{
  "name": "Congenital Heart Disease",
  "slug": "congenital-heart-disease",
  "url": "https://nursingplex.com/care-plans/congenital-heart-disease",
  "category": "Cardiac",
  "summary": "Structural defects in infants and children; feeding tolerance, growth, cyanosis and surgical prep.",
  "nursing_diagnoses": [
    "Decreased cardiac output",
    "Imbalanced nutrition",
    "Delayed growth and development"
  ],
  "overview": [
    "Congenital heart disease is a structural cardiac defect present at birth. Acyanotic defects such as ventricular septal defect, atrial septal defect and patent ductus arteriosus shunt blood left to right, increasing pulmonary blood flow and producing heart failure symptoms. Cyanotic defects such as tetralogy of Fallot and transposition shunt right to left, producing hypoxemia.",
    "Infants with significant defects show their heart failure through feeding: tachypnea, sweating and fatigue during feeds, prolonged feeding times and poor weight gain. Because feeding is the infant's main exertion, growth failure is often the earliest measurable sign.",
    "Nursing care centers on conserving energy, maximizing calorie delivery, monitoring for worsening heart failure or hypercyanotic spells, preventing infection, and preparing families for surgical repair and long-term follow-up."
  ],
  "key_facts": [
    {
      "label": "Feeding rule",
      "text": "Limit feedings to about 30 minutes and use high-calorie formula; gavage the remainder if the infant tires."
    },
    {
      "label": "Tet spell",
      "text": "For a hypercyanotic spell, place the infant in knee-chest position, give oxygen, calm them and notify the provider."
    },
    {
      "label": "Digoxin",
      "text": "Check apical rate for a full minute; hold and report if below 90–110 in infants or below 70 in older children per protocol."
    },
    {
      "label": "Growth",
      "text": "Weight gain is the most sensitive indicator of whether therapy is working."
    }
  ],
  "nursing_priorities": [
    "Maintain adequate oxygenation and perfusion.",
    "Reduce cardiac workload with clustered care and energy conservation.",
    "Ensure adequate caloric intake and growth.",
    "Recognize worsening heart failure and hypercyanotic spells.",
    "Prevent infection and support the family through surgical planning."
  ],
  "assessment": {
    "subjective": [
      "Parent reports of poor feeding, sweating during feeds or long feeding times",
      "Reports of fast breathing, irritability or unusual sleepiness",
      "Reports of bluish color with crying in cyanotic defects",
      "Parental anxiety about surgery and prognosis"
    ],
    "objective": [
      "Murmur, tachycardia, gallop or thrill on examination",
      "Tachypnea, retractions, nasal flaring, crackles",
      "Cyanosis, clubbing or low oxygen saturation",
      "Hepatomegaly, periorbital edema, poor peripheral pulses",
      "Weight below growth curve; delayed developmental milestones"
    ],
    "related_factors": [
      "Structural cardiac defect with abnormal shunting",
      "Increased pulmonary blood flow or decreased systemic oxygenation",
      "Increased metabolic demand with limited caloric intake",
      "Pulmonary congestion predisposing to respiratory infection"
    ]
  },
  "goals": [
    "The infant will maintain oxygen saturation within the target range for the defect.",
    "The infant will gain weight steadily along an appropriate curve.",
    "The infant will feed without excessive tachypnea, sweating or fatigue.",
    "The parents will describe medication administration and warning signs correctly."
  ],
  "interventions": [
    {
      "title": "Cardiopulmonary monitoring",
      "points": [
        "Monitor heart rate, respiratory rate, saturation, perfusion and liver span regularly.",
        "Weigh daily on the same scale and record strict intake and output.",
        "Administer digoxin and diuretics precisely, checking apical rate and potassium.",
        "Recognize and treat hypercyanotic spells with knee-chest positioning and oxygen."
      ]
    },
    {
      "title": "Energy conservation and feeding",
      "points": [
        "Cluster care to allow long uninterrupted rest periods.",
        "Use a soft or enlarged nipple and hold feeds to about 30 minutes; supplement by gavage if needed.",
        "Provide calorie-dense formula or fortified breast milk as ordered.",
        "Position semi-upright and burp frequently."
      ]
    },
    {
      "title": "Infection prevention and family support",
      "points": [
        "Keep immunizations current, including RSV prophylaxis when indicated.",
        "Teach handwashing and avoidance of crowds and ill contacts.",
        "Explain the defect using diagrams and prepare the family for procedures.",
        "Connect families to social work, financial resources and parent support groups."
      ]
    }
  ],
  "patient_teaching": [
    "Demonstrate accurate measurement and administration of digoxin and diuretics.",
    "Teach the signs of worsening failure: faster breathing, sweating with feeds, poor weight gain, puffiness.",
    "Show parents how to respond to a cyanotic spell.",
    "Stress dental hygiene and endocarditis prophylaxis when indicated, plus lifelong cardiology follow-up."
  ]
}