NURSING CARE OF CHILDREN AFTER OPEN HEART SURGERY

Abstract

THE role of the nurse in caring for a child after open heart surgery is a very significant one. Not only must she be aware of symptoms that might indicate postoperative complications, but she must also be able to interpret behavioral signs shown by little children who, because of their age, cannot verbalize their feelings. In order to be a helpful assistant, the nurse must have knowledge of the surgical procedure, and she should anticipate the doctor's orders. Familiarity with the necessary equipment and drugs is most essential. The nurse is responsible for having any equipment and supplies complete and ready for immediate use. At Texas Children's Hospital, patients who have cardiac defects are admitted for diagnostic studies before surgery is scheduled. The immediate preoperative care given by the nurse includes washing the chest, axilla, and groin with a hexachlorophene soap solution. Penicillin and strentomycin and a barbituate are usually given the evening before surgery. Early the next day, the child receives a mild sedative such as chloral hydrate, with a narcotic and scopolamine usually, given about one hour before the child goes to the operating room. The children who have undergone open heart surgery are taken first to the recovery room. They frequently are awake, but drowsy. The chest catheters are connected to sterile under water seal drainage bottles, which allow any air, blood, or serous fluid to escape from the pleural space. We use commercial thoracic suction machines and secure all the connections with tape. The drainage bottles are marked with adhesive tape showing the amount of sterile water originally put in the bottles. At least every eight hours, or more often if the amount of drainage appears to be excessive, the total amount of drainage is indicated on the tape. The chest drainage bottles are not emptied. Since there is almost always a catheter in the right and left pleural spaces, we check both carefully to see that they are draining properly and that the tubing