Tetralogy of Fallot Nursing Diagnoses
- March 17, 2022
- Posted by: admin
- Category: DNP GUIDES
The tetralogy of Fallot can occur at any age and is one of the most common congenital heart disorders. The term congenital heart disease refers to diseases caused by malformations of the heart’s septum, valves, and large arteries (Hayes-Lattin & Salmi, 2020). In Tetralogy of Fallot, pulmonary stenosis, ventricular septal defect, right ventricular hypertrophy, and a geniculate aorta are all present (Smith et al., 2019). Various conditions can cause a decrease in blood flow in the lungs, such as pulmonary stenosis, where there is a blockage at the pulmonary valve or narrowing of the pulmonary valve. An opening between the left and right ventricles that enables blood to mix in the right ventricle is known as a ventricular septal defect (van der Ven et al., 2019). During an overriding aorta, the aorta shifts to the right side in a way that it sits on top of a ventricular septal defect. Right ventricular hypertrophy appears as an increase in the right ventricle as an adaptive response to pumping blood with more energy against pulmonary obstruction (Smith et al., 2019).
A variety of causes have been implicated for this condition, including genetics in connection with environmental exposure, chromosomal abnormality, or a mistake in the gene that controls the development of the heart (Ali, 2015). Furthermore, other causes such as maternal use of alcohol can also cause fetal alcohol syndrome, which can lead to tetralogy of Fallot. Mothers who are taking antiepileptic medications during pregnancy and those with phenylketonuria are also more likely to give birth to babies with the malformation. The cause of tetralogy of Fallot is not fully understood since in most cases the condition occurs spontaneously without any obvious cause (Smith et al., 2019).
Presentations in clinical settings
Tetralogy of Fallot is characterized by cyanosis as its most common clinical feature. Through the ventricular septal defect, deoxygenated blood mixes with oxygenated blood, resulting in bluish discoloration (Wilson et al., 2019). In this case, the child appears blue in the extremities, particularly the lips, toes, fingers, nose and ear. Additionally, if not treated early, a child will develop significant finger clubbing at the age of 2 years, which is a sign of a cardiorespiratory problem (Wilson et al., 2019). In addition, children are often shown in a squatting position after performing little activities, which indicates exertional dyspnea. In general, there is a delay in growth and development, which is mostly observed in delayed developmental milestones and stunted growth (Khan et al., 2019).
The severity of the tetralogy of Fallot can be assessed based on the baby’s symptoms, the results of the physical examination, and other tests. The physical exam involves assessment of the cardiopulmonary system with stethoscopes, assessment of signs and symptoms related to heart failure, and assessment of the general appearance (Ali et al., 2018). Echocardiography is one of the diagnostic tests conducted, which produces a live picture of the heart through sound waves. It is possible to visualize the suspected defects on the heart’s structure during this test, allowing a diagnosis for tetralogy of Fallot to be made after the confirmation of all four defects (Ali et al., 2018). It is also conducted to assess the electrical activity of the heart and determine various parameters such as the heart rate, the regularity of the heart rate, and to determine if there is an enlargement of the right ventricle. With a chest X-ray, the heart and other structures within the chest can be visualized. As a result of this chest exam, the nurse or doctor can see if the patient’s heart is enlarged or if there are other signs such as pulmonary edema that might indicate heart failure. In pulse oximetry, the level of oxygen in the blood is actively monitored (Puri et al., 2017).
Deficiency in cardiac output due to structural problems with the heart
In litres per minute, the cardiac output represents the amount of blood pumped out by the heart every minute. The condition is common among the elderly because of the reduced compliance of the ventricles, but it is also common in people with congenital heart defects, such as Tetralogy of Fallot, Myocardial Infarction, hypertension, and valvular heart disease (Oliveira et al., 2016).
Subjective assessment data
Patient complaints typically involve difficulty breathing while exercising, which could include the child stopping to breastfeed to gasp for air, exercise intolerance where the child stops playing and rests while squatting, fatigue, insomnia, and chest pain (Oliveira et al., 2016).
Assessing data: objective
Nursing assessment is essential to help the nurse distinguish between conditions involving decreased cardiac output. Initially, the nurse should check the colour, temperature, and moisture of the skin. Cold, pale, clammy skin often indicates low oxygen levels and inadequate blood flow to the tissues. In addition, the nurse should check for signs of altered consciousness, as decreased cerebral perfusion and hypoxia due to decreased cardiac output can result in difficulty concentrating, irritability, and altered awareness. Low stroke volume is indicated by weak pulses and slow capillary refill lasting more than 3 seconds. It is also important for the nurse to listen to the heart sounds for gallops and murmurs that can indicate structural defects. Moreover, a decreased urine output indicates that the heart is unable to supply enough blood to the kidneys for them to filter. In this case, the nurse should monitor the input-output chart closely to determine the extent of the reduced cardiac output and possibly prevent renal failure (Rojas Sánchez et al., 2016).
In this diagnosis, the ideal outcome is for the child to demonstrate a normal and adequate cardiac output, as measured by normal hemodynamics, such as normal blood pressure, pulse rate, strength, volume, and rhythm, and ability to participate in physical activities without experiencing symptoms such as dyspnea, fatigue, chest pains, or syncope.
