CASE

Loise Acosta
6 Joannie
Aguirre
Christine Ala
Pamela Alcoy
Reginald
Alfaro

What are the two types of CHD? Name

the conditions under both groups. Which
do you think does CN have?

THE HEART

PRENATAL CIRCULATION

POSTNATAL
CIRCULATION

 CC:

DOB (1 day PTA)

Irritable, refused to play
Loss of weight (current:10kg)
3 months old: respiratory infection
hole in the heart
Physical Exam:
RR: 35-50 mins, productive cough, T:
39C
Neck vein engorged, abdomen slightly
enlarged, liver is big, clubbed fingers
Diagnostic test: couer-on-sabot

TETRALOGY OF FALLOT
Tetralogy of Fallot(TOF) is a cardiac

anomaly that refers to a combination of four

related heart defects that commonly occur
together. The four defects are:
1.Ventricular septal defect (VSD)
2. Overriding aorta the aortic valve is
enlarged and appears to arise from both the left
and right ventricles instead of the left ventricle
asin normal hearts
3. Pulmonary stenosis narrowing of the
pulmonary valve and outflow tract or area below
the valve that creates an obstruction (blockage) of
blood flow from the right ventricle to the
pulmonary artery
4. Right ventricular hypertrophy thickening

What are the diagnostic tests

that may be ordered for CN to
find out specifically what he has?

Chest XRay
Coeur-ensabot(boot
-shaped
heart)

Preparation
A chest X-ray doesn't require special
preparation.
The child may be asked to remove all
clothing and jewelry from the waist
up and change into a hospital gown
because buttons, zippers, clasps, or
jewelry might interfere with the
image.
Developing babies are more sensitive
to radiation and are at more risk for
harm

Procedure
Parents are usually able to accompany their
child to provide reassurance and support.
infants may require gentle restraint. Keeping
the chest still is important to prevent blurring
of the X-ray image. Two X-rays are usually
taken, one from the back and one from the
side.
A chest X-ray may be performed in a standing,
sitting, or lying position.

Complete Blood
Common blood
test that evaluates the
Count

three major types of cells in the blood:

red blood cells, white blood cells, and
platelets.
Results:
RBC = 10 MILLION/l (Normal:
3,700,000 5,300,000)
Hemoglobin = 18 g/dl (Normal 10.5
13.5 g/dl)
Hematocrit = 70% (Normal: 33-49%)
Platelet = 280,000/l (Normal: 150,000
450,000)
WBC = 12,000/l (Normal: 6000
17000)

RBC = 10 MILLION/l (Normal:

3,700,000 5,300,000)
A high red blood cell count is an increase
in
oxygen-carrying
cells
in
the
bloodstream. Red blood cells transport
oxygen from lungs to tissues throughout
our body. A high red blood cell count can
result from a condition that limits your
oxygen supply or a condition that directly
increases red blood cell production.
A high RBC count could be due to a
number of health conditions or healthrelated factors including:
CONGENITAL HEART DISEASE
Dehydration

for
example,
from
severediarrhea
low blood oxygen levels (hypoxia)

Hemoglobin = 18g/dl (10.5

13.5 g/dl)
A high hemoglobin count indicates an abovenormal level of hemoglobin in the blood.
Hemoglobin (often abbreviated as Hb or Hgb)
is the oxygen-carrying component of red
blood cells.
A high hemoglobin count is somewhat
different from a high red blood cell count,
because each cell may not have the same
amount of hemoglobin proteins. Therefore,
you could have a high hemoglobin count
even if your red blood cell count falls within
the normal range.
Causes:
Red blood cell production increases to

Hematocrit = 70%
(Normal: 33-49%)
Hematocrit is a blood test that measures
how much of a person's blood is made
up of red blood cells. This measurement
depends onthe number of and size of
the red blood cells.
The hematocrit blood test determines
the percentage of red blood cells (RBC's)
in the blood
Causes of a high hematocrit include:
Dehydration(heat exhaustion, no
available source of fluids)
Low availability of oxygen (smoking,
high altitude, pulmonary fibrosis)
GENETIC (CONGENITAL HEART
DISEASES)

Echocardiography

Echocardiography
Echo, Cardiac Ultrasound, Doppler ultrasound of
the heart, Cardiac Ultrasonography, 2D echo test
and 3d echo test.
used to give an image of the heart using sound
waves.
used in conjunction with a stress test to show the
heart as it beats while the patient is exercising.
Echocardiography is a very precise method to detect

2D echo ejection fraction 30% (50 to 75

percent)

However, some patients have a very low EF

(less or equal to 30) and yet have minimal or
even no symptoms. Other signs of heart failure
may also accompany a low EF. These include:
An abnormal heart murmur (due to a heart
valve disorder)
A crackling sound of fluid in the lungs due to
pulmonary congestion
A rapid heartbeat or other abnormal heart
rhythms
Hypertrophy or enlargement of the
heart
Liver or kidney malfunction
Congestion of the lungs
Swollen neck

Preparation:
Clothing should be removed from the waist up.
The patient is on a supine position for some infants
may be able to lie in their parents lap.
Electrodes will then be placed on the patients
body. A gel is applied to the chest followed by a
transducer i.e. a machine that sends and receives
sound which is placed on the body over the heart
and measures distance to produce the visual
representation of the heart on a monitor.
Most children do not need to do anything special to
get ready for an echocardiogram. However, if the
child is under three years old, he may need a
sedative. An echocardiogram works best when the
child does not move.
If the child is not sedated give them their favorite
toy, a security blanket, or a favorite videotape.

