MANISHA COLLEGE OF NURSING

CASE PRSENTATION

ON

TETRALOGY OF FALLOT

Submitted to Submitted by

Submission on

General objectives:

At the end of class students will able to understand and gain knowledge

regarding Tetralogy of Fallot and implementing the patient in clinical area.

Specific objectives:

Students will able to

to introduce the Tetralogy of Fallot

to define the definition of Tetralogy of Fallot

to enumerate the etiological and risk factors, classification/ types of

Tetralogy of Fallot

to explain the pathophysiology of Tetralogy of Fallot

to know the diagnostic evaluation of Tetralogy of Fallot

to list out the clinical manifestation of Tetralogy of Fallot

to describe the medical management of Tetralogy of Fallot

to discuss the nursing management of Tetralogy of Fallot

INTRODUCTION

I am Nimisha Rajan, studying 2nd year M.Sc (N) in Manisha College of

Nursing Dept of child health Nursing. I am going to speciality practical’s in

R.K.childrens Hospital, there I am posted in CICU there I find one case i.e;

Tetralogy of Fallot. So as felt to this s my case presentation

Mr M.Harish, 5 years, male from Gajuwaka admitted in R.K.childrens

Hospital in CICU on 29-3-13 at 4:30pm under the consultant of Dr. Naveen

with the complains of poor maternal nutrition, viral illness.

IDENTIFICATION

Student Profile Patient Profile

Name Of The Student: Mrs. Nimisha Rajan

2nd year M.Sc(N)

Subject: child health Nursing

Topic: tetralogy of fallot

Submitted to: Mrs. TulasiMadam

M.Sc(N); Lecturer

Dept.of Medical Surgical Nrsing

Submitted on:

Venue:

Time duration:

No.of.persons attended

date of care started

total days of nursing care

Name of the patient: Mr. M.Harish

Age:1 years

Sex: male

Address: 6-57-6/1; road no:9

sramikanagar, gajuwaka

E.P NO: 11794104

Bed no:1

Ward:ICU

Education: nil

Occupation: nil

Marital status:single

Date of admission:

29/03/13 at 4:30pm

Name of the doctor: Dr. Naveen

Diagnosis: tetralogy of fallot

HISTORY COLLECTION

Chief complains:

My patient Mr. M.Harish,1years, male admitted in R,K Hospital complains poor maternal nutrition, viral illness..

Present medical history:

he admitted in CICU due to poor maternal nutrition, viral illness with complain of tetralogy of fallot as diagnosed by physician

Past medical history:

he was admitted in hospital due to poor maternal nutrition, viral illness

Present surgical history:

Not significant of surgical history

Family history:

Family profile:

Slink name of the family members

age sex relation ship

occupation remark

1

2

3

M.samba murthy

M.rathnam

M.pushpa

29y

26y

3y

M

F

F

Father

Mother

sister

employ

house wife

-

-

-

--

Nutritional history:

Sl.no Time Diet Amount Caloric Protein Carbohydrate

Fat

1.

2.

3.

4.

5.

8am

9am

12:30pm

4:00pm

8:30pm

milk

idly -2

with chutney

rice with curry

tea

rice with curry

150ml

2nos

200 grms

150ml

150 grms

110k.cal

372k.cal

690k.cal

15.0k.cal

372k.cal

3.0

6.9

6.9

3.0

20.8

4.0

58.9

74.5

4.0

58.9

3.8

0.2

5.2

3.8

0.2

Personal history:

Diet: patient diet includes vegetarian a. he takes food in per day 3 times.

Rest & sleep: disturbed sleep pattern

Elimination: abnormal bowel & bladder (bowel – constipation & urination is frequently & small amount of urine is passing)

Socio economic history:

Environmental history:-

Housing: building and own house

Ventilation: adequate ventilation

Electricity: present

Water supply: municipality tap

Physical examination:

vitals signs patient value normal value remarks

Temperature

Pulse

Respiration

Blood pressure

Spo2

98.60F

92b/min

22b/min

120/60mmhg

93%

98.60F

72b/min

16-18b/min

120/80mmhg

100%

normal

abnormal

abnormal

abnormal

normal

Genarl appearance:

Consciousness: conscious

Orientation: oriented time, place, and date

Nourishment: moderate nourished

Health: un healthy

Body build: moderate

Activity: dull

Look: anxious

Hygiene: moderately hygiene

Speech: clear

REVIEW OF SYSTEMS

Skin /integumentary system:

Colour: black

Texture: wrinkles skin/dry skin

Skin turgor: present

Hydration: well hydrated

Discolouration: no discolouration of skin

Subjective symptoms: dry skin is present

Nails:

Nail beds: pale in colour

Nail plates: flat, absnce of clubbing

Cyanosis: no central and peripheral cyanosis

Colour: black

Texture: dry

Eyes:

eye brows: symmetric

Eyelashes: equally distributed

Papillary reflex: abnormal

Conjunctiva: abnormal

Vision: abnormal vision (blurred vision)

