Nursing Care Plan (NCP) for Congenital Heart Defects
You're watching a preview. 300,000+ students are watching the full lesson.
Included In This Lesson
Study Tools For Nursing Care Plan (NCP) for Congenital Heart Defects
NURSING.com students have a 99.25% NCLEX pass rate.
Outline
Lesson Objective for Congenital Heart Defects
- Understanding Congenital Heart Defects:
- Gain comprehensive knowledge about the various types of congenital heart defects, their anatomical and physiological implications, and the impact on cardiac function.
- Identification of Common Defects:
- Develop the ability to identify common congenital heart defects through clinical manifestations, diagnostic tests, and imaging studies, facilitating timely recognition and intervention.
- Assessment of Hemodynamic Consequences:
- Understand the hemodynamic consequences of congenital heart defects, including alterations in blood flow, cardiac output, and systemic/pulmonary circulation, to guide nursing assessments and interventions.
- Collaborative Care and Interventions:
- Learn about the collaborative multidisciplinary approach to caring for patients with congenital heart defects, including surgical interventions, medical management, and the role of nursing in optimizing outcomes.
- Education and Support for Patients and Families:
- Acquire skills in providing education and emotional support to patients and their families, addressing their concerns, promoting adherence to treatment plans, and facilitating coping strategies.
Pathophysiology of Congenital Heart Defects
- Structural Abnormalities:
- Congenital heart defects result from malformations in the structure of the heart or major blood vessels during fetal development. These abnormalities can involve the heart chambers, valves, septa, or great vessels.
- Hemodynamic Consequences:
- The altered cardiac structure leads to disruptions in normal blood flow patterns. Depending on the specific defect, there can be shunting of blood between the systemic and pulmonary circulations, leading to increased or decreased oxygenation of blood.
- Increased Workload on the Heart:
- Many congenital heart defects cause the heart to work harder to pump blood effectively. This increased workload can lead to hypertrophy of the cardiac muscles, especially in the ventricles, as the heart compensates for the abnormal circulation.
- Oxygen Saturation Variations:
- Oxygen saturation levels may vary based on the type of defect. Some defects lead to mixing of oxygenated and deoxygenated blood, affecting the overall oxygen content delivered to the body’s tissues.
- Risk of Complications:
- Individuals with congenital heart defects are at an increased risk of developing complications such as heart failure, infective endocarditis, arrhythmias, and developmental delays. The severity and manifestation of complications depend on the type and complexity of the defect.
Etiology of Congenital Heart Defects
- Genetic Factors:
- Many congenital heart defects have a genetic basis. Mutations or abnormalities in certain genes responsible for cardiac development during fetal life can contribute to the occurrence of these defects.
- Chromosomal Abnormalities:
- Conditions such as Down syndrome (Trisomy 21) and Turner syndrome are associated with an increased risk of congenital heart defects. Chromosomal anomalies disrupt normal development and can affect the heart’s structure and function.
- Environmental Factors:
- Exposure to certain environmental factors during pregnancy, such as maternal infections (rubella), medications, alcohol, and illicit drugs, can increase the risk of congenital heart defects in the developing fetus.
- Maternal Health Conditions:
- Certain maternal health conditions, including diabetes, obesity, and autoimmune diseases, can contribute to an increased risk of congenital heart defects. Proper management of these conditions during pregnancy is essential.
- Multifactorial Causes:
- In many cases, congenital heart defects result from a combination of genetic and environmental factors. The interplay of multiple influences during fetal development contributes to the complex etiology of these conditions.
Desired Outcome for Congenital Heart Defects
- Optimal Cardiac Function:
- The primary goal is to achieve and maintain optimal cardiac function, ensuring effective circulation of blood throughout the body.
- Normal Growth and Development:
- Support the child’s normal growth and development, promoting milestones appropriate for their age.
- Prevention of Complications:
- Minimize the risk of complications associated with congenital heart defects, such as heart failure, arrhythmias, and infections.
- Enhanced Quality of Life:
- Improve the overall quality of life for the child by managing symptoms, promoting independence, and facilitating participation in age-appropriate activities.
- Empowered Family Coping:
- Provide education and emotional support to the family, empowering them to cope with the challenges associated with raising a child with congenital heart defects.
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 Assessment for Congenital Heart Defects
- Cardiorespiratory Assessment:
- Monitor vital signs, paying close attention to heart rate, respiratory rate, and oxygen saturation levels.
- Growth and Developmental Milestones:
- Evaluate the child’s growth patterns and developmental milestones to identify any delays or abnormalities.
- Nutritional Assessment:
- Assess the child’s nutritional status, ensuring adequate caloric intake for optimal growth and development.
- Skin Color and Perfusion:
- Observe skin color and peripheral perfusion for signs of cyanosis or poor circulation.
- Cardiac Auscultation:
- Perform regular cardiac auscultation to detect any abnormal heart sounds or murmurs.
- Respiratory Assessment:
- Assess respiratory effort, noting any signs of increased work of breathing or respiratory distress.
