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The nurse needs to get information on Alyssa’s health history and the physical assessment results to propose adequate interventions. Alyssa was diagnosed with Ventricular Septal Defect (VSD), which may be an additional risk factor for other heart problems. The girl’s current symptoms include noticeably rapid heartbeat, dizziness, pale complexion, and increased sweating. She has already experienced the same symptoms, which denotes that her condition might be reoccurring. The nurse needs to evaluate the cardiac output rate formed by the heart rate and the stroke volume, heart sounds, and calcium level (Hinkle & Cheever, 2018). The physical assessment results may indicate some acquired cardiovascular condition, such as supraventricular tachycardia (SVT), which major symptom is the increased heart rate (Hinkle & Cheever, 2018). The information obtained from the physical assessment will influence the nursing plan and the necessary nursing interventions.
The nurse should support Alyssa and closely monitor her condition. The first priority nursing intervention is assessing heart rate and blood pressure (Nurseslabs, 2019). The rationale for it is that it is important to monitor these indicators as compensatory tachycardia and decreased blood pressure may indicate reduced cardiac output (Nurseslabs, 2019). The second nursing intervention is monitoring an electrocardiogram (ECG) for heart rate, rhythm, and ectopy (Nurseslabs, 2019). It will help detect cardiac dysrhythmias and tachycardia that affect cardiac output (Nurseslabs, 2019). The nursing third intervention includes providing adequate rest periods that decrease myocardial and oxygen demand (Nurseslabs, 2019). These are three important interventions that Alyssa’s nurse must perform.
Another important intervention is the administration of the prescribed medication – adenosine. Adenosine is one of the drugs included in the list of antiarrhythmic agents (Karch, 2020). Adenosine decelerates “conduction through the atrioventricular (AV) node, prolongs the refractory period, and decreases automaticity in the AV node” (Karch, 2020, p. 1960). It has a short duration of action (about 15 seconds) and may have only a few negative side effects, including headache, flushing, and dyspnea of short duration (Karch, 2020, p.1960). Antiarrhythmic drugs are not usually prescribed to children unless they had cardiac surgery or, as in Alyssa’s case, have congenital heart issues (Karch, 2020). Thus, Alyssa should be monitored by the nurse after the drug’s administration to detect possible adverse effects (Karch, 2020). This is the key pharmacologic and administration information on adenosine.
The nurse needs to provide adequate patient and family medication education before Alyssa’s discharge. It should cover digoxin’s effects and possible side effects, which should be immediately reported to the healthcare provider if detected, the dosage, and the compatibility with other drugs. Digoxin (or Lanoxin) is a drug utilized to “increase the strength of heart contractions” (Karch, 2020, p. 75). It decelerates calcium leaving the cell, increasing the action potential and “slowing conduction and heart rate” (Karch, 2020, p. 1960). Alyssa’s parents should report any changes in her diet and medications to the healthcare provider to avoid any adverse effects (Karsh, 2020). As for compatibility, it is prohibited to use digoxin together with St. John’s wort, quinidine, rifampin, and midodrine (Karch, 2020). Before administering the dose, it is necessary to count the apical pulse for one full minute and withhold if it is less than 90 (Ricci, 2021). Giving an oral form of digoxin with meals should be avoided (Ricci, 2021). Digoxin has narrow safety margins for the dosage, especially for children (Karch, 2020). Therefore, it is vital for Alyssa’s parents not to violate the nurse’s recommendations on its administration.
References
Hinkle, J. L., & Cheever, K.H. (2018). Brunner & Suddarth’s textbook of medical-surgical nursing (14th ed.). Wolters Kluwer.
Karch, A. M. (2020). Focus on nursing pharmacology (8th ed.). (R. G. Tucker, Ed.). Wolters Kluwer.
Nurseslabs. (2019). 5 congenital heart disease nursing care plans. Web.
Ricci, S.S., Kyle, T., & Carman, S. (2021). Maternity and pediatric nursing (4th ed.). Wolters Kluwer, Lippincott Williams & Wilkins.
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