Ventricular septal defect
Terms in this set (22)
Heart condition in which an opening in the septum between the ventricles allows blood to shunt between the left and right ventricles
Also known as VSD
VSDs are located in the membranous or muscular portion of the ventricular septum and vary in size.
Some defects close spontaneously; in other defects, the entire septum is absent, creating a single ventricle.
As the pulmonary vasculature gradually relaxes, right ventricular pressure decreases, allowing blood to shunt from the left to the right ventricle.
Secondary to acute myocardial infarction (MI)
Limited coronary artery disease and hypertension (post-MI)
VSD is slightly more common in females than in males.
With VSD after MI, males are more commonly affected than females.
Right ventricular outflow obstruction
Possibly asymptomatic if the defect is small and isolated
History of respiratory infections
Prominent anterior chest wall
Syncope on exertion
Widened pulse pressure
Forceful apical impulse
Thrill over the third or fourth left intercostal space
Elevated jugular venous pressure
With a large VSD, audible murmurs, loudest at the fourth intercostal space, usually with a thrill, and a loud and widely split pulmonic component of S2
With fixed pulmonary hypertension, diastolic murmur possibly audible on auscultation, systolic murmur becoming quieter, and S2 greatly accentuated
Displacement of the point of maximal impulse to the left
Typical murmur associated with a VSD, blowing or rumbling and varying in frequency
In small VSD, functional murmur or characteristic loud, harsh systolic murmur
Diagnostic Test Results-Imaging
Chest X-rays may be normal in small defects; in large VSDs, they may show cardiomegaly, left atrial and left ventricular enlargement, and prominent pulmonary vascular markings.
Two-dimensional Doppler echocardiography may detect a large VSD and its location in the septum, estimate the size of a left-to-right shunt, suggest pulmonary hypertension, and identify associated lesions and complications.
Diagnostic Test Results-Diagnostic Procedures
Electrocardiography (ECG) findings are normal with an isolated defect but may reveal intraventricular conduction delay or right bundle-branch block; in large VSDs, it shows left and right ventricular hypertrophy, suggesting pulmonary hypertension.
A 12-lead ECG may help to determine the severity of a VSD.
Cardiac catheterization determines the size and exact location of the VSD, calculates the degree of shunting by comparing the blood oxygen saturation in each ventricle, determines the extent of pulmonary hypertension, and detects associated defects.
Watch-and-see approach if the VSD is small
Intra-aortic balloon counterpulsation to stabilize a patient with a post-MI VSD before surgery
Digoxin (Lanoxin) to improve contractility
Diuretics, such as I.V. furosemide or spironolactone
Angiotensin-converting enzyme inhibitors, such as captopril
For small defects, simple suture closure
For moderate to large defects, insertion of a patch graft using cardiopulmonary bypass
Percutaneous transcatheter device closure of muscular and perimembranous defects, if surgical closure is too difficult or unsuccessful
Possible concomitant repair of associated valvular dysfunction, such as aortic or tricuspid valve
Nursing Considerations-Nursing Diagnoses
Decreased cardiac output
Imbalanced nutrition: Less than body requirements
Impaired gas exchange
Risk for decreased cardiac perfusion
Risk for infection
Nursing Considerations-Expected Outcomes
carry out activities of daily living without weakness or fatigue
maintain adequate cardiac output and hemodynamic stability
consume adequate daily calories
maintain adequate ventilation and oxygenation
exhibit adequate cardiac tissue perfusion
remain free from signs and symptoms of infection.
Nursing Considerations-Nursing Interventions
Ensure a patent airway.
Position the patient with the head of the bed elevated to maximize lung expansion.
Administer supplemental oxygen as needed based on oxygen saturation levels via pulse oximetry or arterial blood gases.
Allow the patient and family to verbalize concerns and fears. Provide clear explanations, answer any questions, and offer emotional support and guidance.
Provide frequent rest periods, and cluster care activities to minimize oxygen demand and energy expenditure.
Institute continuous cardiac and hemodynamic monitoring as ordered, noting changes in cardiac rate, rhythm, and pressures.
Encourage appropriate activities based on the patient's activity tolerance level.
Promote the use of positive coping strategies.
Provide the prescribed diet, and enlist the aid of a dietitian to assist with food selection and meal planning.
Obtain the patient's daily weight to evaluate nutritional and fluid balance status.
Administer the prescribed drug therapy, such as digoxin and furosemide.
Assess the apical pulse rate and rhythm for changes.
Check skin turgor and mucous membranes for evidence of fluid loss.
Inspect invasive device insertion sites for signs and symptoms of infection.
Encourage coughing, deep breathing, and incentive spirometry to prevent respiratory infection.
Prepare the patient and family physically and psychologically for surgery, as appropriate. Explain preoperative and postoperative procedures and equipment.
Provide postoperative care as indicated.
Cardiopulmonary status, including heart rate and rhythm, respiratory rate and depth, and heart and lung sounds
Oxygen saturation levels
Skin color and cyanosis, including degree and amount
Signs and symptoms of heart failure
Signs and symptoms of infection
Nursing Considerations-Associated Nursing Procedures
Blood pressure assessment
IV bag preparation
IV bolus injection
IV catheter insertion
IV pump use
Intake and output assessment
Intra-aortic balloon insertion, assisting
Intra-aortic balloon management
Oral drug administration
Preparing a patient for cardiac surgery, OR
12-lead electrocardiogram (ECG)
disorder, diagnosis, and treatment, including the need for careful monitoring if the patient is asymptomatic or needs surgery
that the prognosis after surgery is excellent
that most post-MI VSDs occur within the first week after the MI and that mortality is high without surgical intervention
prescribed drug therapy, including drug names, dosages, frequency and schedule of administration, and possible adverse effects, such as fluid and electrolyte imbalances with furosemide and signs and symptoms of digoxin toxicity (nausea, vomiting, mental status changes, and visual disturbances)
need for periodic laboratory testing to evaluate serum digoxin and electrolyte levels
prescribed nutritional therapy, such as increased calorie intake, restricted fluids, and a low-sodium diet
importance of preventing complications
signs of heart failure, such as poor feeding, sweating, and heavy breathing
importance of participating in normal activities as tolerated and of providing appropriate rest periods, and energy-conservation measures
postoperative care measures and concerns, such as surgical site care, diet, activity, and danger signs and symptoms.
Patient Teaching-Discharge Planning
Refer the patient and family to home health care services as appropriate.
Refer the patient to social services for assistance with resources and sources of support.
Refer the patient to a cardiac rehabilitation program after an acute MI as appropriate.