Nursing Care Plan for Congenital Heart Defects

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Pathophysiology

A congenital heart defect is a structural problem with the heart that is present at birth, but may not be detected until later in childhood or adulthood. Congenital heart defects are often divided into two main categories:  cyanotic and acyanotic.

Cyanotic heart defects are those that result in low blood oxygen level and create a bluish color of the skin. Some cyanotic heart defects include heart valve defects, Tetralogy of Fallot, and defects of the pulmonary vein.

Acyanotic heart defects are characterized by defects of the atrial septum or ventricular septum that may change the flow of blood, but does not affect the oxygen level in the blood.

Etiology

The heart begins developing and taking its shape during the sixth week of pregnancy. While it is still unclear why many of these defects develop, it is believed that genetics, maternal medications and environmental factors (such as smoking during pregnancy) may be involved.

In cyanotic defects, the blood flows from the right side to the left side of the heart through defects in the valves or abnormal openings. This causes the oxygenated blood to mix with deoxygenated blood so that there is less oxygen being pumped to the body.

In acyanotic defects, the blood flows from the left side to the right side of the heart, usually due to an abnormal opening in the septum that divides the atrium or ventricles or may be caused by an opening between the pulmonary artery and the aorta. Narrowing of the pulmonary or aortic valves can also cause acyanotic defects.

Desired Outcome

Patient will have adequate cardiac output with blood pressure and heart rate within normal limits; patient will have optimal activity tolerance; patient will have adequate oxygenation and tissue perfusion

Congenital Heart Defects Nursing Care Plan

Subjective Data:

  • Poor appetite / difficulty feeding infant
  • Becoming short of breath with activity
  • Fainting during exercise

Objective Data:

  • Pale gray or blue skin color
  • Tachypnea
  • Swelling of the hands or feet
  • Hypotension or signs of heart failure

Nursing Interventions and Rationales

  • Assess and monitor vital signs

 

Patient may have tachycardia with low blood pressure. Monitor for changes from baseline.

 

  • Auscultate heart and lungs for abnormal sounds

 

Listen for murmurs or gallops to help determine location and severity of condition.

Abnormal lungs sounds may indicate pulmonary edema related to heart failure.

 

  • Assess skin for cyanosis or pale color

 

Bluish or pale gray  color indicates lack of oxygenation and may be present in fingers and around the mouth at first

 

  • Obtain 12 lead ECG per facility protocol

 

Monitor for dysrhythmias

 

  • Assess peripheral pulses and capillary refill

 

Note weak or absent pulses, slow capillary refill due to decreased cardiac output

 

  • Obtain daily weights

 

Fluid and sodium retention, caused by activation of the RAAS, may cause sudden increase in weight. Monitoring weights daily helps intervene as necessary to maintain appropriate fluid balance.

 

  • Position patient for comfort in upright or semi-Fowler’s position

 

An upright position makes breathing easier as it allows the lungs to expand more fully and decreases stress on the heart. Patients may prefer to sit with legs pulled up to the chest, or young children may prefer to play in the squatting position.

 

  • Administer supplemental oxygen via mask or hood as required

 

To prevent hypoxia and decrease the strain on the heart. Monitor oxygen saturation to maintain above 90% or as ordered.

 

  • Administer medications appropriately

 

Medications may be given depending on the particular defect, such as prostaglandins to close a PDA.

ACE inhibitors and beta blockers may be given to help lower blood pressure to decrease preload and  afterload.

 

  • Cluster care and provide rest periods

 

Decrease the demand and stress on the heart and lungs.

 

  • Prepare patient for and assist with catheterization or surgery as appropriate

 

Many conditions can now be repaired with catheterization while others require open surgery or transplant. Patient will need to be NPO prior to surgery or procedure.

 

  • Provide patient and parent education regarding lifestyle restrictions and prevention of complications

 

  • Exercise restrictions may be necessary depending on the condition and severity.
  • Reduce the risk of infection with good dental care and hygiene practices.
  • Encourage healthy diet and hydration.

 


References

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