Exam 9 OB Tetralogy of Fallot – s&s – nursing interventions – Flashcards

Tetralogy of Fallot "Tetra" = 4 Means that there are four separate defects within this one syndrome

Right-to-left (if pulmonary vascular resistance is higher than systemic resistance) Left-to-right (if systemic resistance is higher than pulmonary resistance)

Decreased

Ventricular septal defect (VSD) between right and left ventricles Obstructive right ventricular flow - pulmonary stenosis (PS) or obstruction Overriding aorta lies directly over VSD and takes blood from both right and left ventricles; permits oxygenated blood to rest of body Secondary thickening of right ventricle (right ventricular hypertrophy) due to restrictive outflow

Acute cyanosis at birth or mild cyanosis that progresses over the first year of life as the PS worsens Characteristic systolic murmur (moderate in intensity) May be acute episodes of cyanosis and hypoxia (blue spells or tet spells). Occur when the infant's oxygen requirements are greater than the blood supply, usually during crying or after feeding. At risk for emboli, seizures, and loss of consciousness or sudden death after an anoxic (blue) spell

Palliative shunt (in infants who cannot undergo primary repair) - increases pulmonary blood flow and oxygen saturation (preferred procedure provides blood flow to the pulmonary arteries from the left or right subclavian artery via a tube graft. In general, shunts are avoided because they may result in pulmonary artery distention. Complete repair - usually performed in the first year of life. Involves closure of the VSD and resection of the infundibular stenosis, with placement of a pericardial patch to enlarge the RVOT. In some repairs, the patch may extend across the pulmonary valve annulus (transannular patch), making the pulmonary valve incompetent. The procedure requires a medium sternotomy and the use of cardiopulmonary bypass.

Operative mortality for total correction is less than 3%

Present at birth or within first year of life Heart murmur may be soft to loud Failure to gain weight Fainting Dyspnea on exertion Polycythemia Boot-shaped heart (right ventricular hypertrophy and small pulmonary artery) As PDA closes, cyanosis increases

Improve oxygenation through clustering of care Maintain sedative or morphine sulfate to decrease agitation Prevent inconsolable crying Maintain fluid balance Provide oxygen to reduce pulmonary vasoconstriction, but note that this will not improve oxygen saturation or alleviate the cyanosis Maintain vasopressors to increase systemic vascular resistance Maintain prostaglandin E drip to keep PDA open Prepare family for possibility of multiple surgeries, such as modified Blalock-Taussig procedure

Relaxes the smooth muscle of the ductus arteriosus, leading to increased pulmonary blood flow with increased blood oxygenation and lower body perfusion; increase SpO2 and PaO2 Watch for respiratory depression or apnea, flushing, bradycardia, irritability, and diarrhea, and monitor for bleeding. Dilatation occurs systemically (not just within the heart)

Teach the family to calm the infant by holding the infant over the caregiver's shoulders with the child's knees drawn up toward the child's chest Support the caregiver's access to a pediatric cardiologist for the child's lifelong care