Tetralogy of Fallot

Question 1

Tetralogy of Fallot is what type of congenital heart defect?

Answer 1

Decreased Pulmonary Blood Flow

Question 2

Pathophysiology of Tetralogy of Fallot

Answer 2

> Composed of four heart defects
1. Pulmonary Stenosis
2. Ventricle Septal Defect
3. Overriding aorta
4. Right Ventricular Hypertrophy

** With pulmonary stenosis, the blood flow from the right ventricle is obstructed and slowed, resulting in a decrease in blood flow to the lungs for oxygenated blood returning to the left atrium from the lungs. The obstructed flow also increases the pressure in the right ventricle. This blood which is poorly oxygenated is shunted across the VSD into the left atrium**

• A mixing of oxygenated blood and poorly oxygenated blood occurs with this blood being pumped into the systemic circulation

Question 3

Signs and Symptoms

Answer 3

1. Hypercyanosis (TETS spells)
   > Increase cyanosis
   > Hypoxemia
   > Dyspnea
   > Agitation
   2.Loud, harsh murmur
2. Shortness of breath or noisy breathing
3. Retraction
4. Clubbing (develops overtime; not a first sign)
5. Tachycardia, Tachypnea
6. Increased RBC (polycythemia)

Question 4

Nursing Assessment: Health History

Answer 4

1. Note history of color changing associated with feeding, activity, or crying
2. Infants: bending at the knees or assuming the fetal position to relieve hypercyanotic spells
3. The walking infant or toddler may squat to improve pulmonary blood flow by increasing systemic vascular resistance
4. Note history of irritability, sleepiness or difficulty breathing

Question 5

Nursing Assessment: Physical Assessment

Answer 5

1. Observe the skin color and note any evidence of cyanosis
2. Observe for changes in skin color with positional changes
3. Inspect fingers for clubbing
4. Note hyper cyanotic spells
5. Count respirations and observe work of breathing
6. Oxygen saturation
7. Auscultate the lungs for adventitious breath sounds (development of heart failure)
8. Auscultate the heart noting a LOUD, HARSH MURMUR

Question 6

Laboratory Tests

Answer 6

1. Increased hematocrit, hemoglobin and RBC associated with polycythemia

Question 7

Diagnostic Testing

Answer 7

1. Echocardiography
2. Electrocardiogram
3. Cardiac Catheterization and Angiography

Question 8

Potential Complications

Answer 8

• Delayed Puberty
• Neurodevelopmental impairment
• Heart failure
• Blood Clots
• Stroke
• Failure to Thrive
• Delayed Development
• Anoxia