Tetralogy of Fallot Management and Pathophysiology
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Questions and Answers

Which maternal illness during the first 7 weeks of pregnancy carries a 50% risk of defects including PDA and pulmonary branch stenosis?

  • Other viral illnesses
  • Rubella (correct)
  • Toxoplasmosis
  • CMV
  • Which condition has a 10% risk of congenital heart disease, with VSD and cardiomyopathy being the most common defects observed?

  • Infants of diabetic mothers (IDMs) (correct)
  • Toxoplasmosis
  • Cytomegalovirus (CMV) infection
  • Fetal alcohol syndrome
  • Which diagnostic procedure is essential for assessing cardiac defects and is particularly useful in identifying issues like pulmonary stenosis?

  • Pulse assessment
  • Electrocardiogram (ECG)
  • Cardiac catheterization
  • Echocardiography (ECHO) (correct)
  • Which condition is characterized by an overriding aorta and a VSD, often leading to desaturation spells and cyanosis?

    <p>Tetralogy of Fallot (TOF)</p> Signup and view all the answers

    A newborn presenting with pulmonic stenosis is likely to exhibit signs of which of the following upon inspection?

    <p>Abnormal pulsations</p> Signup and view all the answers

    In post-procedural care after a diagnostic procedure, what should be monitored for equality, especially below the catheterization site?

    <p>Pulses</p> Signup and view all the answers

    What is a common symptom due to right ventricular hypertrophy often seen in infants with certain congenital heart defects?

    <p>Tachypnea</p> Signup and view all the answers

    During pre-procedural care for cardiac interventions, what is crucial to prevent infections and ensure proper healing post-procedure?

    <p>&quot;Dressing cleanliness&quot;</p> Signup and view all the answers

    What is a common sign observed on palpation in infants with various congenital heart defects due to abnormal blood flow through cardiac chambers?

    <p>Thrills</p> Signup and view all the answers

    What is the primary anatomical defect described in the text for which surgical correction involves ligation of the patent vessel?

    <p>Localized constriction or narrowing of the aortic wall</p> Signup and view all the answers

    Why does narrowing of the aorta in the described condition put strain on the left ventricle?

    <p>It obstructs the pumping of the left ventricle</p> Signup and view all the answers

    In the mentioned condition, why is the pressure in the upper extremities higher than in lower extremities?

    <p>Narrowing of the aorta</p> Signup and view all the answers

    What is a key difference between congenital and acquired heart disorders?

    <p>Onset time</p> Signup and view all the answers

    Which cardiac disorder involves a hole in the septum that divides the upper chambers of the heart?

    <p>Atrial Septal Defect (ASD)</p> Signup and view all the answers

    Which clinical manifestation is unique to the condition with an overriding aorta, VSD, pulmonary stenosis, and right ventricle hypertrophy?

    <p>Cyanotic spells</p> Signup and view all the answers

    What complication is a child at risk for due to disease processes causing muscle hypertrophy and congestive heart failure?

    <p>Postoperative complications</p> Signup and view all the answers

    In fetal circulation, where does most of the newly oxygenated blood from the placenta enter the fetus?

    <p>Through the inferior vena cava</p> Signup and view all the answers

    What is a common sign seen in infants with congenital heart defects due to abnormal blood flow through cardiac chambers?

    <p>Heart murmurs</p> Signup and view all the answers

    What is a common symptom of heart failure associated with congenital heart diseases?

    <p>Cyanosis</p> Signup and view all the answers

    Which fetal shunt allows blood to bypass the liver in fetal circulation?

    <p>Ductus Venosus</p> Signup and view all the answers

    Which structure connects the pulmonary artery to the descending aorta in fetal circulation?

    <p>Ductus Arteriosus</p> Signup and view all the answers

    What is the approximate percentage of CHD seen in infants with Fetal Alcohol Syndrome?

    <p>50%</p> Signup and view all the answers

    Which viral illness during pregnancy can result in cardiac defects in the newborn, including PDA and pulmonary branch stenosis?

    <p>Rubella</p> Signup and view all the answers

    What is a common sign of digoxin toxicity that can be observed on an electrocardiogram (ECG) in patients receiving this medication?

    <p>Prolonged PR interval</p> Signup and view all the answers

    What is the primary cause of Congenital Heart Disease in infants with an IDM (Infant of Diabetic Mother)?

    <p>Maternal Illness</p> Signup and view all the answers

    Which aspect is NOT part of the post-procedural care after a cardiac diagnostic procedure?

    <p>Encouraging immediate ambulation post-procedure</p> Signup and view all the answers

    What is a common characteristic noted on inspection in infants with Congenital Heart Disease?

    <p>Clubbing of nails</p> Signup and view all the answers

    In infants born to mothers with Rubella infection early in pregnancy, what are common cardiac defects observed in approximately 50% of cases?

