Tetralogy Of Fallot

Predisposing Factors - Age - Sex - Culture - Race - Genetics (Chromosome 22 deletion)

Precipitating Factors - Problems during pregnancy - Exposure to teratogens - Taking of teratogenic medications during pregnancy - 4 TOOs (too young, too old, too sick, and too many pregnancies/deliveries)

Congenital deformity of the leaflets of the pulmonic valve Echocardiography: size of pulmonary artery Pulmonary valvotomy and/or balloon valvuloplasty Beta-blocker (Propanolol) Chest pains Narrowing of the entrance of the pulmonary artery Pulmonay Stenosis afterload pressure in the right side of the heart

pressure in the right side of the heart pushes deoxygenated blood to other possible exits

amount of deoxygenated blood going to the pulmonary artery deoxygenated blood going to the lungs lung perfusion oxygenated blood from the lungs going to the left side of the heart

Deep-breathing exercises

Tachypnea

Dyspnea

workload/effort of the right ventricular muscles to Deep-breathing push deoxygenated blood exercises out to the stenosed Dysrhythmias pulmonary artery Echocardiograhy & ECG results: Right Ventricular enlarged chamber of the right Hypertrophy side of the heart

O2 administration Promote rest periods

O2 saturation

oxygenated blood supply in the circulation

Congenital deformity of the ventricular septum

Opening in the ventricular septum

Aortal opening in the left heart is faced slightly to the right Diaphoresis Promote rehydration Poor feeding Aorta is dextropositioned (positioned to the right side)

Brock Procedure Ventricular Septal Defect

Promote good nutrition Tachypnea Deep-breathing exercises

Overriding Aorta (aorta overriding both ventricles) Blablock-Taussig Operation Brock Procedure

Loud, harsh, widely transmitted murmur or a soft scratchy localized systolic murmur in left 2nd, 3rd, or 4th parasternal space

Deoxygenated blood from the right ventricle shunted to the left ventricle and aorta

Deoxygenated blood mixes with the oxygenated blood in the left ventricle and aorta

Mixed deoxygenated and oxygenated blood going to the circulation

O2 administration Hypercyanotic attacks Knee-chest position (tet spells) Morphine Sulphate - General cyanosis - Hyperpnea Promote rehydration - Irritability Promote rest periods - Diaphoresis - Limpness Promote safety - Loss of consciousness Risk for Injury r/t sudden loss of consciousness and weakness

Cardiac decompensation Right sided heart failure

Syncope Hypoxemia

Clubbing of fingers Fatigue O2 supply to the different organs

Failure to thrive

Lab. Results: polycythemia, Hgb., Hct., total polycythemia RBC count blood viscosity embolism thrombophlebitis Thrombolytic medications (Alteplase recombinant) Heart by-pass surgery

Activity Intolerance r/t decreased energy and oxygen supply to the body and fatigue Promote rest periods

Plan activities that limit exertion and promote energy conservation Antianginal medications (Ranolazine)

oxygenated blood supply in the cardiac circulation O2 supply to the cardiac muscles/tissues

Increased venous engorgement of the liver

thromboembolism Obstruction in the heart

hepatomegaly

Non-pharmacological pain relief (ex. Back rub, diversional activities like playing toys, etc.) Risk for Decreased Tissue Perfusion r/t decreased amount of oxygenated blood in the circulation

Chest pains/ angina Cardiac glycosides (Digoxin)

Tissue ischemia cardiac contractility

Hepatic dysfunction

Antiarrhythmic medications (Adenosine)

Cardiovascular accident

Underlying Factors Pathophysiologic Changes Underlying Heart Defect Signs and Symptoms Nursing Diagnoses

Hepatic Failure

Congestive heart failure

LEGEND:

Submitted by: Hannah Marga C. Dalman Geraldine A. Ferraren John Kevin C. Giangan A3 Submitted to: Asst. Prof. Freslyn Lim, NCM 104, Pediatric Rotation, SMC

DEATH

Independent Nursing Care Collaborative Nursing Care Complications