Activity intolerance, resulting from an imbalance in oxygen supply and demand, as evidenced by the need to rest after playing for a short time, exertional dyspnea, and an abnormal heart rate
It can affect any person regardless of their age or any other factor, as it can be caused by any number of factors including physical impairment, cognitive impairment, pain, muscle weakness, inadequate sleep, prolonged bed rest, sedentary lifestyle, cardiovascular problems, respiratory problems, and metabolic problems (Kılıç, 2017).
Assessment of nursing: Subjective data
An individual with activity intolerance will probably complain of stiffness when moving, general weakness, shortness of breath when exerting themselves, chest tightness and altered consciousness. Nevertheless, subjective data suggest shortness of breath upon exertion is the most prominent feature of tetralogy of Fallot patients, as is feeling dizzy after simple activities like climbing stairs (K*l*c, 2017).
An objective assessment of nursing practice
A patient with TOF will generally present similarly to one with heart failure, as the heart has generally been unable to perform its functions as optimally as it could. Therefore, nurses should evaluate for signs of elevated heart rates, elevated blood pressure, signs of shortness of breath, such as laboured breathing and use of accessory muscles when breathing, low oxygen saturation, changes in EKG, and frequent refusal to engage in physical activity (Pereira et al., 2016). Additionally, the nurse must investigate the patient’s nutritional status as energy is required for exercise; therefore, a poor diet could make the patient intolerant to exercise. Nurses should monitor and observe the patients’ sleeping patterns as well. It is vital to identify any sleep deprivation that might be contributing to activity intolerance so that the nurse can provide appropriate care (Pereira et al., 2016).
In addition to TOF, other nursing diagnoses include:
Impairment of gaseous exchange due to altered pulmonary blood flow.
In this case, the stenosis prevents blood from flowing into the lungs. As a result, the nurse should place the child in the knee-chest position while monitoring the oxygen saturation levels and arterial blood gases. Knee-chest positioning, or squatting, is a compensatory mechanism that can be used by the nurse to increase the peripheral vascular resistance of a child, thereby reducing the magnitude of the left-to-right shunt across the sepal defect. Consequently, there is an increased gaseous exchange and minimal mixing of oxygenated and deoxygenated blood. The monitoring of arterial blood gasses helps in detecting any metabolic complications that might occur when the body tries to compensate for decreasing oxygen levels in the blood or increasing carbon dioxide levels in the blood.
Insufficient nutrition to meet the child’s nutritional needs, resulting in decreased energy for sucking and chewing
In addition to being difficult to breastfeed and engage in other feeding activities, activity intolerance adversely affects the child’s ability to do so. In addition to activity intolerance, shortness of breath makes it very difficult for the child to breastfeed continuously since they get tired. Additionally, parental anxiety as a result of the condition of the child can affect mild production, as well as her ability to feed her child. In addition, a parent may be unaware of her child’s nutritional requirements due to a health condition, which may affect how the child is fed (Ali, 2015).
Management and treatment
Tetralogy of Fallot requires open-heart surgery during infancy or soon after birth to be corrected. In surgical management, the goal is to repair the defects and to ensure that the heart returns to its natural state (Puri et al., 2017). In addition, pharmacological treatment can also be utilized to treat the condition. A pharmacological management regimen consists of administering propranolol, 1 mg/kg four times a day, to reduce pulmonary spasms and protaglandin E1 intravenously to increase pulmonary blood flow, making the arterial blood more oxygenated (van der Ven et al., 2019). Surgery for the condition consists of both palliative and corrective procedures. It was traditionally used to temporarily improve the circulation of blood to the lungs during palliative surgery. The condition was completely repaired through another surgical procedure later on in childhood. In modern times, children with tetralogy of Fallot often undergo complete repair during their infancy. The primary goal of palliative surgery is to improve blood flow so that the child can grow strong as he or she prepares to undergo corrective surgery (van der Ven et al., 2019).
The outlook is much better for children with tetralogy of Fallot due to recent advances in healthcare and technology. Nevertheless, home care will remain required for children for many years. Nutrition and feeding can be stressful for babies with the condition. Due to this, frequent, small meals that the baby can handle can significantly improve the baby’s health. Furthermore, supplemental nutrition provides the baby with extra calories, vitamins and other nutrients that are needed for recovery and other developmental nutritional needs (Smith et al., 2019).
Babies with a tetralogy of Fallot that hasn’t been corrected are more likely to experience tet spells. To prevent a baby from experiencing the spells, mothers should reduce their anxiety or any predisposing stress. There may be activity restrictions for some children, though these restrictions may vary from child to child. Moreover, children with tetralogy of Fallot require frequent medical care, such as hearing checkups with pediatric cardiologists and regularly scheduled health checkups with pediatricians (Smith et al., 2019).
Tetralogy of Fallot is a common congenital heart defect characterized by four defects and should be diagnosed and treated as early as possible. Diagnostic techniques include an EKG, echocardiography, and X-rays of the chest. Due to the condition’s adverse effect on the cardiopulmonary system, relevant parameters must be closely monitored. In addition to surgical management for correcting the defects, babies with the condition need additional support for better outcomes later in life.
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