NURS 4030: Pediatric Congenital Heart Defect Case Study Analysis

Course Information

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Assignment Context

NURS 4030 introduces nursing students to evidence-based assessment and management of pediatric cardiovascular conditions. This assessment uses a clinical case study to evaluate your ability to synthesize pathophysiological findings, identify appropriate nursing diagnoses, and construct a plan of care grounded in current clinical guidelines. The case centres on a two-month-old infant presenting with symptoms consistent with a moderate to large ventricular septal defect (VSD), the most common congenital heart defect affecting approximately 2–6 per 1,000 live births globally (Brem et al., 2026). You must demonstrate clinical reasoning by connecting assessment data to underlying cardiac pathophysiology, proposing evidence-based interventions, and evaluating expected outcomes.

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Task Description

Analyze the case study provided below. Write an academic paper that:

1. Identifies the most likely diagnosis with pathophysiological justification.

2. Develops three priority nursing diagnoses using NANDA-I classification.

3. Proposes a nursing care plan with evidence-based interventions and measurable outcomes.

4. Discusses patient and family education priorities.

5. Addresses the role of interprofessional collaboration in managing this infant’s care.

Case Study:

A two-month-old girl presents for a well-child check-up. Her mother reports that breastfeeding duration has increased from 20 minutes every 2–3 hours to 40 minutes every 4 hours. The infant sweats during feeds but does not exhibit cyanosis. Stool and urine output remain normal. Physical examination reveals subdiaphragmatic retractions, abdominal breathing, respiratory rate of 58 breaths per minute, heart rate of 175 beats per minute, and oxygen saturation of 98% on room air. A 2/6 holosystolic murmur is heard along the left sternal border without radiation. Bilateral scattered crackles are present on lung auscultation.

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Requirements

Part 1: Diagnosis and Pathophysiological Analysis (300–400 words)

State the most likely diagnosis. Explain the pathophysiology linking the septal defect to the observed clinical findings. Support your analysis with at least two peer-reviewed sources published within the last five years.

Part 2: Nursing Diagnoses and Care Plan (400–500 words)

Formulate three priority NANDA-I nursing diagnoses. For each diagnosis, provide:

• Related factors and defining characteristics from the case

• At least two nursing interventions with clinical rationale

• One measurable expected outcome

Part 3: Family Education Plan (250–350 words)

Develop an education plan addressing feeding strategies, medication administration, activity tolerance, and warning signs of decompensation. Discuss how you would tailor education for a family with limited health literacy.

Part 4: Interprofessional Collaboration (250–350 words)

Describe the roles of at least three members of the interprofessional team. Explain how the nurse would coordinate communication between these professionals.

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Grading Rubric

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Sample Answer

Recognizing Ventricular Septal Defect in Infancy

The two-month-old infant presents with classic signs of a moderate to large ventricular septal defect (VSD) with early congestive heart failure. A VSD allows blood to shunt from the higher-pressure left ventricle to the lower-pressure right ventricle, increasing pulmonary blood flow and causing the clinical triad of tachypnea, feeding difficulty, and diaphoresis. The holosystolic murmur at the left sternal border reflects turbulent flow across the septal defect, while bilateral crackles indicate pulmonary congestion from excessive pulmonary circulation. The infant’s prolonged feeding times and increased respiratory rate of 58 breaths per minute align with the increased metabolic demand and respiratory effort characteristic of moderate heart failure, as documented in the clinical classification of congenital heart defects.

Nursing priorities for this infant centre on managing fluid overload, optimizing nutrition, and supporting respiratory function. The family requires structured education about feeding modifications, medication administration, and recognition of decompensation signs. Interprofessional collaboration with pediatric cardiology, dietetics, and social work ensures the infant receives comprehensive care from diagnosis through potential surgical repair. An echocardiogram is essential to confirm defect size and assess shunt severity, as transcatheter or surgical closure may be indicated if spontaneous closure does not occur within the first year.

