Nursing Care Plan (NCP) for Congenital Heart Defects

Join NURSING.com to watch the full lesson now.

Included In This Lesson

Study Tools

Outline

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 keep the PDA open. Prostaglandins are used to keep a PDA patent/open until surgery occurs to close the PDA. Prostaglandin inhibitors (such as NSAIDS) can also be used to close the PDA if surgery is not needed. 

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.

Writing a Nursing Care Plan (NCP) for Congenital Heart Defects

A Nursing Care Plan (NCP) for Congenital Heart Defects starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

Join NURSING.com to watch the full lesson now.

Transcript

Hey guys, in this care plan, we are going to be talking about congenital heart defects. In this care plan, we are going to cover descriptions of congenital heart defects, subjective and objective data and then we’ll also look at our nursing interventions and rationales for them.

 

Okay, so a congenital heart defect is a structural problem that’s present in the heart when the child is born, so, this means it’s developing in utero. Now, the heart actually begins to develop during the six weeks of pregnancy and we don’t totally know what causes these defects to happen, but we do know that there are some risk factors that may be associated with it. So it’s important to be aware of those, a couple are family history, maternal medications, maternal infections and then other environmental factors like smoking. Now, there’s a lot of information to cover on congenital heart defects, so it’s really helpful to think about how you’re going to classify and organize your information. 

 

One really common way to divide heart defects and thinking is to think about them as being cyanotic or acyanotic. Now, this way of doing it is a bit outdated, but you still may find it really useful for studying. The other way to think about it is to look at the way that the heart defects might be affecting blood flow. So, we want to think about what happens to blood as it’s flowing through the heart when these defects are present. We’ve got a lot of really good information for you here that goes into it in really great detail, but I’m just going to break it down into two really quick sentences. So, here it goes. Heart defects that cause an increase in pulmonary blood flow or allow blood to mix, are going to be less likely to cause cyanosis. Then, the second thing is that heart defects that cause a decrease in pulmonary blood flow or obstruct blood flow are more likely to cause cyanosis.

 

Okay, these are super important concepts to understand. So, like I said, read through this information here and it will build on that. The desired outcomes for our patients who have congenital heart defects are first, that they will have adequate cardiac output. So, that’s super important and that’s going to help them have normal blood pressure and heart rate. Second, we want them to have optimal activity and tolerance, and third, that we’re going to be monitoring for adequate oxygenation and tissue perfusion. Okay, so let’s take a look at our care plan. The subjective data associated with congenital heart defects are primarily poor feeding, becoming short of breath with exercise and activity, and then possibly even fainting during exercise. Now, this first one that you see here is primarily associated with infants, then those that you see down here are more likely to be seen with children. 

 

Objective data that you may see with congenital defects are things like pale or blue skin, which is again, related to our decrease in oxygen saturation. You may tachypnea, you might see some edema, swelling in the hands and feet and then remember, our infants often have difficulty feeding, so you’re likely to see poor weight gain and then, if the defect has gone undetected and untreated, you might also see signs of heart failure. 

 

Your first nursing intervention is going to be to assess and monitor vital signs and also weight really closely. Remember these patients may have tachycardia, tachypnea and blood pressure changes. And like we said, weight variations and difficulty feeding are really common. So, remember with our older children that you might see edema and weight gain, so weight increases in our older children and then for our younger children, because they’re having a difficult time feeding, you might see that weight drop. Then you need to make sure you auscultate the heart and lungs for abnormal sounds. So, the key things that you’re listening to in the heart are gallops and murmurs and then in the lungs, you want to pay attention to things like crackles. You’re also looking for signs of things like a wet cough that might indicate that they’ve got fluid on the lungs. Continuing with your assessment, you want to be looking at the patient, looking for things like cyanosis, pallor and alterations in perfusion. Now, remember this lack of oxygenation, so when we have a drop in our oxygen saturations, if it gets severe enough, you’re going to be seeing cyanosis on that patient. If perfusion is compromised, you’re going to be seeing things like weak pulses or a decreased heart rate, or maybe compensating with an increased heart rate and then you’re going to see decreased capillary refill time as well. Next, you want to plan to get a 12 lead ECG per your hospital. Um, protocol dysrhythmias can occur with congenital heart defects, so it’s really, really important to get a baseline. 

 

Okay, so the rest of our interventions here are really going to be focused on symptom management and treatment options. The first and most simple intervention that we can do to help ease breathing for these patients is really just to make sure that we position them well. So, we want them sitting upright or in a semi-Fowler’s position. Now, actually something that we see that’s kind of unique to children is that they may actually put themselves in a squatting position. What this does, is it’s going to help increase blood flow to the heart and that’s going to help decrease cyanosis and just reduce their symptoms in general. Next, you want to think about medications that may need to be given. Now, oxygen is very commonly given to children with congenital heart defects, if they are cyanotic. Other medications that you want to think about are prostaglandins, diuretics, ACE inhibitors and beta blockers. The prostaglandins are given when the PDA or peyton ductus arteriosus needs to remain open to allow blood to mix and diuretics are given to treat fluid overload. Your ACE inhibitors and your beta blockers are going to be given to treat high blood pressure.

 

Okay, so remembering that these patients are likely to tire out really easily, It’s really important that we cluster our nursing care and provide rest as much as possible. Now, this is going to apply to feeding as well and the whole reason for it is we really want to minimize stress that the heart is experiencing, so some congenital heart defects are going to need to be repaired surgically. Others may be treated with catheterization and then kind of in more extreme cases, you may even come across situations where a transplant is necessary, so it’s really important as nurses that we spend time with the patient and their family to prepare them for what may be coming in terms of surgical interventions. 

 

Now, lastly, continuing along the lines of what we just said, you want to provide patient and parent education. So, in addition to talking about treatment options, you want to think about exercise restrictions, making sure we’re reducing stress on the heart. Think about healthy diets and monitoring weight closely and always remember, it’s important to talk about good dental hygiene because children with congenital heart defects are at an increased risk for tooth decay.

 

Alright, that completes our care plan for congenital heart defects. We love you guys. Now, go out and be your very best self today and as always, happy nursing!

Join NURSING.com to watch the full lesson now.
[NextGen]
[NextGen]