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PRESENTATION
ON
TETRALOGY OF
FALLOT
SUBMITTED ON:13/04//2017
General objectives:
Specific objectives:
Fallot
Fallot
Fallot
INTRODUCTION
in CICU on ..at 4:30pm with the complains of poor maternal nutrition, viral
illness.
IDENTIFICATION
1. Personal Data
Name: Master.Harish
Age: 3y/o
Sex: Female
Address:
Occupation: N/A
Education: nil
Admitting Physician:
Chief complains:
Family history:
There is no any evidence of hereditary and communicable disease in
his family
Family profile:
FAMILY TREE
Mr. samba murthy Mrs. Mala
29 yrs/male 26yrs/female
BIRTH HISTORY
1.Antinatal History
The child mothers arranged marriage. Mother had taken 2 doses of TT injection 5 th
and 7th month of gestation. The child mother had attended the regular antenatal check up. But
the mother doesnt taken Iron and Folic acid tablet during pregnancy period. The mother
does not exposed to radiation/toxic drugs and any illness/complications during pregnancy.
2.Natal History
The mother Mrs. Mala delivered baby at 35 weeks and 1.8 kg. Vaginal delivery in
Govt. Hospital Trichy on 02/12/2013 at 11.30am. The delivery was contacted by trained
health team members from hospital. Baby cried late 10 minutes after delivery. Birth weight
was 1.800kg. The child have any birth injuries. Thus child is the 2nd child of Mrs. Mala .
3.Post Natal History
The child does not have any history of cyanosis, and no history of eye discharge. The
breast feeding was initiated within 2 hours. The baby was passed meconium but does not
pass urine within 48 hours. The baby have low birth weight 1.800kg also APGAR SCORE
was 6/10. The child met various kinds of care and intensive care support.
IMMUNIZATION SCHEDULE
3 12.30pm Rice with 200 gms 690 kcal 6.9 74.5 5.2
curry
DEGREE OF MALNUTRITION
Actual Weight
100
Expected Weight
Expected Weight =?
=32+8
10
100=71.4
14
Biological Development:-
Vital signs:-
Temperature: the child the child had
36.5 C Temp: 36 C decreased
Pulse : 90-130 b/m Pulse: 92 b/m Respiration
Respiration:26-28 Res: 18 b/m
b/m Blood pressure:
Blood Pressure: 100/60 mm of Hg
99/6426/24 mm of Hg
6)Psychosocial
development:-
Begins to
passiveness she imitate her parents
Beings to imitate
parents she able to identify her
girl and boy friends
Awareness of gender
identity the child had jealously
with her brother
Increase autonomous
behavior
focuses on own
wishes
Decrease thumb
sucking
Imitates sex role
behavior of adults
the child mother says
7)Psychosexual that she calls her
development:- during the toileting
the child had attain
Anal stage:- appropriate
Obtains pleasure psychosexual
from the feeling of development
distended bladder according to her
from the masses of age
focus in the rectum
and from the release
of content from those
organs
Conscious sense of
self and learning to
tolerate frustration
9)Intellectual
development/cognitive
development:-
the child tells past
Sensory motor stage 15- events for eg she can
24 months able to remember what
she ate 2 days before
Pre-operational stage:
(24-30 months ) the child had
Beginning of mental the child can able to attained
representation of carry the past events appropriate
events and in the mind. intellectual
differentiates past development
and present except.
Short attention span child cant able to Cant differentiate
differentiate self from self from objects
Beginning of traces others
of memory begins
sense of time and
anticipation of
events
Beginning to think,
begin casual
thinking
thinks some
solution to problem
can differentiate self
from objects the child can able to
follow mothers orders
10)Moral development:-
14)Problems:-
Health problems:-
Dental carries the child had itchy
Nutritional skinrashes
deficiency the child does not problem
Warm infestation haveany
developmental
15)Developmental problems
problem:-
Book Picture Childs Picture Remark
Selfishness
Hurting others
Destructiveness the child does not
Ensuesis have any
Encorpresis developmental
Bad languages problems
Masturbation
Sibling rivalry
16)Needs of Toddler:-
Toileting, napping,
healthy practices and
play indoor and out
door games, dental
hygiene optional
valines
IMPRESSION:-
The child had a problem itchy dry skin, incomplete intellectual development, the child had
poor Nutritional pattern due to loss of appetite.
