this is my case presentation when i was assigned in NICU.

1. Ventricular Septal
defect (VSD)
Miljie
Tompong

2. Ventricular septal defect (VSD)?
• a heart malformation
present at birth.
"congenital" condition
• a type of congenital
heart disease (CHD).

3. Anatomy and physiology
• The heart with a VSD has a hole in the wall (the septum) between its two lower
chambers (the ventricles).

5. How do VSDs cause problems?

6. How is a VSD diagnosed?
• chest X-ray

7. • Echocardiogram
(used to define
the anatomy
and evaluate
the
characteristics
(amount and
pressures) of
the shunted
blood)

8. Electrocardiogram
• is a noninvasive
test that is used
to reflect
underlying
heart
conditions by
measuring the
electrical
activity of the
heart.

9. What are the symptoms of a VSD?
• A murmur is a sound
generated by abnormally
turbulent flow of blood
through the heart.
• symptomless at birth
usually develop until later
in the first week of life.
• no signs of cyanosis.

10. • Small defects (less than
0.5 square cm) are
common
• small VSDs close
spontaneously (on their
own).
• closure is due to the
small VSD being located
between heart fibers that
increase in size in time

11. • large VSD (usually one
greater than 1 cm2
• Infant will fail to thrive
and become sweaty
and tachypnoiec
(breathe faster) with
feeds
• increase in the blood
pressure of the lungs
called "pulmonary
hypertension.

12. Medical Management
• Digoxin (LANOXIN)
• works directly on the heart to increase the
velocity of contraction and the force of the
contraction.
• FUROSEMIDE (LASIX)
• Diuretics remove edema and act to lower
blood pressure. This helps reduce the extra
load on the pulmonary system.

13. Treatment
• PA Banding
a palliative
treatment
particularly
reserved for those
patients who are
unable to
withstand an open
heart procedure
for total
correction.

14. Surgical Treatment
• median sternotomy
• Surgical access to the VSD depends upon it's
location and the presence of other cardiac
defects.
• The right ventricle is often opened to gain
access to perimembranous or inlet defects.
• The pulmonary artery may be used to close
outlet septum VSDs

15. • Large defects
may be repaired
using a
pericardium
patch sutured
into place to
occlude the
space.

16. Preoperative and postoperative
• prophylactic antibiotics are often required to
prevent infectious endocarditis.
• The child should be assessed postoperatively
for dysrhythmia, since edema in the septum
may interfere with conduction.

17. Nursing Diagnosis
“Decrease in cardiac output
associated with heart
malformations”
Objective: improve the heart Rainfall
Outcome criteria: signs of improvement in cardiac
output

18. Nursing Intervention :
• Observation of the quality and strength of heart
rate, peripheral pulse, skin color and warmth.
• Set the degree of cyanosis (mucous membranes,
clubbing)
• Monitor signs of CHF (anxiety, tachycardia,
tachipnea, cramped, tired while drinking milk,
periorbital edema, and hepatomegaly Oliguria.
• Collaboration for the administration of drugs
(diuretics, to reduce after load) as indicated.