Paediatric Nursing Skills for Australian Nurses

Introduction

The majority of paediatric patients do not have cardiac-related health problems, but some paediatric patients experience cardiac arrhythmias, have congenital heart disease or develop acquired heart disease. Therefore, as a beginning paediatric nurse, you will be required to manage these patients. This chapter will provide you with an understanding of the foundation skills, including performing an electrocardiograph (ECG), cardioversion and defibrillation, cardiac pacing, care of the post-operative paediatric cardiac surgery patient and the principles of care for infants and children with chronic heart failure.

Background: Paediatric heart disease in Australia

Congenital heart disease (CHD) affects between 0.4 and 1 per cent of all children, and is the most common cause of death from a structural abnormality in the world. There are over 2000 children born in Australia each year, or approximately six to eight per 1000 live births, with a congenital heart defect, and at least half of these children will require either a surgical or interventional procedure. CHD is the largest cause of death in children under the age of 1 year. Up to 20 per cent of congenital heart defects can be genetically linked. Acquired heart disease, including cardiomyopathy, Kawasaki disease and rheumatic heart disease, is also prevalent in young children. Australia and New Zealand have one of the highest incidences of rheumatic fever in the world, particularly among the Indigenous populations in both countries (Blue et al., 2012; HeartKids Australia, 2016).

CHD is thought to be related to teratogens, the environment and genetics, as well as unknown causes. Contributing factors include maternal-related disorders such as phenylketonuria, diabetes, infection, obesity, systemic lupus erythematosus and epilepsy. Maternal drug exposure, including to non-therapeutic drugs, chemical exposure and genetics are also considered risk factors. The Human Genome Project, chromosomal analysis and advances in molecular biology have advanced our understanding of the causes of CHD (Blue et al., 2012; Hazinski, 2013). Chromosomal anomalies are present in 8–10 per cent of all congenital heart disease patients.

The number of adolescents over 16 years of age with CHD outweighs the number of young children being born with CHD, which will require future planning and resource allocation as these children transition to adulthood. These young people have ongoing haemodynamic and electrophysiologic issues, including reduced exercise olerance, arrhythmias, heart failure and sudden death (Celermajer et al., 2016; Hazinski, 2013; HeartKids Australia, 2016; Khairy et al., 2010; van der Linde et al., 2011).