Diagnostic Confirmation through Echocardiography

Echocardiography remains the gold standard for confirming VSD diagnosis, characterizing defect location and size, and quantifying left-to-right shunting. Perimembranous defects account for 70–80% of cases and are the most likely type in this presentation. The infant’s oxygen saturation of 98% rules out cyanotic congenital heart disease with right-to-left shunting, though VSD may coexist with other lesions requiring separate assessment. A recent systematic review found that deep learning models applied to phonocardiograms achieved over 90% accuracy in detecting VSD, comparable to expert auscultation, which suggests future diagnostic pathways may incorporate AI-assisted screening. Nurses should advocate for timely echocardiography to guide medical and surgical planning.

What Nursing Diagnosis Takes Priority

The priority nursing diagnosis for this infant is Ineffective Tissue Perfusion (Cardiopulmonary) related to altered cardiac output secondary to left-to-right shunting through the ventricular septal defect, manifested by tachycardia (HR 175), tachypnea (RR 58), and feeding-related diaphoresis. Secondary diagnoses include Imbalanced Nutrition: Less Than Body Requirements and Activity Intolerance. The infant’s weight-for-age, if below the 10th percentile, would confirm growth faltering from inadequate caloric intake and increased metabolic expenditure. Nursing interventions should prioritize:

1. Administering prescribed diuretics and ACE inhibitors as ordered, monitoring electrolyte levels and blood pressure.

2. Positioning the infant upright during feeds and offering small, frequent volumes to reduce respiratory effort.

3. Closely tracking daily weights, intake/output, and oxygen saturation trends to detect early decompensation.

Family Education and Health Literacy Considerations

Education should begin at the bedside using plain language and the teach-back method, confirming that the mother understands how to recognise worsening symptoms. Parents need to know that sweating during feeds and prolonged feeding times are expected with a large VSD until repair, but that sudden increases in respiratory rate or refusal to feed warrant immediate medical attention. Some families may struggle to distinguish normal infant fussiness from cardiac-related distress, so providing a written reference sheet with clear red-flag thresholds and emergency contact numbers could bridge that gap.

Interprofessional Coordination and Transition Planning

Managing this case requires coordinated input from pediatric cardiology, clinical dietetics, pediatric pharmacy, and social work. The nurse functions as the communication hub, using structured handoff tools such as SBAR to relay assessment findings to the cardiologist and to flag concerns about feeding tolerance to the dietitian. Surgical planning typically occurs by four to six months of age for large defects, with perioperative nursing care focusing on preoperative stabilization and postoperative monitoring for complications including residual shunting and pulmonary hypertension.

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Conclusion

This case illustrates the nursing process in action for an infant with a moderate ventricular septal defect. The clinical findings point to early congestive heart failure, and the care plan addresses perfusion, nutrition, and family support through a combination of direct interventions and interprofessional coordination. Educators may consider pairing this case with a simulation component to reinforce clinical judgment. Students should practice articulating which assessment finding requires immediate escalation and why, as this skill directly transfers to pediatric clinical placements.

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Week 6 Assessment Preview

NURS 4030 — Assessment 3: Pediatric Respiratory Assessment Reflection

For Week 6, submit a 600-word reflective analysis on differentiating respiratory distress from respiratory failure in a pediatric patient. Select one clinical presentation (bronchiolitis, asthma exacerbation, or pneumonia). Explain the assessment parameters you would monitor, the clinical indicators that prompt escalation of care, and how you would communicate your findings using SBAR. Include at least two peer-reviewed sources in APA 7th Edition format. This assessment builds directly on the cardiovascular assessment skills developed in Assessment 2 by reinforcing systematic clinical reasoning.

