Nurse’s Roles in Caring for Pediatric Patients with Congenital Heart Disease and Supraventricular Tachycardia

Abstract

Supraventricular tachycardia (SVT) in pediatrics with congenital heart disease is complicated when compared with those with normal heart functions. The condition is typically more severe and life-threatened. The prolonged conditions may result in low cardiac output, poor perfusion, and an increased risk of sudden cardiac arrest. The objective of this article is to provide information about SVT in pediatrics with congenital heart disease covering SVT mechanisms, assessment, and treatment options, and to provide essential points for nurses regarding care and SVT relapsing prevention. The mechanisms of SVT involve the atrioventricular node functions. The mechanism can be elucidated with accessory pathway re-entry to the atrioventricular node (AVRT), AV node re-entry tachycardia (AVNRT), and abnormal automaticity. A 12-lead electrocardiogram assessment commonly shows regular rhythms with tachycardia and abnormal QRS complex and P wave. Pediatric nurses must be able to assess the signs and symptoms of SVT and interpret the electrocardiogram that indicates SVT accurately for their prompt clinical decision-making. The treatment options depend on the hemodynamic conditions of the patients and can be both non-invasive and invasive procedures at the bedside including vagal maneuvers, synchronized cardioversion, and drug administration. The vagal maneuvers are optional with the Ice bag technique, carotid sinus massage, Valsalva maneuver, and gag reflex stimulation. The pharmacologic treatment for acute termination of SVT when vagal maneuvers fail, including adenosine, amiodarone, digitalis, and others. The drug administration requires a double syringe technique. Synchronized cardioversion, the use of low-energy electrical shocks, is chosen in cases of unstable hemodynamics. Hemodynamic monitoring and the evaluation of possible complications before, during, and post-treatment are essential for nurses to ensure the safety of their patients. Family-centered care is highly recommended in all processes of treatment and care. To prevent relapse of SVT, it is essential for nurses to ensure that the patients and their families are well-informed about how to avoi d the triggering risk factors. Nursing approaches for pediatrics with congenital heart diseases with SVT require advanced clinical skills to assess and prompt emergency management at the bedside. Treatment options can be utilized in series. Advanced clinical skills regarding the treatment procedures must include adequate equipment preparations, life-saving skills, high-alert drug preparation and administration, and clinical decision-making. These skills are essential at all stages of illness. Family-centered care is a key and holistic lens to patient and family education covering self-care at home, risk reductions, self-monitoring to assess the initial symptoms of SVT, and timely hospital referral.