1. 2. Most frequent parental complaint: difficulty feeding.
      1. Infant must be awakened to feed.
      2. Has weak suck.
      3. May turn blue when eating, especially with cyanotic defects.
      4. Infant takes overly long time to feed.
      5. Falls asleep during feeding, without finishing.
   3. Nursing observations
      1. Most frequent symptom - tachycardia, as body attempts to compensate for lack of oxygen (hypoxia), i.e., heart rate over 160 beats/min.
      2. Tachypnea, corresponding to heart rate, i.e., respirations over 60 breaths/min.
      3. Cyanosis due to hypoxia:
         1. Not with acyanotic defects (unless CHF is present).
         2. Always with cyanotic defects (“blue babies”).
      4. Failure to grow at a normal rate, i.e., slow weight gain, height and weight below the norm due to difficulty feeding and hypoxia.
      5. Developmental delays related to weakened physical condition.
      6. Frequent respiratory infections associated with increased pulmonary blood flow or aspiration.
      7. Dyspnea on exertion due to hypoxia, shunting of blood.
      8. Murmurs may or may not be present, e.g., patent ductus arteriosus (PDA) machinery murmur.
      9. Changes in blood pressure, e.g., coarctation - increased blood pressure in arms; decreased blood pressure in legs.
      10. Possible congestive heart failure - Note: Infants may not demonstrate distended neck veins.
      11. Cyanotic heart defects:
          1. “Tet. spells” - choking spells with paroxysmal dyspnea: severe hypoxia, deepening cyanosis; relieved by squatting, or placing infant in knee-chest position, which alters cardiopulmonary dynamics, thus increasing the flow of blood to the lungs.