Pediatric Nursing Demystified

The classic form of tetralogy of Fallot (TOF) has four defects:

Ventricular septal defect

Pulmonic stenosis

Overriding aorta

Right ventricular hypertrophy

Signs and Symptoms

Cyanosis

Hypoxia

Anoxic spells when infant’s oxygen supply exceeds blood supply

Test Results

Cardiac catheterization: Catheters are inserted into the heart via a large

peripheral vein and advanced into the heart to measure pressures and

oxygen levels in heart chambers and visualize heart structures and blood

flow patterns. Reveals the four defects.

Pulse oximetry (SpO 2 ): Device used to evaluate the degree of oxygen

saturation in the blood using a small infrared light probe. Decreased

according to degree of deoxygenation.

Electrocardiogram: Detects electrical events normal and abnormal

cardiac rhythm in the heart. Signs of right ventricular hypertrophy noted.

Echocardiogram: Two-dimensional Doppler evaluation to detect evidence

of valve leakage, cardiac anatomy, size, and function. The four defects

are revealed.

Treatment

Blalock-Taussig procedure to increase pulmonary blood flow

Complete repair by

• Closing the VSD


• Resectioning the infundibular stenosis


• Enlarging the right ventricular outflow tract

Nursing Interventions for Child Undergoing

Cardiac Catheterization

Prepare the patient for cardiac catheterization:

• Take complete nursing history.


• Patient must be NPO for 4 to 6 hours.


• Complete assessment including calculation of body surface area.


• Check for allergies; allergies to iodine, contrast dyes, and shellfish
  should be relayed to the physician prior to the procedure.


• Document baseline assessment of pedal pulses and pulse oximetry.


• Utilize child life specialists to alleviate anxiety for the child and
  family.


• Arrange a tour of the lab with the child if age appropriate.

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CHAPTER 6/ Cardiovascular Conditions^115