FranciAnn G Lewandowski
Pasco-Hernando Community College
This paper discusses the disease Tetralogy of Fallot. Found within is disease description, etiology, epidemiology, clinical manifestations/signs & symptoms, diagnosis of the disease and related lab tests, clinical and medical management of the disease including collaborative disciplines, and prognosis of living with the disease. There is also a section that describes nursing care, complete with NANDA approved diagnoses, outcomes, interventions and rationale for the interventions. Key words: tetralogy of Fallot, congenital heart defects
Tetralogy of Fallot
Tetralogy of Fallot is the most common form of cyanotic congenital heart defect [CHD] (PubMed Health, 2011; National Institutes of Health – National Heart Blood and Lung Institute [NIH-NHBLI], 2011; Wikipedia, 2012). It is rare (PubMed Health, 2011), and according to Children’s Hospital and Clinics of Minnesota it occurs in two to five out of every 10,000 births, and accounts for 9-14% of all congenital heart defects, and affects boys and girls equally (2012).
Figure 1. Anatomy and physiology of the heart. Side A shows the structure and blood flow inside a normal heart. Side B shows a heart with the four defects of tetralogy of Fallot (National Institutes of Health – National Heart Blood and Lung Institute [NIH-NHBLI], 2011)
The tetralogy is a combination of four different defects within the heart. See Figure 1. The first is a ventricular septal defect (VSD), which is a hole between the left and right ventricles. The second is an overriding aorta. The aorta, instead of rising from the left ventricle, is located further to the right, directly above the VSD. Third, there is pulmonary valve stenosis. The narrowing of the pulmonic valve induces the right side of the heart to work harder to push blood through it and results in the fourth defect, right ventricular hypertrophy (Children’s MN, 2012).
Cyanosis and dyspnea present when poorly oxygenated blood is circulated thoughout the body, as these four defects work together to reduce blood flow to the lungs (Children’s MN, 2012). Etiology. The exact cause of tetralogy of Fallot is unknown (Children’s MN, 2012; NIH-NHBLI, 2011; PubMed Health, 2011), but the defect arises during fetal heart development within the first eight weeks of growth (Children’s MN, 2012). Both PubMed Health and the National Heart Blood and Lung Institute list the following factors that may increase the risk for this disease (2011; 2011): •Rubella or other viral illnesses during pregnancy
•Maternal age over 40
Heredity may be a factor in causing tetralogy of Fallot. A child is more likely to be born with the disease if a parent had it. And children who suffer from genetic disorders, such as Down syndrome or DiGeorge syndrome, often have the condition (PubMed Health, 2011; NIH-NHBLI, 2011). The search for the cause of tetralogy of Fallot as well as other congenital heart diseases is ongoing (NIH-NHBLI, 2011). Clinical Manifestations. Signs and symptoms of tetralogy of Fallot include (Children’s MN, 2012; PubMed Health, 2011): •Cyanosis
•Clubbing of fingers and toes (see Figure 2)
•Tet spells (sudden decrease of oxygen levels in the blood) •Poor appetite and poor weight gain
•Fainting, seizures or loss of consciousness
•Poor growth and development
•Unusual tiredness or irritability
Figure 2. Digital clubbing with cyanotic nail beds in an adult with tetralogy of Fallot (Wikipedia, 2012). Diagnostic and Lab Tests
Diagnostic and lab tests ordered upon suspicion of tetralogy of Fallot may include (NIH-NHBLI, 2011): •Chest x-ray
•Complete blood count (CBC)
•MRI of the heart (generally after surgery)
In August of 2010, universal pulse oximetry...