Down Syndrome with Severe Pulmonary Stenosis

Vijayalakshmi1, Ambiga2

1Nursing Incharge, Kauvery Heartcity, Trichy, India

2Senior Staff Nurse, Kauvery Heartcity, Trichy, India

*Correspondence nursing.heartcity@kauveryhospital.com

Abstract

An 8-year-old girl, with Down’s Syndrome, was diagnosed to have severe valvular pulmonic stenosis. She was advised Balloon Pulmonary Valvotomy and admitted for the same. The patient underwent successful Balloon pulmonary valvotomy on 30/11/2022. Her procedure and post procedure period were uneventful. She was treated with all possible supportive measures. Her condition improved and  was discharged with stable vitals with the necessary advice.

Definition

Pulmonary valve stenosis is a type of heart valve disease that involves the narrowing of pulmonary valve, which controls the flow of blood from the heart’s right ventricle into the pulmonary artery to carry to the lungs.

Symptoms

Complaints of shortness of breath; baby had blue skin.

Vital Sign

BP: 90/60mmHg

 

HR: 84bpm

 

CVS: S1 – Normal S2 – Normal split, Pancystolic murmur in left parasternal border

 

RS: Clear

 

P/A: NAD

Investigation

  1. ECHO
  2. X – Ray
  3. Blood reports – Pre cath

ECHO:

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downsyn2

Scan Report

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Diagnosis

  1. Severe valvular pulmonic stenosis
  2. Down’s syndrome

This is a well known association

Procedure

Balloon pulmonary valvulotomy done

Nursing Care

  1. Baby was shifted to Critical Care Unit 1 with a duty doctor and continuous cardiac monitoring.
  2. Nurses skilled in IV infusion and blood sampling techniques (Phlebotomy) obtained the samples for blood investigations like (CBC, ESR, Sodium, Potassium, etc.,) with a sterile technique to prevent thrombophlebitis.
  3. Doctors explained the baby’s condition to the attenders. Nurses obtained consent for the clinical procedures after proper counseling.
  4. Nurses used AIDET technique (Acknowledge, Introduce, Duration, Explanation and Thank you) while communicating with patient and attenders to gain their confidence and improve the satisfaction level.
  5. Auscultate lung sounds to detect an increase or decrease in pulmonary crackles.
  6. Determine the degrees of jugular vein distension.
  7. Identify and evaluate the severity of edema.
  8. Monitor the baby’s pulse rate and BP and monitor for dysrhymia’s hypotension.
  9. Examine skin colour (pallor or cyanosis), skin turgor and mucous membranes for signs of dehydration.
  10. Assess for symptoms of fluid overload.
  11. Watch for bleeding or hematoma from the puncture site.

Discharge advice

  1. Advised to regular follow up
  2. Infective endocarditis prophylaxis (Whenever indicated for the next 6 months)
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Ms. G. Vijayalakshmi

Nursing Incharge

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Ms. Ambiga

Senior Staff Nurse

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