CUS

ETHICO-MORAL REASONING

II. Discharge Plan

MEDICATIONS
Give the baby’s medicine exactly as directed. Instruct caregivers (parents or
whoever will be left with the baby) to take medications at right time, dose,
frequency, route and explain when and why should the baby take them.
- Diuretics (water pills, if prescribed,)
- Medications for pain management- if prescribed
- Multivitamins (if prescribed, to help grow and stay healthy)
- Supplemental formula (if prescribed, may add to breastmilk to meet the
special growth needs)

Explain and discuss the drug-drug, herb-drug, and food-drug interaction to

avoid any complications.

Instruct caregivers to contact the healthcare provider if they think that the
take-home medicine (if any prescribed) is not helping and working as
expected or if the baby is experiencing adverse effects.

Advise caregiver to carry the list of medicines, vitamins and herbs with them
in case of an emergency.

EXERCISE
Explain to caregivers that they should keep the baby from crying for too long
for the first 3 to 4 weeks. That they can calm the baby by staying calm
themselves. When lifting the baby, support both the baby’s head and bottom
for the first 4 to 6 weeks.

For the first 4 weeks after surgery, caregivers must strictly monitor the baby to
avoid do any activity that could result in a fall or a blow to the chest, the need
to be careful about how they use their arms and upper bodies for the first 6 to
8 weeks.
- Do not pull or lift the baby by the arms or from their armpit area. Scoop
the baby up instead.
- Prevent the baby from doing any activities that involve pulling or
pushing with the arms.
- Try to keep the baby from lifting the arms above the head and should
not lift anything heavy that puts stress to the abdomen area.
 Help the caregivers choose appropriate exercises to support in decreasing the
delay of baby’s growth and developmental skills, and to help improve muscle
strength.
- Touching and talking to the baby can soothe her and give reassurance,
especially in the intensive care unit or right after surgery, even if she
has been sedated.
- Provide the baby with a variety of toys and other objects that stimulate
the senses of hearing, vision, touch, and smell, even while in the
hospital.
- Let your child take part in everyday family activities as much as he or
she can tolerate. Children also learn new skills from interaction with
brothers, sisters, and friends.
- Muscle Strength: gentle stretching of the baby’s limbs and shoulder,
wrist and leg by the parents, like the baby’s feet touching the mother’s
feet with bending and extending movements, and stepping on a
bicycle.
: Rotating the upper body slowly to each side with the head and upper
extremities supported; approximately 45 degrees of rotation

Encourage mother to come up with a balanced scheduled plan of both activity

and rest periods. Just like exercise, the body gets the time it needs to recover
the lost strength and to fully heal from cardiac surgery.

TREATMENT
Instruct caregivers to call the physician if the baby is at life threatening
situations with complications such as having a fever, episodes of vomiting,
sudden chest pain difficulty or shortness of breathing, fainting, seizure and
abnormal heart palpitations. Teach parents on how to monitor blood pressure
of the baby. To relieve pain, medication like Tylenol (if prescribed) may be
given.

Encourage caregivers to place the baby on her side and pull her knees up to
his chest if she turns blue. This will help increase blood flow to her lungs.

Provide support to the mother through referral to a lactation consultant to

know how to use a breast pump or, in actual infant breastfeeding, how to
position the infant for comfort and ease of nursing, how to use nipple shields
as needed, and how to manage engorgement, milk supply problems, sore
nipples, and infant sucking problems.

Explain that the pediatrician may recommend a referral for an intervention

services for the baby’s overall development to continuously observe any delay
 in development of gross motor skills, fine motor skills, language ability,
cognitive performance, and adaptive behavior of the baby.

HYGIENE
Involve the parents in the care of for baby while hospitalized to be more
prepared in taking care of the baby at home and educate on how to monitor
the incision site for signs of infection, such as redness, swelling, tenderness,
warmth, or drainage.

A sponge bath may be advisable for 3 to 4 weeks after surgery or until the
pediatrician says otherwise. Usage of mild unscented soap is a must. Do not
apply any lotions, ointments, or creams to the incision site. Steri-Strips should
not be soaked in water. For as long as the scar looks pink, advise the
caregivers to make sure it is covered with clothing or a bandage whenever
going out for important appointments.

In breastfeeding, highly encourage the mother to do proper breast care to

help the baby be at ease when sucking. Pay close attention to the area under
the baby's chin where food and moisture can collect.
Instruct to keep the baby’s gums and teeth clean and healthy. Gently brush or
use washcloth wrapped around finger in baby’s gums or teeth regularly.
Advise caregivers to ask if the baby needs antibiotics when she gets her teeth
cleaned.
Do not smoke around the baby or avoid the baby from people who smokes.
Smoke can harm the baby’s heart and lungs and make it hard for her to
breathe.
For the baby to avoid harbouring any infections educate caregivers to wash
their hands with soap and water after changing nappies, preparing food or
going to the toilet.

Advise to ask visitors to wash their hands when they enter the home. Advise
to try to restrict the number of other people who hold the baby, as far as
possible.

Keep surfaces clean and keep any pets away from food or surfaces where
food is being prepared or eaten.

OUTPATIENT
Instruct caregivers to visit physician on the dates given for follow-up visits, this
is for the physician to monitor the progress of the therapeutic intervention
given to the patient and also to detect recurrent or new cardiac complications
 such as pulmonary regurgitation and ventricular arrhythmias as early as
possible.

The follow-up visit includes monitoring of the incision scar from the palliative
or corrective heart surgery and then instruct caregivers to strictly follow the
date marked on the dressing which is the date the dressing should be
removed to avoid any infections.

Follow-up visits in the cardiology clinic usually consist of a physical

examination, electrocardiogram and periodic echocardiography.

Suggest in writing down questions or concerns so she can remember to ask

them during visits.

DIET
Limit feeding time to around 30 minutes. Advise caregivers to ask their
physician on how to add extra calories to formula if it is necessary.

A high-calorie foods and snacks can play a very important role in providing
good nutrition. Don't restrict fat in the diet, particularly in the first two years of
life. It's needed to help children grow and develop properly.

Educate that in achieving an effective result in exercise, it should be

combined with a balanced diet. Encourage caregivers to prepare food that
will boost the energy levels of the baby such as
- High-calorie milk, formula, or breastmilk. Mothers may be able to
add special nutritional supplements to formula or pumped breastmilk to
increase the number of calories in each ounce. These let the baby
drink less but still get enough calories to grow.
- High-calorie foods and snacks. Try to offer the baby with nutritious
foods and snacks that are high in calories and nutrients when possible.
Read labels and become aware of the calorie content of foods.

After discharge, the nutrient needs of some babies with congenital heart
disease still may not be met, especially those weighing less than 1,500 g.
Breast milk fortification can be accomplished by adding commercially
available liquid or powdered fortifiers that contain additional calories,
macronutrients, vitamins, calcium, and phosphorus.

SPIRITUALITY
Provide spiritual and emotional support. Encourage family member to provide
emotional support to lessen anxiety and stress felt by the parents due to their
separation.

Encourage family in praying for the fast recovery of the baby’s overall well-
being.