    <p>Ventricular Septal Defect (VSD)</p> Signup and view all the answers

    In the management of digoxin toxicity at home, what is the recommended action if a child vomits after taking a dose of digoxin?

    <p>Wait for the next scheduled dose</p> Signup and view all the answers

    What is the significance of monitoring potassium levels in patients receiving digoxin, especially if they are taking Lasix concurrently?

    <p>To avoid worsening digoxin toxicity</p> Signup and view all the answers

    Which nursing diagnosis is associated with heart failure and indicates the patient's inability to perform physical activities due to the disease process?

    <p>Activity intolerance</p> Signup and view all the answers

    What is a crucial aspect of managing heart failure in children that involves educating the family about the child's condition?

    <p>Helping the family adjust to the disorder</p> Signup and view all the answers

    What is the primary cause of Acute Rheumatic Fever (ARF) in young people, typically affecting late school-age children and adolescents?

    <p>An abnormal immune response to streptococcal infection</p> Signup and view all the answers

    What is the primary objective of the study conducted by Green et al., 2020?

    <p>To assess the impact of pre- and post-operative biomarker levels on pediatric congenital heart surgery outcomes.</p> Signup and view all the answers

    Which of the following is NOT mentioned as part of the management plan for acute rheumatic fever?

    <p>Surgical intervention.</p> Signup and view all the answers

    Which joints are typically affected in acute rheumatic fever?

    <p>Large joints like knees, hips, and elbows.</p> Signup and view all the answers

    What skin manifestation is commonly observed in patients with acute rheumatic fever?

    <p>Non-pruritic erythematous macules on the trunk and extremities.</p> Signup and view all the answers

    Why is treating acute rheumatic fever with antibiotics important?

    <p>To eradicate the underlying Streptococcal infection and prevent further heart damage.</p> Signup and view all the answers

    What is the recommended prophylactic therapy after treating acute rheumatic fever?

    <p>Daily oral penicillin.</p> Signup and view all the answers

    Study Notes

    Tetralogy of Fallot

    • Growth delay/retardation is a common clinical manifestation
    • Recurrent upper respiratory infections occur due to the condition
    • Tet spells are a characteristic of Tetralogy of Fallot
    • Squatting positions can help increase pulmonary artery blood flow

    Management of Tetralogy of Fallot

    • Palliative shunt is performed to increase pulmonary artery blood flow
    • Total repair is usually done after the completion of one year

    Pathophysiology

    • The pulmonary artery leaves the left ventricle
    • The aorta leaves the right ventricle with no communication between the systemic and pulmonary circulation

    Clinical Manifestations

    • Poor feeding and fatigue are common
    • Sweating, even when at rest, worsens when feeding
    • Generalized edema, respiratory distress, and crackles or wheezing on lung auscultation are characteristic
    • Jugular vein distention (JVD) and poor peripheral pulse may be present

    Management of Heart Failure

    • Physical assessment includes respiratory and cardiac evaluation
    • Improve cardiac function with medications such as Digoxin, ACE, and B-blockers
    • Remove fluid excess with diuretics like Furosemide
    • Oxygen supplement reduces respiratory effort
    • Monitor potassium levels as it affects Digoxin
    • Monitor intake and output strictly and weigh daily
    • Implement fluid and salt restrictions, depending on appetite
    • Activity as tolerated reduces oxygen consumption
    • Semi-fowler's position reduces respiratory effort

    Cyanotic Heart Defects Classification

    • Based on hemodynamic characteristics, there are four types:
      • Increased pulmonary blood flow (signs of HF)
      • Decreased pulmonary blood flow (e.g., Tetralogy of Fallot)
      • Obstruction of blood flow (e.g., Coarctation of Aorta, Aortic stenosis, Pulmonic stenosis)
      • Mixed blood flow (e.g., Transposition of Great Arteries)

    Atrial Septal Defect (ASD)

    • Pathophysiology: abnormal connection between two sides of the heart
    • Increased volume on the right side of the heart
    • Increased pulmonary blood flow
    • Decreased systemic blood flow
    • Clinical manifestations: asymptomatic, characteristic murmurs, atrial arrhythmias, signs of congestive heart failure, and pulmonary emboli
    • Management: surgical patch closure repair usually done before school age
    • Prognosis: good with very low operative mortality (<1%)

    Ventricular Septal Defect (VSD)

    • Anatomy: abnormal opening between the right and left ventricles
    • Either membranous (80%) or muscular
    • Size varies from a small pinhole to absence of the septum
    • 20%-60% of cases may close spontaneously
    • Pathophysiology: left-to-right shunt occurs due to high pressure in the left ventricle and low pressure in the right ventricle

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    Description

    Learn about the management and pathophysiology of Tetralogy of Fallot, a congenital heart defect characterized by four anatomical abnormalities. Topics covered include growth delay, recurrent upper respiratory infections, Tet spells, squatting positions, palliative shunt, and total repair.

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