Tetralogy of fallot

Congenital Heart Defects

1. TETRALOGY OF FALLOT Rahul Moothedan (MSc N) Lecturer Dep. Of Paediatrics KHFH College Of Nursing Patna, Bihar.

2. DEFINITION Tetralogy of fallot is the most complex congenital heart defect with decreased pulmonary blood flow. It includes…, VSD Overriding of aorta Pulmonary stenosis Right ventricular hypertrophy.

3. INCIDENCE Accounts for 6-10% of all congenital heart defects

4. HEMODYNAMICS

5. CLINICAL FEATURES Most significant feature is CYANOSIS. Clubbing of fingers and toes occur at 1-2 years of age. Exercises causes DYSPNOEA. [SQUATTING POSITION] TETT SPELLS Delayed Growth and Development.

6. Harsh systolic murmor on the left sternal border. Boot shaped heart.

7. DIAGNOSTIC EVALUATION Physical examination Cardiac examination Echocardiogrphy Cardiac cathterization

8. THERAPEUTIC MANAGEMENT Knee chest position Propanolol 1mg/kg upto 4 times in a day reduces pulmonary and valve spasm. Intravenous prostaglandin E1 therapy increases pulmonary blood flow and improving arterial blood oxygenation.

9. SURGICAL MANAGEMENT PALLIATIVE SURGERY. CORRECTIVE SURGERY.

10. PROCEDURES Blalock – Taussing shunt. Artificial ductus is created by connecting right or left S ubclavian artery to the pulmonary artery on the same side. This allows increased blood flow to the lungs. This procedure is performed through lateral thoracotomy incision.

11. POTT’S PROCEDURE. The upper descending aorta is anastomosed with left pulmonary artery WATERSTON SHUNT. It involves side to side anastomosis of ascending aorta with right pulmonary artery BROCK’S PROEDURE. Pulmonary valvotomy is done to correct pulmonary stenosis .

12. NURSING DIAGNOSIS Impaired gas exchange related to altered pulmonary blood flow or pulmonary hypertension. Position the child in semi-upright position Suction oral and nasal secretions Monitor the saturation level Administer medication like diuretics and bronchodialators ABG analysis.

13. Decreased cardiac output related to reduced myocardial functiong Provide bed rest to the child Child should not be alowed to do straneous activities Organize periods of medication and nursing care to give uninterupted rest. Administer medications- digoxin and diuretics Monitor BP

14. Impaired physical mobility and fatigue related to activity intolerance secondary to pulmonary congestion and hypoxia. Ensure uninterrupted period of rest and sleep Administer oxygen as required Monitor oxygen saturation through pulse oxymetre Provide feeding, tactile stimulation and change wet diapers to prevent child from crying.

15. Delayed growth and development related to inadequate tissue perfusion. Assess the child for developmental milestones Provide visual, tactile and auditory stimulations approp to child’s age Encourage parents to provide tender loving care Assure the parents.

16. Imbalanced nutrition less than body requirements related to anorexia and decreased energy available for sucking and chewing. Parental anxiety related to child’s condition Parental knowledge deficit related to child’s treatment regimen. Risk for potential complications related to disease condition.

17. THANK YOU….