, and to accept temporary setbacks in development. Stressful events may cause the child to need extra reassurance and may cause a temporary regression in development as the child reverts to comfortable, familiar “safe” activities; children, like adults, have a need to replay stressful events in order to understand and cope, and this is often accomplished through play activities.
Risk For Injury

Risk for Injury: Vulnerable for injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources, which may compromise health.

May be related to

Altered hemostasis and trauma from a percutaneous puncture

Possibly evidenced by

Decreased level of consciousness
Increased apical heart rate and decreased blood pressure
Bleeding from the catheterization site
Bruising

Desired Outcomes

Child will not experience bleeding from the puncture site.
Child’s heart rate and blood pressure will remain within normal limit.

Nursing Interventions Rationale
Monitor vital signs every 15 minutes for 4, every 30 minutes for 3 hours, then every 4 hours. Vital sign changes may reveal blood loss and with internal bleeding may be the first indicator of health problem.
Gather baseline laboratory results
from pre-catheterization assessment. Provides comparative data for post-catheterization assessment.
Keep pressure dressing on the catheterization site and assess every 30 minutes for bleeding. If bleeding does occur, apply continuous direct pressure 1 inch above the puncture site and immediately report to the physician. Direct constant pressure on site is needed to avoid bleeding; no bleeding, even oozing, should happen.
Maintain bed rest for 6 hours
post-catheterization as ordered. Bed rest avoids strain to catheterization site which otherwise might hasten bleeding; an elevation of the head (45-degree) and a slight bend at the knees are acceptable; young children may be held by parents, this is beneficial in lessening agitation.
Encourage parents and child to engage
in quiet activities such as storytelling, music. Allows for expression and interaction without physical stress; provides a distraction for comfort.
Inform parents and child of the need for
periodic monitoring and for bed rest. Promotes understanding and cooperation.
Encourage parents of infants and young children to hold their children as an acceptable option for resting in bed. Allows parents to be in contact and comfort their child in a more normal manner; this minimizes episodes of agitation, thereby encouraging more rest.
Instruct parents to observe and notify any sign of bleeding immediately. Educate parents that pressure dressing will be removed after 24 hours and that they should continue to assess the site and report to the physician if any bleeding is noted.

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