HEALTH ASSESSMENT
Personal history:
Electricity: present
Pulse 92b/min
92b/min 72b/min
72b/min abnormal
Abnormal
Respiration 22b/min 16-18b/min abnormal
22b/min 16-18b/min Abnormal
Blood pressure 120/60mmhg 120/80mmhg abnormal
120/60mmhg 120/80mmhg Abnormal
Spo2 93% 93% 100% 100% normal
normal
General appearance:
Consciousness: conscious
Orientation: oriented time, place, and date
Health: un healthy
Activity: dull
Look: anxious
Speech: clear
REVIEW OF SYSTEMS
Colour: black
Nails:
Nail beds: pale in colour
Nail plates: flat, absnce of clubbing
Texture: dry
Eyes:
Conjunctiva: abnormal
Ears:
Cerumen: no defect
Otarrhea: no discharges from ear
Nose:
Smell: no defect
Neck:
SYSTEMIC EXAMINATION
Heart:
Cardiovascular system:
H/O hypertension: hypertensive
Varicose veins: no H/o varicose veins
Dysponea: present
Palpitation: present
Pluse:92b/min
Heart beat: abnormal rate and rhythm
Auscultation: on auscultation at 5 areas , pulmonic, aortic, erbs point, mitral, apical area.
S1 S2 sounds are clear and gallop sounds present
INVESTIGATIONS
3. DC
P 86% 4,5000c/cumm abnormal
L 11%
E 0.3%
Introduction:
Tetralogy of Fallot (TOF) is one of the most common congenital heart disorders
(CHDs). This condition is classified as a cyanotic heart disorder, because tetralogy of
Fallot results in an inadequate flow of blood to the lungs for oxygenation (right-to-left
shunt) (see the following image). Patients with tetralogy of Fallot initially present with
cyanosis shortly after birth, thereby attracting early medical attention.
Louis Arthur Fallot, after whom the name tetralogy of Fallot is derived, was not
the first person to recognize the condition. Stensen first described it in 1672; however, it
was Fallot who first accurately described the clinical and complete pathologic features
of the defects.
ANATOMY OF HEART:
The heart is a hallow muscular organ located in the center of the thorax
where it occupies the space between the lungs (mediastinum) and rests on the
diaphragm.
It weights approximately 3oogrms (10.6oz) the weights and size of the
heart are influenced by age, gender, body weight, extent of physical
exercises and conditioning and heart disease.
The hart pumps to the blood to the tissues, supplying them with oxygen
and other nutrients.
Exacitability
Automaticity
Contractility
Refractoriness
Conductivity
Contractility: the heart muscle is composed of long narrow cells or fibres. The action of
potential initiates the muscles contraction by releasing calcium through the tubules of
the cell membrane.
DEFINITION:
Heart failure is a significant cardiac functional disorder that can results in reduced
oxygen delivery to the bodys organs tissues.
The in ability of heart to supply blood circulation for the body needs.
INCIDENCE:
Heart failure can affect both women and men alough the mortality is higher
among women
Heart failure affects about 5million people in U.S with 5000,000 new cases
diagnosed each year
3) After load (the pressure against which the left ventricles ejects)
4) Heart rate
Myocardial infraction
Myocarditis
Cardiomyopathy
Ventricular aneurysm
Cardiac tamponade
Constrictive pericarditis
PATHOPHYSIOLOGY:
The cause(s) of most congenital heart diseases (CHDs) are unknown,
although genetic studies suggest a multifactorial etiology. A study from
Portugal reported that methylene tetrahydrofolate reductase (MTHFR) gene
polymorphism can be considered a susceptibility gene for tetralogy of Fallot.
Prenatal factors associated with a higher incidence of tetralogy of Fallot
(TOF) include maternal rubella (or other viral illnesses) during pregnancy, poor
prenatal nutrition, maternal alcohol use, maternal age older than 40 years,
maternal phenylketonuria (PKU) birth defects, and diabetes. Children with
Down syndrome also have a higher incidence of tetralogy of Fallot, as do
infants with fetal hydantoin syndrome or fetal carbamazepine syndrome.