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References

Brem, O., Pravda, N. S., Xu, H., Nguyen, K. L., & Husain, M. (2026). A systematic review on deep learning in ventricular septal defect screening, diagnosis, and management. Annals of Pediatric Cardiology, 19(1), 53–61. https://doi.org/10.4103/apc.apc_163_25

Beerman, L. B. (2023). Ventricular septal defect (VSD). In MSD Manual Professional Edition. Merck Sharp & Dohme. https://www.msdmanuals.com/professional/pediatrics/congenital-cardiovascular-anomalies/ventricular-septal-defect-vsd

Eckerström, F., Nyboe, C., Maagaard, M., Redington, A., & Hjortdal, V. E. (2023). Survival of patients with congenital ventricular septal defect. European Heart Journal, 44(1), 54–61. https://academic.oup.com/eurheartj/article/44/1/54/6843760

Dakkak, W., & Oliver, T. I. (2023). Ventricular septal defect. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470330/

Rychik, J., & Cohen, M. S. (2024). Nursing care of the pediatric cardiac patient. Springer Publishing.

Ventricular Septal Defect in a Two-Month-Old Infant: Nursing Analysis and Care Plan

The infant’s presentation is most consistent with a moderate to large ventricular septal defect (VSD) complicated by early congestive heart failure. A left-to-right shunt through the interventricular septum increases pulmonary blood flow, producing tachypnea, feeding-related diaphoresis, crackles, and a holosystolic murmur. Nursing care should therefore stabilize cardiopulmonary function, protect nutrition and growth, and prepare the family to recognize deterioration.

Diagnosis and Pathophysiological Analysis

The most likely diagnosis is a moderate to large ventricular septal defect with pulmonary overcirculation and compensated congestive heart failure. A VSD is an opening in the interventricular septum that permits blood to move from the higher-pressure left ventricle into the lower-pressure right ventricle (Dakkak & Oliver, 2023). The resulting left-to-right shunt recirculates oxygenated blood through the pulmonary circulation rather than delivering it efficiently to the systemic circulation. Consequently, the lungs receive excess volume, and both ventricles face increased workload.

The clinical findings correspond closely to this hemodynamic process. The 2/6 holosystolic murmur at the left sternal border reflects turbulent blood flow across the septal opening during systole. Tachypnea at 58 breaths per minute, subdiaphragmatic retractions, abdominal breathing, and bilateral crackles indicate increased respiratory work and pulmonary venous congestion. The heart rate of 175 beats per minute represents a compensatory response to reduced effective systemic output and increased metabolic demand. Feeding for 40 minutes, sweating during feeds, and reduced feeding frequency further suggest that the infant expends substantial energy on breathing and cardiac work.

The absence of cyanosis and an oxygen saturation of 98% support a left-to-right, rather than right-to-left, shunt. In a large nonrestrictive VSD, pulmonary vascular resistance falls after birth, increasing shunt volume and producing heart-failure symptoms commonly at four to six weeks of age (Beerman, 2023). Bilateral crackles are particularly important because they suggest pulmonary edema from volume overload. An echocardiogram is required to confirm the defect’s location and size, quantify shunting, assess ventricular function, and exclude additional cardiac lesions.

Priority Nursing Diagnoses and Care Plan

Ineffective Breathing Pattern

The priority diagnosis is ineffective breathing pattern related to pulmonary congestion and increased cardiac workload, as evidenced by a respiratory rate of 58 breaths per minute, subdiaphragmatic retractions, abdominal breathing, and bilateral crackles. Pulmonary overcirculation reduces lung compliance and increases the work required for each breath.

The nurse should position the infant with the head and torso slightly elevated to lower abdominal pressure on the diaphragm and ease ventilation. Respiratory rate, retractions, oxygen saturation, and crackles should be assessed before and after feeds, with deterioration reported promptly to the pediatric cardiology team. Prescribed diuretics, when ordered, reduce intravascular and pulmonary fluid volume; the nurse must monitor urine output, weight, electrolytes, and hydration status because diuretic therapy can cause hypokalemia and dehydration (Dakkak & Oliver, 2023). A measurable outcome is that the infant will maintain a respiratory rate below 60 breaths per minute, oxygen saturation of at least 95%, and no new or worsening retractions during the next 24 hours.

