5 Congenital Heart Disease Nursing Care Plans

Congenital heart disease results from malformations of the heart that involve the septums, valves, and large arteries. They are classified as acyanotic or cyanotic defects. Acyanotic defects occur when a left-to-right shunt is present that allows a mixture of oxygenated and unoxygenated blood to enter the systemic circulation. The most common consequences of these defects in children are growth retardation and congestive heart failure (CHF).

Common cyanotic defects include tetralogy of Fallot and transposition of the great vessels. Tetralogy of Fallot involves four defects that include pulmonic stenosis, ventricular septal defect, right ventricular hypertrophy, and an aorta that overrides the ventricular septal defect. Transposition of the great vessels is a condition in which the aorta arises from the right ventricle instead of the left ventricle, and the pulmonary artery arises from
the left ventricle instead of the right ventricle, thereby causing a reversal of the normal position of these arteries. Transposition of the great vessels is incompatible with life unless septal defects are also present to allow mixing of blood from the two circulations.

Acyanotic defects include coarctation of aorta, patent ductus arteriosus, and ventricular septal defect. Coarctation of the aorta is the narrowing of the aorta proximal to the ductus arteriosus (preductal), distal to the ductus arteriosus (postductal), or level with the ductus arteriosus (auxtaductal). The position of the narrowing during fetal development determines circulation to the lower body and development of collateral circulation. Patent
ductus arteriosus is the failure of the structure needed for fetal circulation to close after birth. Ventricular septal defect is the incomplete development of the septum that separates the right and left ventricles, and it often accompanies other defects.

Nursing Care Plans

Congenital heart defects vary in severity, symptoms, and complications, many of which depend on the age of the infant/child and the size of the defect. Treatment may include management with medications, open heart surgery to repair or resect, or to temporarily correct the defect until the child is older and growth takes place.

Here are five (5) nursing care plans (NCP) for congenital heart diseases:

  1. Decreased Cardiac Output
  2. Activity Intolerance
  3. Compromised Family Coping
  4. Risk for Injury
  5. Risk for Infection

Decreased Cardiac Output: Inadequate blood pumped by the heart to meet metabolic demands of the body.

May be related to

  • Structural factors of congenital heart defect

Possibly evidenced by

  • Variations in hemodynamic readings (hypertension, bounding, pulses, tachycardia, specify values)
  • Widened pulse pressure
  • ECG changes,
  • Arrhythmias
  • Murmur
  • Decreased peripheral pulses
  • Fatigue
  • Dyspnea
  • Cyanosis or absence of cyanosis
  • Oliguria
  • Squatting or knee-chest position

Desired Outcomes

  • Child will demonstrates adequate cardiac output as evidenced by blood pressure and pulse rate and rhythm within normal parameters for patient; strong peripheral pulses; and an ability to tolerate activity without symptoms of dyspnea, syncope, or chest pain.
Nursing Interventions Rationale
Assess heart rate and blood pressure. Most patients have compensatory tachycardia and significantly low blood pressure in response to reduced cardiac output.
Note skin color, temperature, and moisture. Cold, clammy, and pale skin is secondary to a compensatory increase in sympathetic nervous system stimulation and low cardiac output and oxygen desaturation.
Check for peripheral pulses, including capillary refill. Weak pulses are present in reduced stroke volume and cardiac output. Capillary refill is sometimes slow or absent.
Assess for reports of fatigue and reduced activity tolerance. Fatigue and exertional dyspnea are common problems with low cardiac output states. Close monitoring of the patient’s response serves as a guide for optimal progression of activity.
Inspect fluid balance and weight gain. Weigh patient regularly prior to breakfast. Compromised regulatory mechanisms may result in fluid and sodium retention; Weight is an indicator of fluid balance.
Assess heart sounds for gallops (S3, S4). S3 indicates reduced left ventricular ejection and is a class sign of left ventricular failure. S4 occurs with reduced compliance of the left ventricle, which impairs diastolic filling.
Monitor electrocardiogram (ECG) for rate, rhythm, and ectopy. Cardiac dysrhythmias may occur from low perfusion, acidosis, or hypoxia. Tachycardia, bradycardia, and ectopic beats can further compromise cardiac output. Older patients are especially sensitive to the loss of atrial kick in atrial fibrillation.
Provide adequate rest periods Rest decreases metabolic rate, decreasing myocardial and oxygen demand.
Position child in semi-Fowler’s position. Upright position is recommended to reduce preload and ventricular filling when fluid overload is the cause; Facilitates lung expansion.
Administer oxygen therapy as prescribed. The failing heart may not be able to respond to increased oxygen demands. Oxygen saturation need to be greater than 90%.
Administer medications as prescribed: 
Increases contractility of the heart and force of contraction.
Maintain open PDA when needed for blood flow.
Decreases edema formation and diminish afterload.

See Also

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Pediatric Nursing Care Plans

Nursing care plans for pediatric conditions and diseases: 

Further Reading

Recommended books and resources:

  1. Nursing Care Plans: Diagnoses, Interventions, and Outcomes
  2. Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
  3. Nursing Diagnoses 2015-17: Definitions and Classification
  4. Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)
  5. Manual of Psychiatric Nursing Care Planning
  6. Maternal Newborn Nursing Care Plans
  7. Delmar's Maternal-Infant Nursing Care Plans, 2nd Edition
  8. Maternal Newborn Nursing Care Plans