- Activity Tolerance:
- Evaluate the child’s tolerance for physical activity and exercise, identifying any limitations or signs of fatigue.
- Family Support and Coping:
- Assess the family’s understanding of the child’s condition, providing emotional support and identifying resources for coping.
Implementation for Congenital Heart Defects
- Medication Administration:
- Administer prescribed medications, such as diuretics or inotropic agents, as directed by the healthcare provider.
- Nutritional Support:
- Collaborate with a dietitian to ensure the child receives a nutritionally balanced diet that meets specific needs, considering any dietary restrictions.
- Oxygen Therapy:
- Provide oxygen therapy as needed, monitoring oxygen saturation levels and adjusting the flow rate based on the child’s respiratory status.
- Promotion of Developmental Milestones:
- Collaborate with physical and occupational therapists to implement interventions that promote developmental milestones, taking into account the child’s cardiac limitations.
- Family Education:
- Educate the family about the child’s condition, including signs of distress, medication management, and when to seek medical attention. Provide resources for ongoing support and education.
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.
Evaluation for Congenital Heart Defects
- Cardiac Function Monitoring:
- Assess and monitor the child’s cardiac function regularly through echocardiograms, EKGs, or other diagnostic tests as prescribed by the healthcare provider.
- Nutritional Status:
- Evaluate the child’s nutritional status and growth regularly, tracking weight gain, height, and developmental progress to ensure appropriate growth.
- Respiratory Status:
- Monitor respiratory status, including oxygen saturation levels, to assess the effectiveness of interventions and adjust the care plan accordingly.
- Developmental Milestones:
- Assess the child’s achievement of developmental milestones, collaborating with therapists to address any delays and modify interventions as needed.
- Family Coping and Adherence:
- Evaluate the family’s coping mechanisms and adherence to the care plan, providing additional support or education as necessary to enhance the child’s overall care.
References
- https://www.mayoclinic.org/diseases-conditions/congenital-heart-defects-children/diagnosis-treatment/drc-20350080
- http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/Congenital-Heart-Defects_UCM_001090_SubHomePage.jsp
Unlock the Complete Study System
Used by 300,000+ nursing students. 99.25% NCLEX pass rate.
- Full lesson outlines
- NCLEX simulator (SIMCLEX)
- 6,500+ practice questions
- 2,000+ lesson videos
- 300+ cheatsheets
200% NCLEX Pass Guarantee.
No Contract. Cancel Anytime.
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!
Study Faster with Full Video Transcripts
99.25% NCLEX Pass Rate vs 88.8% National Average
- Full lesson outlines
- NCLEX simulator (SIMCLEX)
- 6,500+ practice questions
- 2,000+ lesson videos
- 300+ cheatsheets
200% NCLEX Pass Guarantee.
No Contract. Cancel Anytime.
Nursing School Doesn't Have To Be So Hard
Go from discouraged and stressed to motivated and passionate
Ground Zero
Concepts Covered:
- Communication
- Fundamentals of Emergency Nursing
- Intraoperative Nursing
- Documentation and Communication
- Legal and Ethical Issues
- Emergency Care of the Cardiac Patient
- Delegation
- Perioperative Nursing Roles
- Preoperative Nursing
- Community Health Overview
- Prioritization
- Studying
- Factors Influencing Community Health
- Concepts of Population Health
- Understanding Society
- Test Taking Strategies
- Medication Administration
- Adult
- Microbiology
- Cardiac Disorders
- Anxiety Disorders
- Depressive Disorders
- Vascular Disorders
- Nervous System
- Upper GI Disorders
- Central Nervous System Disorders – Brain
- Gastrointestinal Disorders
- Immunological Disorders
- Dosage Calculations
- Circulatory System
- Concepts of Pharmacology
- Hematologic Disorders
- Newborn Care
- Adulthood Growth and Development
- Disorders of Pancreas
- Respiratory Disorders
- Postoperative Nursing
- Pregnancy Risks
- Neurological
- Postpartum Complications
- Substance Abuse Disorders
- Noninfectious Respiratory Disorder
- Bipolar Disorders
- Peripheral Nervous System Disorders
- Learning Pharmacology
- Psychotic Disorders
- Prenatal Concepts
- Tissues and Glands
- Basics of Chemistry
- Gastrointestinal
- Newborn Complications
- Labor Complications
- Fetal Development
- Terminology
- Labor and Delivery
- Postpartum Care
- EENT Disorders
- Infectious Disease Disorders
- Lower GI Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Hematologic Disorders
- Integumentary Disorders
- Cardiovascular Disorders
- Musculoskeletal Disorders
- Endocrine and Metabolic Disorders
- Renal and Urinary Disorders
- Urinary System
- Oncologic Disorders
- Renal Disorders
- Infectious Respiratory Disorder
- Urinary Disorders
- Sexually Transmitted Infections
- EENT Disorders
- Behavior
- Emotions and Motivation
- Growth & Development
- Psychological Disorders
- State of Consciousness
- Health & Stress