Tetralogy of Fallot is a congenital heart defect characterized by four heart defects including ventriculat septal defect, pulmonic stenosis, right ventricular hypertrophy and overriding aorta.
The cause is unknown. Risk factors include poor nutrition during pregnancy, parents having tetralogy of fallot, drinking alcohol during pregnancy, viral illness during pregnancy anf maternal age of more than 40 years.
The signs and symptoms are cyanosis which depends on severity of pulmonic stenosis, dyspnea on exertion, clubbing of fingers and toenails, sysytolic heart murmur.
Acute episode of cyanosis and hypoxia is called Tet Spell or Blue Spell. It occurs when oxygen requirement exceeds blood supply usually during crying.
Diagnostic investigations include auscultation of murmur, echocardiography, cardiac catheterization. chest X ray shows boot shaped heart.
The surgical treatment options include palliative shunt, Modified Blalock Taussig Shunt operation and complete repair.
Management of Tet Spell includes providing Knee Chest Position to child, supplemental oxygen and IV fluids for volume expansion. Standard medical tretament includes morphine, phenylepherine and propranolol.
Nursing diagnoses include:
1. Impaired gas exchange related to altered pulmonary blood flow as evidenced by cyanosis.
2. Activity intolerance related to imbalance between oxygen supply and demand evidenced by need to rest after a short period of activity.
3. Risk of infection related to hospitalization.
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