tof

3.  Tetralogy Of Fallot is a congenital heart defect which
is classicaly understood to involve four anatomical
abnormalitiesof the heart (although only three of
them are always present) it is the most common
cyanotic heart defect,and its also known as blue baby
syndrome
 it was described in 1888 by the french physician
etienne-louis arthur fallot, after whom it is named.

4. INVOLVES FOUR HEART DEFECTS
 PULMONARY STENOSIS
 AN OVERRIDING AORTA
 A LARGE VENTRICULAR SEPTAL DEFECT(VSD)
 RIGHT VENTRICULAR HYPERTROPHY

7.  GERMAN MEASLES(Rubella)& Some other
VIRAL ILLNESS.
 POOR NUTRITION
 ALCOHOL USE
 AGE(being older than 40)
 DIABETES
 HERIDITY
 CHILDREN WITH GENETIC DISORDERS (Down
syndrome, DiGeorge Syndrome)

8.  BLUE COLOUR TO THE SKIN(CYANOSIS)
 CLUBBING OF FINGERS
 DIFFICULTY FEEDING(POOR FEEDING HABIT)
 DYSPNEA ON EXERTION
 POLYCYTHEMIA
 HEART MURMUR

11. A TET spell occurs when the
oxygen level in the blood suddenly drops.
This causes the baby to become very blue.
He or she also may have trouble
breathing, become very tired and limp,not
respond to a parents voice or
touch,become very fussy,or pass out.

12.  It occurs while baby awakening from sleep
after crying or during
 During or after defecation
 or during or immediately following feeding

15. SQUATTING
Obstruction of Femoral Arteries
Increased Peripheral vascular resistance
Increased LV After load
Increased LV Pressure
Decreased Right ventricular over Left
Ventricular pressure gradient
.

16. Decreased shunting of blood from right ventricle to left
ventricle (R to L shunt) through the VSD
Improved flow to the pulmonary artery
Better alveolar perfusion
Better oxygenation
Decreased symptoms of TOF spell

17.  HAVE A HARD TIME BREATHING
 BECOME VERY TIRED AND LIMP
 NOT RESPONDING TO A PARENTS VOICE OR
TOUCH
 BECOME VERY FUSSY
 LOSS OF CONSCIOUSNESS

18.  PHYSICAL EXAMINATION
 ECHOCARDIOGRAPHY
 EKG(Electro cardiogram)
 CHEST X RAY
 PULSE OXIMETRY
 CARDIAC CATHETERIZATION

21.  BLALOCK-TAUSSING SHUNT:-
Anastamosis between subclavian
artery and pulmonary artery.
 POTT’S PROCEDURE:-
Side to side anastamosis of left
pulmonary artery to descending aorta.
 WATERSON-COOLEY PROCEDURE:-
Anastamosis of right pulmonary
artery to descending aorta.

22.  Pulmonary artery atresia
 Major associated anomalies
 Multiple previous surgeries
 Absent pulmonary valve syndrome
 Young or Old age
 Small pulmonary arteries
 Multiple VSDs
 Low birth weight
 Coexisting cardiac anomalies

24.  Closure of the ventricular septal defect in a manner
that ensures left ventricular aortic continuity by
using the VSD patches.
 Infundibular muscle resection
 Pulmonic valve is opened by using Hegars dilator.

26.  NURSING DIAGNOSIS:DECREASED CARDIAC OUTPUT
 ↓ BP
 Tachycardia
 Jugular venous distention(jvd)
 Sudden stoppage of drainage from chest tubes
 ↓ in HB and hematocrit
 Cool,clammy skin
 ↓ urine output

27. NURSING INTERVENSIONS RATIONALE
LOW CARDIAC OUTPUT Inflammatory response associated with
CPB, Myocardial ischemia From aortic
clamping or circulatory arrest.
Assess Peripheral and central pulses Good peripheral pulses and adequate
capillary refill are signs of good CO
Assess for mental status changes Early signs of cerebral hypoxia are
restlessness with confusion and loss of
consciousness later stages
Assess respiratory rate, rhythm,and
breath sounds
Rapid shallow respirations and
presence of wheezes are characteristic
of decreased output.

28.  COMMON RISK FACTORS:
 Intubation during surgery
 extubation
 Mechanical ventilation
 Perioperative CPB time
 Ease of intubation

29. NURSING INTERVENTIONS RATIONALE
Assess respiratory rate,rhythm,and
depth every hour
Rapid, shallow respirations may occur
from hypoxia or from acidosis
Assess for any increasing in work of
breathing
After extubation patients may
experience acute respiratory distress
syndrome.
Assess pulse oximetry and ABGs O2 saturation should be kept at 90%
or greater
Change position every 2 hours This facilitates movement and
drainage of secretions

30. NURSING INTERVENTIONS RATIONALE
Observe and documents serial
laboratory data: na,K+,CL,MG,CA+
Levels
Hemodilution from ECC and resultant
fluid shifts changes in fluid composition
Monitor ECG for changes Widening QRS,ST
changes,arrhythmias,and
atrioventricular blocks are seen with
electrolyte imbalance
Monitor for hyperglycemia Tight glycemic control significantly
reduces the incidence of morbidity and
mortality

31.  COMMON RELATED FACTORS:
 Intensive care unit environment
 Unfamiliarity with postoperative care
 Threat of pain related to major surgery
 Threat of death

32. NURSING INTERVENTIONS RATIONALE
Recognize patients level of fear Controlling fear helps reduce
physiology reaction that can aggravate
condition and ↑ o2 consumption
Approach the child and parent in a
confident and composed manner
This approach increases the patient’s
feeling security
Avoid unnecessary conversations
between team members in front of
patients
This reduces patients misconceptions
and fear or anxiety