Chapter 26: Tetralogy of Fallot (Children)

Question 1

Tetralogy of Fallot (TOF)

Answer 1

combination defect
cyanotic
-right-to-left shunting 
-tetra= "four" 
-always four associated conditions: VSD, overriding aorta, hypertrophic RV, and pulmonary stenosis or atresia

Question 2

4 Associated conditions with TOF

Answer 2

• VSD
• overriding aorta
• hypertrophic RV
• pulmonary stenosis

Question 3

Signs and Symptoms

Answer 3

• tachypnea
• dyspnea on exertion
• growth failure
• cyanosis after ductus arteriosus closes
• loud systolic ejection murmur that is described as harsh and radiating
• right ventricular hypertrophy caused by a stenotic vessel and high pulmonary vascular resistance (PVR)

Question 4

Diagnosis

Answer 4

based on s/s such as cyanosis, breathing difficulties, fainting, fatigue and weakness, slow growth, or developmental delay
-ECG, echocardiogram, chest x-ray, and cardiac cath support and confirm diagnosis

Question 5

Nursing Care

Answer 5

pre-surgical care involves preventing or minimizing symptoms associated with the defect

Question 6

Surgical Care

Answer 6

-Blalock-Taussig shunt (classic or modified)

Question 7

Auscultation of Heart Murmurs

Answer 7

most heart sounds are made through the opening and closing of valves or blood flow through an abnormal opening
-when listening for each valve, the auscultation landmarks are not located above the valve itself but in the direction of the flow of blood; therefore, the aortic and pulmonic valves are best heard above the valve and the tricuspid and mitral sounds are best heard below the valve

Question 8

Hallmark sign of TOF

Answer 8

cyanosis with crying or playing, which is relieved by squatting or drawing up the legs
-these episodes (“TET” spells) are cyanotic events exacerbated by excitement and crying, then relieved by a decrease in pulmonary vascular resistance