As one of the conotruncal malformations, tetralogy of Fallot can be associated
with a spectrum of lesions known as CATCH 22 (cardiac defects, abnormal facies,
thymic hypoplasia, cleft palate, hypocalcemia). Cytogenetic analysis may demonstrate
deletions of a segment of chromosome band 22q11 (DiGeorge critical region). Ablation
of cells of the neural crest has been shown to reproduce conotruncal malformations.
These abnormalities are associated with the DiGeorge syndrome and branchial
arch abnormalities.
The hemodynamics of tetralogy of Fallot depend on the degree of right
ventricular (RV) outflow tract obstruction (RVOTO). The ventricular septal
defect (VSD) is usually nonrestrictive, and the RV and left ventricular (LV)
pressures are equalized. If the obstruction is severe, the intracardiac shunt is from right
to left, and pulmonary blood flow may be markedly diminished. In this instance, blood
flow may depend on the patent ductus arteriosus (PDA) or bronchial collaterals.
BOOK PICTURE PATIENT PICTURE
Nutritional therapy:
a low sodium (2-3g/day) diet and
avoidance of drinking excessive Nutritional therapy:
amount of fluid are usually
recommended Provided a low sodium (2-3g/day)
diet and avoidance of drinking
dietary restriction of sodium excessive amount of fluid are
reduces fluid retention and the usually recommended
symptoms of peripheral and dietary restriction of sodium
pulmonary congestion reduces fluid retention and the
diet needs to be made with symptoms of peripheral and
consideration of good nutirion as pulmonary congestion
well s the patients likes and dislikes diet needs to be made with
and cultural food patterns consideration of good nutirion as
well s the patients likes and dislikes and
Additional therapy: cultural food patterns
supplemented oxygen Additional therapy:
other interventions
coronary artery revascularization supplemented oxygen
with PTCA; CABG surgery may be
considered
ventricular function may improve
in some patients when coronary
flow is increased.
Cardiac resynchronization therapy
Cardiac transplantation
Mechanical circulation assistance
with an implanted ventricular
assist device
ultra filtration
COLLABORATIVE THERAPY:
treatment for underlying cause
o2 therapy at 2-6l/min by
nasalcannula
rest activity period
COLLABORATIVE THERAPY:
drug therapy
daily weights treatment for underlying cause
sodium restricted diet o2 therapy at 2-6l/min by nasal
circulatory assisted devices cannula
cardiac resynchronization therapy rest activity period
with internal cardio ventricular drug therapy
defibrillator daily weights
cardiac transplantation sodium restricted diet
Complication:
Theory application
Roys adaptation model Introduction:
Sister callista Roy began her nursing career in 1963. After receiving B.Sc(N)
from moult saint marry college.
General system:
INPUT: Input includes tensions adaption level (the range of stimuli to which
persons adaptation early)
THROUGH PUT: through put makes use of a person processes and effect
ions. Process refers to control mechanism that a person uses as a adaptive system.
Effectors refers to the physiologic function, self concept and role function
involved in adaptation.
OUTPUT: output is the outcome of the system when system is a person.
Output refers to persons behaviour.
Metaparadigm and RAM:
Human being:
Person is a bio psychological being in constant interaction with changing environment and
recipient the nursing care as living system
Environment:
Environment and surrounding and effect the development
and behaviour of the persons group. The internal and external are the part of
the persons environment.
For ex: elderly person admitted to hospital all the conditions of influence on
him/her.
Health:
heath is a process whereby individual are striving to achieve their
maximum potential. It can be seen in healthy people, exercises regularly, not
smoking pay attention dietary pattern. It is a process to relieve acute and
chronic illness and terminal stages of diseases & to control the sign and
symptoms, to promote health of the persons by promoting adaptive
responses.
Nurses:
the nurses to reduce the ineffective responses as output behaviour of the person. The
nurse
promotes the health in all life processes. The nurses suggested by the model include
approaches
aimed at maintaining adaptive responses that support the persons effort to creativity use
his or
her coping
Nurses Notes
duolin}
o2 inhalation
Administered O2
Provide nebulisation
History collection
and performed
physical
examination
Provide
psychological
support
Provided health
education about
Diet
Exercises
Personal hygiene
Relaxation therapy.
HEALTH EDUCATION
1.Medication :
instructed to:
2.2.Exercise :
instructed to:
3.Treatment :
instructed to:
4.Hygiene :
5.Outpatient orders:
6.Diet :
instructed to:
no:820-837