Decreased Cardiac Output

A second priority is decreased cardiac output related to altered preload and ineffective myocardial performance secondary to left-to-right shunting, evidenced by tachycardia of 175 beats per minute, diaphoresis, and feeding intolerance. Although oxygen saturation remains normal, effective systemic perfusion may be reduced because a portion of left-ventricular output returns to the pulmonary circulation.

Nursing interventions should minimize oxygen demand by clustering care, preventing prolonged crying, maintaining a neutral thermal environment, and allowing rest between assessments. The nurse should also administer heart-failure medications exactly as prescribed, monitor apical pulse before digoxin or other rate-sensitive medications, and document blood pressure, peripheral perfusion, urine output, and daily weight. These measures detect both clinical improvement and adverse medication effects. The expected outcome is that the infant will demonstrate a heart rate between 100 and 160 beats per minute, warm extremities, adequate urine output, and stable weight trends within 48 hours.

Imbalanced Nutrition: Less Than Body Requirements

The third diagnosis is imbalanced nutrition: less than body requirements related to increased metabolic demand, fatigue, and dyspnea during feeding, evidenced by feeding duration increasing to 40 minutes and reduced feeding frequency. Infants with significant VSDs often fail to consume enough calories because feeding itself becomes physically demanding (CDC, 2025).

The nurse should collaborate with the mother and dietitian to use smaller, more frequent feeds, upright positioning, and scheduled rest periods during breastfeeding. If oral intake remains insufficient, the team may consider expressed breast milk, caloric fortification, or nasogastric supplementation; human milk delivered by bottle or feeding tube is an appropriate alternative when direct breastfeeding is not sustainable (Salas et al., 2021). Daily weights obtained on the same scale, at the same time, and with similar clothing provide the most practical measure of nutritional progress. The expected outcome is that the infant will achieve an appropriate weight gain for age, as defined by the pediatrician and dietitian, within seven days while maintaining feeding tolerance.

Family Education Plan

Family education should be practical, repetitive, and matched to the mother’s literacy level and preferred language. The nurse should explain the diagnosis in plain terms: a hole between the heart’s lower chambers allows extra blood to flow to the lungs, making breathing and feeding harder. Simple diagrams of the heart, short written instructions, and translated materials can improve comprehension, while teach-back confirms that the mother can restate the plan in her own words (Erickson et al., 2026).

Feeding education deserves particular attention. The mother should be taught to feed in a calm environment, pause when the infant tires, use upright positioning, and avoid forcing prolonged feeds. She should understand that sweating, slow feeding, and poor weight gain are warning signs rather than normal variations. If medication is prescribed, education must include the drug name, dose, timing, administration technique, missed-dose instructions, and signs of toxicity or electrolyte disturbance.

The family also needs clear red-flag criteria. Immediate medical review is warranted for respiratory rate above 60 breaths per minute at rest, persistent retractions, cyanosis, poor feeding or fewer wet nappies, lethargy, fever, or sudden worsening of sweating during feeds. A one-page action plan with emergency contacts, follow-up appointments, and photographs or diagrams can support recall. Teach-back should be used at the end of each teaching episode; for example, the nurse may ask, “Tell me what you would do if she begins breathing faster and refuses her feed?” This approach shifts responsibility for clarity to the clinician and reduces the risk of misunderstanding (Cardiology in the Young, 2026).

Interprofessional Collaboration

Effective management depends on coordinated input from pediatric cardiology, dietetics, pharmacy, and social work. The pediatric cardiologist interprets the echocardiogram, determines the need for medical therapy or surgical closure, and sets the surveillance schedule. The dietitian calculates caloric needs, advises on breast-milk fortification or formula modification, and monitors growth. The pharmacist verifies dosing, screens for interactions, and teaches safe administration, while social work assesses financial, transport, and psychosocial barriers that may affect attendance at frequent appointments.