Pulse oximeter reading = 75% (Normal:

95 oximetry
100%) in clinical
Pulse
practice has allowed for
simple, noninvasive, and
reasonably
accurate
estimation
of
arterial
oxygen saturation.
How it measures oxygen
saturation:
The
calculation
of
the
percentage of arterial
oxyhemoglobin is based
on
the
distinct
characteristics of light
absorption in the red and
infrared
spectra
by
oxygenated
versus

Electrocardiography
Measures the electrical activity of the heart and
records it on graph paper in the ECG. This allows the
evaluation of the sequence and magnitude of the
electrical impulses generated by the heart.
The standard pediatric ECG is measured using 15
leads, with leads added on the right side of the chest
and on the left lateral chest area.

Cardiac Catheterization
Most invasive diagnostic procedure, in which
radiopaque catheter is inserted through a
peripheral blood vessel into the heart. It is
usually combined with angiography, in which a
radiopaque contrast material
is injected
through the catheter and into the circulation.
Cardiac catheterization provides information
regarding the following:
Oxygen saturation
of blood within the
chambers and great vessels
Pressure change
Cardiac output or stroke volume
Anatomic abnormalities

What possible
complication/s is/are
pointed out by the
symptoms he is
presenting in the third
paragraph?

What are the actions of the 3 drugs being

given to him and why is he given those?
What are your nursing responsibilities in
giving these drugs?

Assuming that C.N. will undergo

surgery, what are the two kinds of
surgery done to patients with CHD
and what is the difference between
the two?

Two types
1. Palliative Surgery
2. Corrective Surgery

Two types
1.
2.

Palliative Surgery
Corrective Surgery

> Most babies who have

tetralogy of Fallot have their
defects fully repaired in infancy.
> Some babies are too weak or
too small to have the full repair
or until the child is older and/or
the defect itself can be repaired.
> They must have temporary
surgery first.

Palliative Surgery
- for infant who cannot undergo
primary repair to blood flow & O2
saturation.
1. Blalock Taussig Shunt
- Provides blood flow from Subclavian
artery to pulmonary artery
2. Modified Blalock-Taussig Shunt
operation
Provides blood flow to pulmonary
arteries from left or right subclavian
artery via tube graft.

Facts:

Complications

Decreased muscle blood flow

Impaired arm development
with decreased muscle mass

Modified BlalockTaussig Shunt

It

is also called the blue baby

operation.
Improves blood flow to the lungs.
It also gives the baby time to
grow and get strong enough
for the full repair.
This is a closed-heart procedure.

Modified Blalock-Tausig
Shunt
The

shunt is inserted between the subclavian

artery and the pulmonary artery
Shunt = small tube, synthetic material
called GORE-TEX, about 3-3.5cm in
diameter.
mimics the role of the ductus arteriosus. Itis
often put in place after the ductus closes
naturally.
Used for four to five months
The child will need to take an anticoagulant such
as aspirin to prevent clots blocking the shunt.

Risks of the BT shunt

shunt

blockage
tube infection
excessive blood flow to the lungs
risking vessel damage
decreased flow of blood to the brain
and body

 This

procedure was developed in

the 1940's and is a palliative
(temporary) treatment used to
improve the blood flow to the
lungs in conditions such as
Pulmonary Atresia, severe
Pulmonary Stenosis, Tricuspid
Atresia, and severe Fallot's
Tetralogy, until such time as the

Tetralogy of Fallot
Staged

operation may be done

- Begins with BT shunt, then
complete repair at about six months
- Removal of pulmonary obstruction
- Closing the ventricular septal
defect with a patch
- Enlarging of artery if needed.

Complete Repair/Corrective
Surgery
performed

in 1st year of life or earlier if the child

has recurrent hypoxic episodes or progressive
cyanosis

Closure

of VSD and resection of infundibular

stenosis
Replacement of pericardial patch
*If pulmonary stenosis is severe, and supplemental
blood flow through the ductus arteriosus is required
to support oxygenation during the neonatal period.

Living With Tetralogy of

Fallot
Caring for Your Child at Home
A. Feeding and Nutrition
- Small, frequent meals
- may need extra nutrition.
- A supplement or an extra feeding
can give the baby more calories,
vitamins, or iron.

Tet Spells
occur

in babies whose tetralogy of Fallot hasn't yet

been repaired.
Lowering the baby's anxiety or stress and save the
baby's energy
slowly picking up the baby and speaking in a soothing
voice can avoid startling him or her, which may prevent
or reduce crying.
How to manage:
Bring the child's knees up tight against his or her chest
(this is called the knee-chest position) or have the child
squat down. This will increase blood flow to the lungs.
Try to calm the child.

Activity Restrictions
the

child needs to restrict activity or

exercise
the child can play in organized
sports, especially contact sports
need a note for your child's school or
coaches about limiting your child's
exercise

Ongoing Medical Care

Important
Seeing

a pediatric cardiologist for heart checkups as

directed
Seeing a pediatrician or family health care provider
for routine exams
Making sure the child takes medicines as prescribed
Children who have severe heart defects, like
tetralogy of Fallot, may be at slightly increased risk
forinfective endocarditis(IE).
the child's doctor or dentist may give the relatives of
the child antibiotics before medical or dental
procedures (such as surgery or dental cleanings) that
could allow bacteria into the bloodstream.

How to manage IE
gently

brush the young child's teeth

every day as soon as they begin to
come in.
As the child gets older, make sure
that she/he brushes every day and
sees a dentist regularly.
Talk with your child's doctor and
dentist about how to keep your
child's mouth and teeth healthy.

THANK YOU