by

P.SAMUEL
CONGENITAL HEART DEFECTS

 CYANOTIC (TETROLOGY OF
FALLOT,TRICUSPID ATRESIA,TGA)
 ACYANOTIC
• (ATRIAL SEPTAL DEFECTS,VSD,PULMONARY
STENOSIS,COARCTATION OF AORTA)
 GENERAL:TO KNOW ABOUT THE CONGENITAL
HEART DEFECTS AND ITS MEDICAL
,SURGICAL AND NURSING MANAGEMENT
 SPECIFIC:
 TO KNOW ABOUT CAUSES,DIAGNOSTIC

EVALUATION,PATHOPHYSIOLOGY,CLINICAL
FEATURES,TREATMENT OF ATRIAL SEPTAL
DEFECTS
 RESEARCH ABSTRACT
 Heart is formed from the mesodermal layer of
embryo

hollow tube

partitioning process

septa divides right and left heart

 GENETIC :
 Chromosomal abnormalities
 ENVIRONMENTAL ;
 Maternal infections (rubella)
 DRUGS , MATERNAL DIABETES , PHENYL

KETONURIA , SYSTEMIC LUPUS

ERYTHEMATOSUS ,
 HEART MURMUR
 FATIGUE AND TIRING EASILY
 SHORTNESS OF BREATHE
 FAST BREATHING
 SWEATING
 SLOW GROWTH
 MEDICAL AND FAMILY HISTORY
 PHYSICAL EXAMINATION
 ECHO CARDIOGRAM

CHEST X RAY
ECG : enlargement of heart chambers and
shows abnormal heart rhythms
 Monitoring and observation:- 3 checkups in a
month up to one year.
 Medicines:-
 DIGOXIN :- to regulate heart beat.
 DIURETICS :- to treat fluid build up.
 ANTIBIOTICS:- to prevent bacterial

endocarditis after cardiac

catheterization.
 Surgical management
 Septal occluder.(angiogram)
Infection .
Bleeding.
Abnormal heart beats.
Stroke, heart attack, kidney failure.
injury to the blood vessel.
 Nursing diagnosis
impaired gas exchange.
 Monitor intake and output
 Limit fluids as order.
 Administer diuretics.
 Change the position every 2 hrs.

Impaired growth and development.

 Teach the parents about freedom of child.
 Promote age appropriate activities as
condition allows.
altered nutrition less than body requirements
 Offer small frequent feedings.
 Use soft nipple for infant to avoid the stress

of sucking.
 Promote rest.

Risk for complications

 Limit exposure to individuals with infections.
 Promote good hygiene.
 Prophylactic antibiotics to avoid infection .
 Avoid pressure on the abdomen to prevent

wound rupture
 Background.
 Surgical repair of muscular atrial septal defects,
particularly those associated with complex heart
lesions, carries a higher risk of reoperation and
death than the repair of membranous defects.
Closing a muscular defect through an incision in
the systemic ventricle may cause late atrial
dysfunction. In a collaborative approach to this
problem, we undertook preoperative
transcatheter closure of muscular atrial septal
defects remote from the atrioventricular and
semilunar valves, followed by the surgical repair
of associated conditions.
 Methods.
 In 12 patients selected jointly by a

cardiologist and a cardiac surgeon, we

attempted preoperative transcatheter
umbrella closure of 21 defects. Half the
patients had associated complex heart
lesions; the others had had pulmonary-artery
banding to reduce the amount of left-to-
right shunting. Half had severe atrialseptal
deficiency.
 Results.
 All 21 defects were successfully closed
without major complications. Subsequent
cardiac surgery for associated conditions in
11 of the 12 patients resulted in a mean
pulmonary-to-systemic flow ratio of 1.1,
indicating minimal residual left-to-right
shunting; 1 patient awaited surgical repair.
No deaths, reoperations, or late
complications have occurred after a follow-
up of 7 to 20 months
 Conclusions.
 A collaborative approach using transcatheter

closure followed by the surgical repair of

associated cardiac lesions may decrease rates
of operative mortality, reoperation, and left
ventricular dysfunction in patients with
muscular atrial septal defects. (N Engl J Med
1991;324:1312–7.)
 So far we have covered (atrial septal defects)

 The disease condition and causes

Clinical manifestations
 Diagnostic evaluation
 Medical, surgical and nursing management.
 Research abstract.
 Essential pediatric nursing :
 Author: piyush gupta
 Publishers: ape jain & co
 Edition: 1st edition (2004); chapter15, page 279-290
 Essentials of pediatric nursing; Marilyn J Hockenberg and
david wilson;2009;wong s; chapter25 atrial septal defects;
page no: 868-880

Electronic references:
www.scribd.com
www.rncentral.com
www.virtualnurse.com/careplans
www.cncplan.com