Nursing Care Plan (NCP) for Congenital Heart Defects

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 Now, this way of doing it is a bit outdated, but you still may find it really useful for studying.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!