NCP Ventricular Septal Defect - Pre-surgical Care and Post-surgical Care

Nursing Care Plan Ventricular Septal Defect - Nanda

Definition of Ventricular Septal Defect

Ventricular septal defect (VSD, Defek Septum Ventrikel) is a hole in the ventricular septum. Ventricular septum is the wall that separates the bottom of the heart (left ventricle and separates the right ventricle).

Ventricular septal defect (DSV) is a SPA, the most frequently found, ie 30% of all types of CHD. In most cases, the diagnosis of this disorder is being established after passing the newborn period, because in the first weeks of significant noise usually has not been heard since resistensis still high pulmonary vascular decreased after 8-10 weeks.

Etiology of Ventricular Septal Defect

The cause is unknown. VSD is more common in children and is often a congenital heart defect.

In children, the hole is very small, cause no symptoms and often shuts itself off before the child turned 18 years old.

In the more severe cases, can occur ventricular dysfunction and heart failure. VSD can be found along with other cardiac abnormalities. Prenatal factors that may be associated with VSD:

  • Rubella or other viral infections in pregnant women.
  • Poor nutrition of pregnant women.
  • An alcoholic mother.
  • Maternal age over 40 years.
  • Mother had diabetes.

Clinical Manifestations of Ventricular septal defect

In both these disorders, the blood from the lungs into the heart, return flows to the lungs. As a result the amount of blood in the pulmonary blood vessels increases and causes:
  • Hurry tired
  • Cough
  • Shortness of breath when resting
  • Slow weight gain and weight did not increase
  • Baby has difficulty when feeding
  • Excessive sweating.

Test Laboratory Diagnosis
  • Cardiac catheterization showed an abnormal relationship between the ventricles.
  • Electrocardiogram (ECG) and chest radiograph showed left ventricular hypertrophy
  • A complete blood count is a test routine pre-surgery.
  • Mass test prothrombin (PT) and partial thromboplastin mass (ICM) is performed before surgery can reveal bleeding tendency (usually normal).

Nursing Care Plan for Ventricular Septal Defect

A. Assessment

a. Pulse
  • Apical pulse - rate, rhythm and quality
  • Peripheral pulse - there or not, if there is a review of frequency, rhythm, quality, and symmetry; the difference between the extremities
  • Blood pressure - all extremities

b. Examination of the thorax and auscultation
  • Circumference of the chest (thoracic)
  • Presence of thoracic deformity
  • Heart sounds - murmurs
  • The point of maximum impulse

c. General appearance
  • The level of activity
  • Height and weight
  • Anxiety and fear behavior
  • Clubbing (clubbing) of the hands and feet

d. Skin
  • Pale
  • Cyanosis of mucous membranes, the extremities, the nail bed
  • Diaphoresis
  • Temperature

e. Edema
  • Periorbital
  • Extremity

f. Assess the presence of complications
  • Diastolic murmur, showed aortic insufficiency
  • Wide pulse pressure, suggesting insifisiensi aorta
  • Arrhythmias
  • Chronic heart failure
  • Bleeding
  • Low cardiac output, especially during the first 24 hours after surgery

Nursing Diagnosis
  1. Anxiety
  2. Activity intolerance
  3. Decreased cardiac output
  4. Changes in tissue perfusion
  5. Excess fluid volume
  6. Risk for infection
  7. Risk for injury
  8. Changes in the family

Intervention

a. Pre-surgical Care

Explain to the child with age-appropriate manner, before surgery

1. Monitor the child's basic status:
  • Vital signs
  • The color of mucous membranes
  • The quality and intensity of the peripheral arteries
  • When the capillary
  • The temperature of the extremities
2. Help and support children during the performance of laboratory tests and diagnostic tests
  • A complete blood count, urinalysis, serum glucose, and blood urea nitrogen
  • Serum Electrolytes - Na, K, and Cl
  • Blood type and cross-examination
  • Radiographic examinations
  • ECG

b. Post-surgical Care

1. Monitor the child's postoperative status every 15 minutes during the first 24 to 48 hours.
  • Vital signs
  • The color of mucous membranes
  • The quality and intensity of the peripheral arteries
  • When the capillary
  • Edema periorbital
  • Pleural effusions
  • Pulsus paradoxus or a decrease in pulse pressure
  • Arterial pressure
  • Heart rhythm

2. Monitor the bleeding
  • Measure the chest tube output per hour
  • Assess the presence of a clot in the chest tube
  • Assess the presence of lesions and ecchymoses petekia
  • Assess the bleeding from somewhere else
  • Record the output of blood for diagnostic studies
  • Monitor intake and output strictly
  • Give fluids as much as 50% to 75% volume maintenance during the first 24 hours
  • Provide the necessary blood products
3. Monitor the child's hydration status
  • Skin turgor
  • Humidity mucous membranes
  • Density
  • Weight daily
  • The output of urine

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