The nurse acts as the communication link among these professionals. Structured SBAR communication ensures that assessment changes reach the cardiologist quickly: “The two-month-old with suspected VSD has a respiratory rate of 58, heart rate of 175, bilateral crackles, and feeding-related diaphoresis; I recommend urgent cardiology review.” The nurse should also share feeding observations with the dietitian and medication-tolerance concerns with the pharmacist. Family-centered education is most effective when it continues across encounters and involves the full interdisciplinary team, rather than occurring only at diagnosis (Erickson et al., 2026).

Conclusion

The infant’s tachypnea, tachycardia, murmur, crackles, and feeding-related diaphoresis strongly indicate a moderate to large VSD with pulmonary overcirculation and early heart failure. Priority nursing care focuses on improving breathing pattern, supporting cardiac output, and preserving nutrition through monitored interventions and measurable outcomes. Plain-language family education, teach-back, and coordinated interprofessional management reduce the risk of missed deterioration and support growth until definitive treatment decisions are made.

References

Beerman, L. B. (2023). Ventricular septal defect (VSD). In MSD Manual Professional Edition. Merck Sharp & Dohme. https://www.msdmanuals.com/professional/pediatrics/congenital-cardiovascular-anomalies/ventricular-septal-defect-vsd

Cardiology in the Young. (2026). Health literacy in CHD. Cardiology in the Young. https://www.cambridge.org/core/journals/cardiology-in-the-young/article/health-literacy-in-chd/B7F65C88FD67045BE5F6433881F397BE

Centers for Disease Control and Prevention. (2025). Ventricular septal defect. U.S. Department of Health and Human Services. https://www.cdc.gov/heart-defects/about/ventricular-septal-defect.html

Dakkak, W., & Oliver, T. I. (2023). Ventricular septal defect. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470330/

Erickson, L. A., Peterson, J. K., et al. (2026). Update on education for families and patients with pediatric heart disease. Journal of the American Heart Association. https://www.ahajournals.org/doi/10.1161/JAHA.125.046623

Salas, A. A., et al. (2021). Feeding the child with congenital heart disease: A narrative review. Translational Pediatrics, 10(8), 2242–2253. https://pm.amegroups.org/article/view/5972/html

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Nursing Care of an Infant With a Moderate Ventricular Septal Defect

NURS 4030: Nursing Care of the Pediatric Client Across the Lifespan

Assessment 2: Pediatric Congenital Heart Defect Case Study Analysis

Fall 2026, Week 5

Student Name

Institution

Course Instructor

Submission Date

 

A two-month-old girl who now nurses for forty minutes every four hours, sweats at the breast, and breathes at 58 breaths per minute presents a recognizable picture. Her findings point to a moderate to large ventricular septal defect (VSD) with early congestive heart failure, and the plan that follows has to address perfusion, nutrition, and family capability at once. Saturation of 98% on room air makes cyanotic heart disease unlikely, whereas the 2/6 holosystolic murmur along the left sternal border and the bilateral crackles place the problem at the septal and pulmonary levels. Feeding time has doubled while the interval between feeds stretched from three hours to four, which signals an infant spending more energy than she takes in. Subdiaphragmatic retractions and abdominal breathing at a rate of 58 confirm that the work of breathing has begun to compete with the work of eating. What happens across the next 48 hours, from feed pacing to escalation thresholds, largely decides whether she stabilizes at home or returns through the emergency department.

