5 Congenital Heart Disease Nursing Care Plans

Decreased Cardiac Output

Congenital heart failure may result in decreased cardiac output due to structural or functional defects in the heart, such as septal defects, stenosis, valvular abnormalities, and cardiomyopathies. These defects can interfere with the heart’s ability to effectively pump blood and deliver oxygen to the body, leading to decreased cardiac output.

Nursing Diagnosis

• Decreased Cardiac Output

May be related to

• Structural factors of congenital heart defect

Possibly evidenced by

• Variations in hemodynamic readings (hypertension, bounding, pulses, tachycardia)
• 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

• The child will demonstrate adequate cardiac output as evidenced by blood pressure and pulse rate and rhythm within normal parameters for the patient; strong peripheral pulses; and an ability to tolerate activity without symptoms of dyspnea, syncope, or chest pain.

Nursing Assessment and Rationales

1. Assess heart rate and blood pressure.
Most patients have compensatory tachycardia and significantly low blood pressure in response to reduced cardiac output.

2. 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.

3. 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.

4. 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 the optimal progression of activity.

5. Inspect fluid balance and weight gain. Weigh the patient regularly prior to breakfast.
Compromised regulatory mechanisms may result in fluid and sodium retention; Weight is an indicator of fluid balance.

6. 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.

7. 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.

Nursing Interventions and Rationales

1. Provide adequate rest periods
Rest decreases metabolic rate, decreasing myocardial and oxygen demand.

2. Position the child in a semi-Fowler’s position.
An upright position is recommended to reduce preload and ventricular filling when fluid overload is the cause; Facilitates lung expansion.

3. Administer oxygen therapy as prescribed.
The failing heart may not be able to respond to increased oxygen demands. Oxygen saturation needs to be greater than 90%.

4. Administer medications as prescribed: 

• 4.1. Digoxin (Lanoxin)
  Increases contractility of the heart and force of contraction.

• 4.2. Alprostadil (Prostin VR Pediatric)
  Maintain open PDA when needed for blood flow.

• 4.3. Furosemide (Lasix); spironolactone (Aldactone)
  Decreases edema formation and diminishes afterload.