ABSTRACT
This analysis of retrospective and prospective data quantified children (age range 0-18 years, total n = 132) during their stay in a cardiothoracic intensive care unit and examined pain management and sedation practices. Data on both factors that could potentially affect pain and its management, and analgesics/sedatives ordered for and administered to subjects were collected from chart review. In the prospective group, pain intensity was measured twice daily using the Wong-Baker FACES Pain Rating Scale. Repeat cardiac surgical procedure subjects reported significantly more pain than nonrepeat subjects on the first postoperative night. Subjects with sternal incisions reported significantly more pain than subjects with submammary incisions. Not all subjects were premedicated with analgesia for invasive procedures. Significantly greater amounts of analgesia were received by the 0-3 year-old subjects. Large amounts of sedation were used, especially in children under 3 years of age. The results prompted development of a nursing standard to assess and manage pain and sedation in this population.
Subject(s)
Cardiac Surgical Procedures/adverse effects , Nursing Assessment/standards , Pain Measurement/standards , Pain, Postoperative/nursing , Adolescent , Age Factors , Child , Child, Preschool , Clinical Nursing Research , Conscious Sedation/nursing , Female , Humans , Infant , Infant, Newborn , Male , Prospective Studies , Retrospective StudiesABSTRACT
Inotropic and vasodilating agents are traditionally used with diuretics to manage heart failure in children with congenital heart disease. This article reviews the developmental aspects of cardiovascular physiology and the rational use of therapeutic agents for acutely ill surgical and medical pediatric patients with cardiac disease. By understanding the actions and indications for inotropic support and afterload reduction, the critical care nurse can intelligently administer these agents and evaluate their effects.