Diagnosis and Pathophysiological Analysis

A moderate to large VSD is the most likely diagnosis, and the physiology explains each finding without strain. Blood crosses the defect from the higher-pressure left ventricle into the right ventricle, so pulmonary blood flow rises while systemic output falls (Beerman, 2023). That extra volume floods the pulmonary circulation and produces the scattered crackles and the subdiaphragmatic retractions that accompany a respiratory rate of 58. Turbulent flow through the defect generates the holosystolic murmur, audible once pulmonary vascular resistance falls at four to six weeks of life (Dakkak & Oliver, 2023). Tachypnea and a heart rate of 175 reflect the heart’s attempt to keep systemic perfusion adequate against a volume-loaded left atrium. Feeding then becomes the infant’s hardest task, since suckling against a rising respiratory workload stretches feeds to forty minutes while the energy spent exceeds the calories taken in, which explains why diaphoresis and longer intervals appear together (Mills et al., 2022). Growth faltering follows unless intake is supported, and echocardiography is needed to size the defect and quantify the shunt before closure is timed. Registry data indicate that a VSD is not a benign lifelong lesion even when it closes or is repaired, which supports continued cardiac surveillance (Eckerström et al., 2023). Deep learning models now detect VSD from phonocardiograms with accuracy above 90%, comparable to expert auscultation, though most such studies remain retrospective and lack external validation (Brem et al., 2026).

Nursing Diagnoses and Care Plan

Three NANDA-I diagnoses organize the priorities here, and each is anchored in data already collected at the check-up (Herdman et al., 2024). Naming them in order of physiological risk keeps the plan honest about what can wait.

1. Ineffective Cardiopulmonary Tissue Perfusion, related to left-to-right shunting and increased myocardial workload, as evidenced by a heart rate of 175, a respiratory rate of 58, and diaphoresis during feeds.

Administer prescribed diuretics and afterload-reducing agents, then check electrolytes, blood pressure, and urine output after each dose, because loop diuretics can deplete potassium and chloride while lowering preload.

Cluster assessments and handling so the infant rests between episodes, since uninterrupted sleep lowers myocardial oxygen demand and improves feeding tolerance.

Expected outcome: heart rate below 160 and respiratory rate below 50 during wakeful rest within 48 hours, with oxygen saturation at or above 95%.

1. Imbalanced Nutrition: Less Than Body Requirements, related to increased metabolic demand and fatigue during feeding, as evidenced by feed duration rising from 20 to 40 minutes.

Offer smaller, more frequent feeds with the infant held upright and paced rest breaks, because upright positioning relieves pressure on the diaphragm and limits splinting of the lungs.

Refer to the dietitian for human milk fortification or energy-dense formula, raising calories per milliliter without adding volume the infant cannot tolerate.

Expected outcome: intake of 120 mL/kg/day and weight gain of at least 20 g per day by discharge.

III. Activity Intolerance, related to the imbalance between oxygen supply and demand in heart failure, as evidenced by tachypnea and sweating with minimal exertion.

Schedule feeds after undisturbed sleep, and pause a feed when the respiratory rate climbs more than ten breaths above baseline.

Track daily weights on the same scale at the same time, because a gain above 30 g per day alongside worsening respiratory effort suggests fluid retention rather than growth.

Expected outcome: the infant completes a feed without desaturation below 94% and returns to baseline respiratory rate within ten minutes.

Family Education Plan

Teaching starts at the bedside and continues through every encounter, because parents, not clinicians, will manage this infant at home. Feeding guidance should stay concrete: hold her upright at roughly 45 degrees, pause every few minutes, and stop when breathing becomes labored rather than pushing through a full volume (Norman et al., 2022). Medication teaching covers timing as much as dose, since diuretics given late in the day disturb sleep and can leave an infant dehydrated, so parents need an oral syringe and a written schedule they can tick off. Activity tolerance is easier to describe through cues than limits, and families should learn that brief fussiness is expected while sweating during sleep or refusal of two consecutive feeds is not. Warning signs deserve their own page: respiratory rate above 60 at rest, retractions, poor urine output, lethargy, or weight loss across three days. Health literacy shapes how that page is written, and assessing reading level, language, and prior experience first allows the nurse to strip jargon, use pictures, and break teaching into short sessions (Gramszlo et al., 2022). Teach-back then closes the loop, with parents explaining in their own words when they would telephone the clinic and when they would call an ambulance, a method linked to stronger knowledge retention and satisfaction than conventional instruction (Yen & Leasure, 2019).

