EA: What the nurse is looking for

EA:The Nurse's Exam and Diagnosis

The nurse will examine your child's heart in a similar fashion to the video above. In order to listen to the heart and to listen carefully for abnormal heart beats (arrhythmias). The nurse will do this while the child is calm and quiet. The nurse will also inspect the child for signs of difficulty breathing, and cyanosis (blue skin). Difficulty breathing is a common finding in children with congenital heart defects such as EA. This difficulty breathing can also lead to exercise intolerance (easy fatigue with activity) and even feeding problems. 

The American Heart Association Website discusses the evaluation of children with congenital heart defects, such as EA: 

Adults with a history of congenital heart defects may find more information about evaluation and medical care at the Adult Congenital Heart Association Website.

The following table shows common nursing diagnoses for EA, and what those diagnoses mean to the nurse[1]: 

Nursing Diagnosis	Explanation	Nursing Care
Impaired gas exchange	The lack of blood flowing to the lungs due to the decreased size of the right ventricle means that the blood which enters the whole body lacks the oxygen necessary to keep the cells working properly. This is commonly seen by cyanosis of the skin.	-        Elevate the head of the bed to 30 degrees to ease the fluid load in the lungs. -        Offer oxygen if indicated.
Activity intolerance	Difficulty maintaining exercise due to fatigue. The child may squat or bend over with hands on the knees to reduce the return of blood to and demand on the right side of the heart.	-        Place infant with knees flexed and HOB elevated or being held by caregiver to reduce blood return to the heart and ease the fluid load on the heart. -        Promote activity as tolerated with rest periods.
Altered Nutrition: Less than body requirements	Difficulty breathing can lead to problems with breast and bottle feeding in newborns and young children. This is a common problem with congenital heart disease. These children	-        Encourage patience with breastfeeding. May need to have more frequent feeds to get the necessary caloric intake for proper growth and development.
Risk for infection	Fluid buildup in the lungs increase the risk for pneumonia. If your child requires surgery, the nurse will be looking for signs of post-operative infection.	-        The nurse will be listening to the lungs using the stethoscope on the child’s chest and back. Fluid in the lungs causes crackle and wheezing sounds as the child breathes. -        The nurse will also be assessing for fever and a cough which produces a lot of fluid.
Risk for altered family processes	The amount of time and expense of hospital visits for treating EA children can be very stressful for families and disrupt normal patterns of living.	-        Assess family coping and encourage parents/caregivers to express their feelings. -        Suggestions about support groups. -        Encourage parent/caregivers to take time for themselves

References:

1. NANDA List of Nursing Diagnoses. Available from: http://nclex.ucoz.net/_ld/0/30_NANDALISTOFDIAG.pdf. Accessed February 11, 2015.