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…,
1. VSD
2. Overriding of aorta
3. Pulmonary stenosis
4. Right ventricular hypertrophy.

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

5. HEMODYNAMICS

6. 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.

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

12. DIAGNOSTIC EVALUATION
• Physical examination
• Cardiac examination
• Echocardiogrphy
• Cardiac cathterization

14. 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.

15. SURGICAL MANAGEMENT
• PALLIATIVE SURGERY.
• CORRECTIVE SURGERY.

16. PROCEDURES
• Blalock – Taussing shunt.
• Artificial ductus is created by connecting right
or left Subclavian 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.

17. • 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.

20. 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.

21. • 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

22. • 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.

23. • 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.

24. • 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.