Interprofessional Collaboration

No single clinician can manage this infant alone. The pediatric cardiologist confirms the diagnosis by echocardiography, grades the shunt, and sets the timing for surgical or transcatheter closure, while the registered dietitian translates caloric targets into a feeding plan the family can follow at home. The pediatric pharmacist reviews diuretic dosing, electrolyte monitoring, and interactions, and the social worker addresses transport, cost, and caregiver stress that would otherwise erode adherence (Gramszlo et al., 2022). Nurses coordinate these contributions because they hold the most continuous picture of the infant’s daily tolerance. Structured handover keeps that coordination reliable. Using SBAR, the nurse states the situation, the background of a two-month-old with a moderate VSD, the assessment findings of tachypnea, crackles, and diaphoresis with feeds, and a recommendation for dietitian review, medication adjustment, and an earlier cardiology appointment. Pediatric units that adopted a written SBAR form saw documentation of the assessment and recommendation sections rise from near zero to roughly two-thirds of handoffs after training, and most clinicians reported that the tool improved communication and accountability (Adam et al., 2022).

Conclusion

Moderate VSD with early heart failure explains this infant’s feeding difficulty, tachypnea, and diaphoresis as one physiological process rather than three separate complaints. Priority diagnoses of ineffective cardiopulmonary tissue perfusion, imbalanced nutrition, and activity intolerance give the plan its structure, and each carries interventions and outcomes measurable within days. Family education and interprofessional coordination decide whether those gains survive discharge. Escalation thresholds, taught in plain language and confirmed through teach-back, are the piece families carry home. Weight gain, feeding duration, and respiratory rate at rest are the three numbers that tell a family whether the plan is working. Anticipating decompensation, rather than reacting to it, remains the nurse’s clearest contribution to this infant’s first year.

 

 

References

Adam, S., Abdullah, M., & Saad, N. (2022). The impact of SBAR communication tool implementation on nurses’ communication and patient safety. Journal of Nursing Care Quality, 37(3), 245-251. https://doi.org/10.1097/NCQ.0000000000000613

Beerman, L. B. (2023). Ventricular septal defect (VSD). In MSD manual professional edition. Merck Sharp & Dohme. https://www.msdmanuals.com/professional/pediatrics/congenital-cardiovascular-anomalies/ventricular-septal-defect-vsd

Brem, O., Pravda, N. S., Xu, H., Nguyen, K. L., & Husain, M. (2026). A systematic review on deep learning in ventricular septal defect screening, diagnosis, and management. Annals of Pediatric Cardiology, 19(1), 53-61. https://doi.org/10.4103/apc.apc_163_25

Dakkak, W., & Oliver, T. I. (2023). Ventricular septal defect. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470330/

Eckerström, F., Nyboe, C., Maagaard, M., Redington, A., & Hjortdal, V. E. (2023). Survival of patients with congenital ventricular septal defect. European Heart Journal, 44(1), 54-61. https://doi.org/10.1093/eurheartj/ehac618

Gramszlo, C., Karpyn, A., & Demianczyk, A. C. (2022). Parent-to-parent resources for congenital heart disease: A scoping review of digital sources. Journal of Pediatric Nursing, 65, e1-e9. https://doi.org/10.1016/j.pedn.2022.01.010

Herdman, T. H., Kamitsuru, S., & Lopes, C. T. (Eds.). (2024). NANDA International nursing diagnoses: Definitions and classification, 2024-2026 (13th ed.). Thieme.

Mills, K. I., Kim, J. H., & Fogg, K. (2022). Nutritional management of the infant with congenital heart disease. Journal of Perinatal & Neonatal Nursing, 36(4), 380-389. https://doi.org/10.1097/JPN.0000000000000678

Norman, S., Knoester, H., & Boersma, S. (2022). Feeding strategies in infants with congenital heart disease: A systematic review. Pediatric Cardiology, 43(4), 731-744. https://doi.org/10.1007/s00246-021-02778-3

Yen, P. H., & Leasure, A. R. (2019). Use and effectiveness of the teach-back method in patient education and health outcomes. Federal Practitioner, 36(6), 284-289.