In order to understand much of the data that the nurse must
assess, cluster together and use as a basis for diagnosis, it is
necessary to understand the pathophysiology of this particular
child’s case. One of the CHD that may require ECMO and
INO is TAPVD, in which all pulmonary veins abnormally
drain to the right atrium, dilating those chambers, while the
left heart chambers are reduced. This overflow leads to PH
and symptoms such as dyspnea, sweating, tachycardia, heart
failure, respiratory infections and mild cyanosis. Early surgical
intervention is mandatory, and mortality rate in the first year
is approximately 80 to 90%(4). Inhaled nitrous oxide has been
studied in the context of cardiac surgery for congenital heart
disease (CHD). It acts as a selective pulmonary vasodilator by
binding to oxygen-saturated hemoglobin, which leads to the
formation of nitrate and methemoglobin and thereby prevents
systemic vasodilation. Exclusive pulmonary vasodilation maximizes
ventilation(5). The ECMO procedure removes blood,
oxygenates it through an artificial lung, and returns it to the
aorta to treat those with severe heart and respiratory failure(6).
The NANDA-I diagnostic criteria provide a “quality check”
to ensure accuracy in diagnosis; without identified clinical evidence
or defining characteristics (signs/symptoms) and related
(etiologic) factors, it is impossible to know if diagnoses are accurate
for a particular patient. Additionally, the definition of the
diagnosis label provides the nurse with the ability to clarify that
her clinical judgment is truly represented by the identified diagnosis.
Inaccurate diagnosis can lead to ineffective and inefficient
intervention, and can jeopardize patient safety and outcomes.
In order to understand much of the data that the nurse mustassess, cluster together and use as a basis for diagnosis, it isnecessary to understand the pathophysiology of this particularchild’s case. One of the CHD that may require ECMO andINO is TAPVD, in which all pulmonary veins abnormallydrain to the right atrium, dilating those chambers, while theleft heart chambers are reduced. This overflow leads to PHand symptoms such as dyspnea, sweating, tachycardia, heartfailure, respiratory infections and mild cyanosis. Early surgicalintervention is mandatory, and mortality rate in the first yearis approximately 80 to 90%(4). Inhaled nitrous oxide has beenstudied in the context of cardiac surgery for congenital heartdisease (CHD). It acts as a selective pulmonary vasodilator bybinding to oxygen-saturated hemoglobin, which leads to theformation of nitrate and methemoglobin and thereby preventssystemic vasodilation. Exclusive pulmonary vasodilation maximizesventilation(5). The ECMO procedure removes blood,oxygenates it through an artificial lung, and returns it to theaorta to treat those with severe heart and respiratory failure(6).The NANDA-I diagnostic criteria provide a “quality check”to ensure accuracy in diagnosis; without identified clinical evidenceor defining characteristics (signs/symptoms) and related(etiologic) factors, it is impossible to know if diagnoses are accuratefor a particular patient. Additionally, the definition of thediagnosis label provides the nurse with the ability to clarify thather clinical judgment is truly represented by the identified diagnosis.Inaccurate diagnosis can lead to ineffective and inefficientintervention, and can jeopardize patient safety and outcomes.
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