1 - Instructing children and families .2 - Observation and reporting the present signs and symptoms.3 - Interpretation of signs and symptoms.4 - Analysis of nursing problems.5 - Organization to ensure a desired outcome. Its goals providing a nursing care plan to meet the patient's individual needs are basically physical, biological, and social-psychological, helping the individual to become more self-directing in order to maintain health of mind and body, assisting children to become independent so as to achieve the goal of health, by instructing the parents to help the child or neonate do for himself what he can within his limits, helping children adjust to their limitations and emotional problems, by the application of immediate post-operative observational list ,Cardiac Rehabilitation Program ,Self-Care Program for the Down syndrome neonates and children with congenital heart defects and their parents .

Material and methods-A consecutive series of Down syndrome young children with Congenital Heart Defects (CHD) who underwent Open Heart Surgery at National Institute of Heart .Cairo, were recruited before surgery and are being followed prospectively. The study sample was started at November 2001 until November 2004, Immediate postoperative cardiopulmonary, neuromuscular, and gastrointestinal assessments, applications of Self-Care Program as regard the child cognitive, motor, musculoskeletal and bawel disabilities and cardiac rehabilitation at the fifth day and follow up of the child's condition after one, six month and after one year.