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 deoxygenated 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 the mixing of blood from the two circulations.
Acyanotic defects include coarctation of the 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 (juxta ductal). The position of the narrowing during fetal development determines circulation to the lower body and the development of collateral circulation. Patent ductus arteriosus is the failure of the structure needed for fetal circulation to close after birth. A 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.
- Decreased Cardiac Output
- Activity Intolerance
- Compromised Family Coping
- Risk for Injury
- Risk for Infection
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.
- 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,
- Decreased peripheral pulses
- Cyanosis or absence of cyanosis
- Squatting or knee-chest position
- 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.
Recommended nursing diagnosis and nursing care plan books and resources.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses as reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of it’s evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions show how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans for cardiovascular system disorders:
- Angina Pectoris (Coronary Artery Disease) | 4 Care Plans
- Cardiac Arrhythmia (Digitalis Toxicity) | 3 Care Plans
- Cardiac Catheterization | 4 Care Plans
- Cardiogenic Shock | 5 Care Plans
- Congenital Heart Disease | 5 Care Plans
- Heart Failure | 18 Care Plans
- Hypertension | 6 Care Plans
- Hypovolemic Shock | 4 Care Plans
- Myocardial Infarction | 7 Care Plans
- Pacemaker Therapy | 6 Care Plans