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.
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.
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
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
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