Case Peds NR 328 Week 4 Cardiac Case Study

Cardiac Case Study A 10-month-old girl was admitted to the hospital for cardiac catheterization. Her history included cyanosis noted at about 6 weeks of age, increasing over the last 7 months and becoming more severe with crying or physical activity. A presumptive diagnosis of tetralogy of Fallot (TOF) was made on admission. 1. What is tetralogy of Fallot (TOF)? Four defects that result in mixed blood flow: Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy. 2. What other conditions may produce cyanosis in the first year of life? Tricuspid atresia, hypoplastic left heart syndrome, pulmonary stenosis. 3. Describe the pathophysiology of TOF. Cyanosis at birth which progresses over first year of life. Episodes of acute cyanosis and hypoxia (blue or “Tet” spells) – meaning cyanotic episodes. There are also Pink “Tet” which means children without cyanosis episodes. 4. What is a "pink Tet"? Pink Tet is children with TOF without cyanosis episodes. A pink “Tet” is a client with TOP with an adequate pulmonary blood flow. 5. What are hyper cyanotic spells? How are they treated? Hyper cyanotic spells are periods of unconduable crying/panic/irritability. Rapid and deep breathing. Increased cyanosis, limpness and lethargy, decreased murmur intensity. Knee-to-chest position is a treat nursing intervention. Hyper cyanotic spells are treated by decreasing stimuli and providing calm environment for the child. Morphine pharmacological treatment to decrease anxiety. Also, phenylephrine and esmolol may be required. Most episodes are self-limiting. 6. What is the natural history of the disease? If TOF is left untreated, it will progress the complication causing right ventricular hypertrophy and right ventricular dilation due to increase resistance of flow into the pulmonary circuit. 7. What are the associated anomalies? This study source was downloaded by from CourseH on :42:53 GMT -05:00