Truncus Arteriosus type 2
Description
Background & Abstract
Case: A newborn girl with several congenital abnormalities and chronic TA type II; the outcome is life-incompatible.
Truncus arteriosus (TA) is a very deadly congenital heart condition.
Involves a single artery trunk that supplies blood to the heart, lungs, and systemic circulation.
It is frequently linked to intricate cardiovascular abnormalities, which makes treatment difficult.
Health history
Birth and Initial Assessment
- A C-section was performed on a female infant after induction failed because to macrosomia.
- History of the mother: poorly controlled gestational diabetes.
- APGAR: 9/10/10, well-perfused, good motor activity, normal labs, and intense weeping.
- Hypoplastic left heart syndrome (HLHS) is a prenatal suspicion.
- Prostaglandin E1 (Alprostadil) infusion (5 ng/kg/min) was the first step in the therapy.
- Without O₂, preductal O₂ saturation ranges from 70 to 85%.
Echocardiography ( Day 2 )
Results:
- hypoplastic LV with mitral atresia.
- RV that is hypertrophied and functioning well.
- The pulmonary arteries came from the truncus arteriosus, which sprang from the RV.
- large cerebral and brachiocephalic arteries that start distally.
- PDA joining the descending aorta and truncus.
- No ascending aorta or aortic valve could be seen.
- Suspected coronary abnormality (truncus brachiocephalicus origin).
- Left-to-right shunt in ASD II.
- normal return of blood to the lungs.
CTA (Day 3)
- TA type II was verified, accompanied by mitral atresia, hypoplastic LV, VSD, and ASD.
- Ascending aortic agenesis.
- One coronary artery from the bicaroticus truncus.
- (aberrant right subclavian) Lusorian artery.
- circulation that is reliant on PDA.
Echocardiography (Day 27)
- Left-to-right shunt with turbulence (mean gradient of 15 mmHg) and ASD enlarged.
- RV function: maintained.
- Little regurgitation from the truncal valve.
- PDA flow is sufficient, but the diastolic return flow is only moderate.
Clinical Program
- Initial treatment: central venous catheterisation and infusion of alprostadil.
- Infections: Antibiotics (ampicillin + cefotaxime → later vancomycin + meropenem) → persistent fever.
- Antibiotics continued after the line was withdrawn due to a possible catheter-related infection.
- Clinical status: weight increase, sufficient nutrition, and typically stable.
- Because of its extremely complicated architecture (single coronary artery + HLHS), cardiac surgery is not a possibility.
- Listing for a heart transplant is not feasible.
Palliative intervention (Day 44):
- Cardiac catheterisation followed by an 8x18 mm drug-eluting stent in TA is the palliative intervention (Day 44).
- In order to alleviate restricted ASD, a Rashkind atrial septostomy was performed.
- Central line removed, alprostadil discontinued.
- released to palliative care at home.
Result:
- Death about two months later as a result of cerebral hypoxia, pulmonary oedema, and progressive heart failure.
Protocol
Medication Errors Issue: Adverse drug events and medication errors.
Interventions:
- Nursing teams examine drugs on a regular basis and aggressively carry out medication reconciliation at each care transfer. These incidences are significantly decreased by double-checking, utilising barcoding technologies, and educating patients about their prescriptions.
Management:
- To improve overall safety, electronic health record implementation, medication safety training for personnel, and recurring audits to identify and address inconsistencies are all recommended.
Infection Control:
- Problem: Healthcare-associated infections, including those from multidrug-resistant organisms.
- Interventions: Nurses implement strict hand hygiene, isolate patients who are at risk, and make sure that settings and equipment are properly disinfected.
- Management: High compliance is maintained by frequent in-service training, audits, and conspicuous reminders. In clinical settings, the spread of the infection is stopped by early detection and isolation of affected individuals.
Pain Management
- Issue: Inadequate pain management compromises patient comfort and healing.
- Interventions: Thorough evaluations of pain are conducted both at admission and on a frequent basis. Both non-pharmacological (music therapy, relaxation methods) and pharmacological (patient-controlled analgesia) approaches are employed.
- Management: Consistent, evidence-based practice is supported by ongoing education on pain management alternatives and methods. Multidisciplinary cooperation guarantees that all aspects of pain are swiftly addressed.
ICU-Acquired Weakness (ICU-AW).
The problem of delirium, muscle weakness, and poor recovery in critically sick patients is known as ICU-Acquired Weakness (ICU-AW).
- Interventions: Packages like the ABCDE strategy include early physical rehabilitation (physiotherapy, neuromuscular stimulation), regular dietary support, airway management, minimum sedation, pain management, and psychosocial care.
- Management: By guiding tailored actions and regular evaluation, theory-driven frameworks (empowerment, goal-oriented) lower ICU length of stay, delirium rates, and frailty.
Resource Constraints and Work Overload
- Problem: Staffing shortages, lack of equipment, and increased workload (exacerbated by crises like COVID-19).
- Interventions: Rapid resource assessment, prioritization of care, delegation to support staff, and innovative resource utilization ensure essential patient needs are met.
- Management: Clear organizational communication, effective scheduling, staff support systems (mentoring, counseling), and fostering adaptability in nurses help maintain standards.
Conflict and Personnel Issues
- Problem: Interpersonal conflicts, absenteeism, and team dysfunction.
- Interventions: Open communication, mediation by nurse managers, team-building exercises, and rotating shifts reduce burnout and misunderstandings.
- Management: Leadership training and collaborative problem-solving foster resilience and positive working relationships.
Patient Education and Engagement
- Problem: Poor adherence to care plans or misunderstanding of health conditions.
- Interventions: Nurses conduct individualized teaching, using plain language, demonstrations, written materials, and follow-up calls.
- Management: Regular review of educational outcomes and adaptation to patient literacy or cultural needs improve engagement, self-care confidence, and outcomes.
Notes
For more information visit https://www.sciencedirect.com/science/article/pii/S2405844022023210