Ears:

Pinna: normally placed

Cerumen: no defect

Otarrhea: no discharges from ear

Hearing: no defect in hearing process

Nose:

Nasal septum: no deviation of nasal septum

Nasal pathway: clear nasal pathway

Smell: no defect

Mouth & pharynx:

Lips: absence of cracks and pale in colour

Tongue: coated tongue

Bleeding : no history of bleeding

Tooth decay: history of tooth decay

Dental care: no history of dental caries

Neck:

ROM: not possible

Lymph nodes: not palpable

Trachea: present in midline

Thyroid gland: not enlarged

Jugular vein: not distended.

SYSTEMIC EXAMINATION

Heart:

Cardiovascular system:

H/O hypertension: hypertensive

Varicose veins: no H/o varicose veins

Dysponea: present

Orthopnea: not evident

Chest pain: evident

Palpitation: present

Heart sounds: present S1 S2 sounds

Pluse:92b/min

Heart beat: abnormal rate and rhythm

Inspection: on inspection the thoracic cavity is normal and clear, no lesions detected, sutured mark presented

Palpation: no palpable masses detected

Percussion: no percussion performed

Auscultation: on auscultation at 5 areas , pulmonic, aortic, erbs point, mitral, apical area. S1 S2 sounds are clear and gallop sounds present

INVESTIGATIONS

Slink Name of the investigation

Pt value Normal value Remarks

1.

2.

3.

4.

5.

6.

7.

Hb%

TWBC

DC P

L

E

platelet count

bil.urea

sr. creatine

ECG

11.1gms

8300cells/cumm

86%

11%

0.3%

1.7 laks/cumm

47mg/dl

1.0

Extreme tachycardia

lt.ant. hemi block

invented T wave

ST-T abnormality

excessive

12-14gms

1,500000cells/cumm

4,5000c/cumm

10-40mg/dl

0.5-1.4mg/dl

normal

abnormal

abnormal

abnormal

abnormal

normal

abnormal

8. x-ray

overload of lt. atrium, lt. ventricular hypertrophy

abnormal

abnormal

abnormal

MEDICATIONS

Slink Medications Dose Route Time Nursing responsibility

1.

2.

3.

4.

5.

6.

7.

Inj. Dytor20

Inj. Taxim

Inj. PNZ

T. Ivas

T.Mtoprolol

oxygen inhalation

floret}

nitrofix} nebulisation

duolin}

1gm

1gm

40mg

10mg

25mg

IV

IV

IV

oral

oral

BD

8th

hrly

OD

BD

OD

assess the patient general condition of client

observe the client for side effects

immediate nursing intervention are to be done

administration of alternatives agonist to prevent the sid effects

administer continuous oxygen inhalation

Tetralogy of fallot

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.

Normal heart Tetralogy of Fallot

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 AND PHYSIOLOGY:

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.

The heart composed of 3 layers

The inner layer or endocardium consists of endothelial tissue and lines the

inside of the heart valves.

The middle layer or myocardium is made up of muscles fibbers and is

responsible for the pumping action.

The exterior layer of the heart is called the epicardium.

The heart is encased in a thin fibrous sac called the pericardium, which is

composed of to layers.

Adhering to the epicardium is the visceral pericardium

Enveloping the visceral pericardium is the parietal pericardium, tough

fibrous tissues that attaches to the great vessels, diaphragm, sternum and

vertebral column and supports the heart in the mediastinum.

The space between 2 layers (pericardial space) is normally filled with about

20ml of fluid which lubricates the surface of the heart and reduce friction

during systole.

FUNCTIONS OF THE HEART:

Electophysiogic properties:

The cardiac electrophysiologic properties of cardiac muscle regulates the

heart rate and rhythm.

The properties of cardiac include:

Exacitability

Automaticity

Contractility

Refractoriness

Conductivity

Exacitability: the ability of cardiac muscle cells to depolarize in response to

stimuli/responses to electrical impulses

Automaticity: ability to initiate an electrical impulse. Ability of cardiac

pacemaker cells to initiate an impulse spontaneously and repetitively with out

external neuro hormonal control.

Contractility: the heart muscle is composed of long narrow cells or fibers. The

action of potential initiates the muscles contraction by releasing calicium

through the tubules of the cell membrane.

Refractoriness: refractoriness is the heart inability to response to a new

stimulus while still in a state of depolarization from an earlier stimulus.

Conductivity: ability to transmit an electrical impulses from one cell to

another.

DEFINITION:

Heart failure is a significant cardiac functional disorder that can results in

reduced oxygen delivery to the body’s organs tissues.

The in ability of heart to supply blood circulation for the body needs.

Heart failure is an abnormal clinical condition involving impaired cardiac

pumping. It results in the characteristics pathophysiologic changes of vaso-

constriction and fluid retension. Heart failure formerly called as congestive

heart failure. Heart failure I not a disease.

