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CONGENITAL HEART DEFECTS

Dobertlo B. Villegas RN

1. Objectives: At the end of the discussion, the students will be able to:

1. define congenital heart defect, 2. explain each congenital heart defect and its respective classification, 3. know the different signs and symptoms of each congenital heart defect, 4. identify the treatments and nursing interventions in patients with congenital heart defects, 5. apply the knowledge learned in the clinical setting.

Introduction:
Congenital means inborn or existing at birth. The word "defect" is more accurate than "disease." A congenital cardiovascular defect occurs when the heart or blood vessels near the heart don't develop normally before birth Congenital heart defects are the most common birth defects.

Normal Heart

Anatomy and Physiology


The shunting or flow of the blood is from lower oxygen concentration to higher oxygen concentration. The septum that divides the heart longitudinally is referred to as the interventricular or interatrial septum.

Predisposing factors:

Maternal rubella during pregnancy Maternal alcoholism Maternal age over 40 years old Maternal insulin-dependent diabetes Sibling(s) with heart disease Parent with congenital heart defect

Congenital Heart Defects Acyanotic Type Cyanotic Type Normal color Cyanosis usually from birth; clubbing of fingers Normal CNS function Possible exercise intolerance May have seizure due to hypoxia, fainting, confusion Marked exercise intolerance; may have hypoxic spells following exercise; squats to decrease respiratory distress Difficulty eating because of inability to breathe at the same time Small stature; failure to thrive Characteristics murmur; frequent and severe respiratory infections

Possible weight loss or gain (with fluid retention) Small stature: failure to thrive Characteristic murmur; increased frequency of respiratory infection

Types of defects 1. Acyanotic- mixing of poorly oxygenated venous blood in systemic circulation
Ventricular septal defect

Atrial septal defect

Pulmonary valve stenosis

Aortic stenosis

Coarctation of the aorta

Patent ductus arteriosus

2. Cyanotic-poorly oxygenated venous blood enters systemic circulation Tetralogy of Fallot

Transposition of the great arteries

Truncus arteriosus

Hypoplastic left heart syndrome

Nursing Intervention: Assessment: Acyanotic Ventricular septal defect -characterized by loud, harsh murmur Atrial septal defect small defect high on the septum may not cause clinical symptoms -audible murmur Pulmonary artery stenosis - resistance to blood flow causes right ventricular hypertrophy -commonly seen with PDA Aortic stenosis - mumur usually heard

Coarctation of the aorta - high blood pressure and bounding pulses in areas receiving blood from vessel proximal to the defect; -weak or absent pulses distal to the defect, cool extremities, muscle cramps Patent ductus arteriosus -increased pulmonary vascular congestion and right ventricular hypertrophy -murmur, tachycardia, bounding pulse
Cyanotic

Tetralogy of Fallot - cyanosis, clubbing of fingers, delayed physical growth and development - child squats or assumes knee-chest position Transposition of the great vessels - severe cyanosis to mild CHF

Truncus arteriosus -cyanosis, left ventricular hypertrophy, dyspnea, marked activity intolerance and growth retardation -CHF, murmur Hypoplastic left-heart syndrome -cyanosis, difficulty to feed and breathe

Nursing diagnosis: -Impaired gas exchange -Altered peripheral tissue perfusion related to CHF -Altered cardiopulmonary tissue perfusion -Altered nutrition, less than body requirements -Anxiety -Ineffective family coping: disabling -Risk for impaired growth & development -Risk for infection

Planning/Implementation
1. Prevent congenital heart defect Optimal maternal nutrition, prenatal care, and avoidance of drugs and alcohol Immunization against rubella in females 2. Recognize early signs/ symptoms- cyanosis, poor weight gain, poor feeding habits, exercise intolerance, unusual posturing, heart murmurs 3. monitor vital signs and heart rhythm 4. provide support for patient as well as restful environment 5. Monitor intake and output

6. Give medications as ordered: Digoxin- in cardiac contractility- take apical pulse 1 min, check for bradycardia Iron preparations (ex. ferrous sulfate) Diuretics (ex. lasix)- check for patients BP Potassium Anti-inflammatory (Indomethacin) to indibit Prostaglandin E Antibiotics 7. Change feeding pattern for infant Small amounts every 2 hours Enlarged nipple hole Diet- low sodium, high potassium

8. Prepare patient for diagnostic procedures Cardiac Catheterization- confirm the diagnosis through visualization of defects and measurement of oxygen saturation Cardiac Magnetic Resonance Imaging Examination Echocardiogram: Sound Imaging of the Heart Echocardiography (Ultrasound of the Heart) Electrocardiogram (EKG or ECG) Exercise Tests CBC- reveals polycythemia Arterial blood gas- diminishing arterial oxygen saturation Chest x-ray

9. Prepare patient for invasive procedures

a. Ventricular septal and Atrial septal defect - purse-string closure or patching - pulmonary artery banding to prevent heart failure b. Pulmonic artery stenosis - open-heart surgery to separate the pulmonary valve leaflets - pulmonary valvulotomy c. Atrial septal defect - valvulotomy d. Coartation of Aorta - resection of the coarted portion and end-to-end anastomosis or replacement of the constricted section e. Patent ductus arteriosus - ligation

f. Tetralogy of Fallot - repair or palliative treatment during 1 year to increase blood flow to the lungs bypassing pulmonic stenosis (BlalockTaussig anastomosis right pulmonary artery to the right subclavian artery) g. Transposition of great arteries - corrective surgery to redirect blood flow by switching the position of the major blood vessel; performed first year of life h. Truncus arteriosus - closing ventricular septal defect so truncus originates from left ventricle and creating pathway from right ventricle i. Hypoplastic left-heart syndrome - may perform heart transplant

Evaluation 1. Check childs growth and development 2. Check for family and childs coping towards the defect. 3. Check for the effectiveness of the treatments and medications given.

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