INCIDENCE:

Heart failure is association with high rest of morbidity, mortality and

economic costs. In hospital mortality for these patients is 4% with a men length

of hospital stay of 6.5 days. Hospital re-admission for 20 to 30 days 50%at 6 to

12 months mortality rate increases.

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

It is mainly affected in aging people age below 75 years of age. In India

mainly affected 33% of people in the year diagnosed as chronic heart failure.

ETIOLOGY AND RISK FACTORS:

The performance of heart depends on 4 essential components:

1) Contractility of the muscle

2) Preload (amount of blood in the ventricles at the end of diastole)

3) After load (the pressure against which the left ventricles ejects)

4) Heart rate

The causes of heart failure can be divided into 3 subgroups

Abnormal loading conditions

Abnormal muscle function

Conditions or disease that limit ventricular filling

Abnormal loading condition:

conditions that increases preload conditions that increases after load

Regurgitation of mitral or tricuspid

valve

Hyper volemia

Congenital defect (left-right shunts)

Ventricular septal defect

Atrial septal defect

Patent ductus arteriosus

Hypertension

Pulmonary or systemic aortic or

plumonic stenosis

High peripheral vascular resistance

Abnormal muscle function:

Myocardial infraction

Myocarditis

Cardiomyopathy

Ventricular aneurysm

Long term alcohol consumption

Coronary heart disease

Metabolic heart disease

Endocrine heart rate

Limited ventricular filling:

Mitral or tricuspid stenosis

Cardiac tamponade

Constrictive pericarditis

Hypertrophic obstructive cardiomyopathy

Causes of heart failure:

chronic heart failure acute heart failure

Coronary heart disease

Hypertension

Rheumatic heart disease

Congenital heart disease

Corpulmonale

Cardiomyopathy

Anemia

Bacterial endocarditis

Val uvular disorder

Acute myocardial infraction

Dysrhythmias

Pulmonary mboli

Thyrotoxicosis

Hypertensive crises

Rupture of papillary muscle

Ventricle septal defect

Myocarditis.

RISK FACTORS:

Primary risk factor CAD and advancing age Hypertension Diabetes mellitus Cigarette smoking Obesity High serum cholesterol level.

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

CLINICAL MANIFESTATION:

The manifestations of heart failure depends on the specific ventricular involved the precipitating cause of failure, the degree of impaired, the rate of progression the duration of the failure and the clients underlying conditions.

The signs and symptoms of heart failure can be related to which ventricles are affected. Left sided heart failure causes different manifestations then right sided heart failure. In chronic heart failure. Patient may have right and left ventricular failure.

left side heart failure:

Pulmonary congestion includes:-dysnea, cough, pulmonary crackleslow oxygen saturation levelsheart sounds s3 or ventricular gallop detected on auscultation, orthopnea, paraxymal nocturnal dysnea, adventitious breath sounds heard in various areas of lungs, oliguria, insomnia, tachycardia, palpitations

CLINICAL MANIFESTATION:

breathlessness cough fever oedema in lower extremities tachycardia increased pulse and respiration

rate oliguria insomnia

right side heart failure:

Congestion in peripheral tissues and the viscra predominates

Increased jugular venous distension Systemic clinical manifestation: oedema of lower extremities hepatomegaly as cites anorexia and nausea, weakness and

weight gain due to retention of fluidAssessing for heart failure:

general:

fatigue decreased activity tolerance dependent edema weight gain

cardiovascular:

third heart sound s3

apical impulses enlarged with leftlateral displacement

pallor and cyanosis jugular venous distension(JVD)

respiratory:

dysnea on exertion pulmonary crackles that don’t

clear with cough orthopnea paroxysmal nocturnal dysnea

(PND)cerbro vascular:

un explained confusion or altered mental status

light headednessrenal:

oliguia and decreased frequency during the day

nocturia

Assessing for heart failure:

general:

fatigue decreased activity tolerance dependent edema

cardiovascular:

apical impulses enlarged with left lateral displacement

jugular venous distension(JVD)

respiratory:

dysnea on exertion pulmonary crackles that don’t

clear with cough paroxysmal nocturnal dysnea

(PND)

cerbro vascular:

un explained confusion or altered mental status

light headednessrenal:

oliguia and decreased frequency

gastro intestinal:

anorexia and nausea enlarged liver ascites hepato jugular reflux

DIAGNOSTIC EVALUATIONS

history collection and physical examination

assessment of ventricular function serum chemistries, cardiac

enzymes, BNP levels, liver function tests, serum electrolytes, BUN,CBC.

Chest x-ray 12 lead ECG Echocardiography Exercise stress testing Nuclear imagaing studies Hemodynamic monitoring Cardiac catherization Routine uninalysisMEDICAL MANAGEMENT

The goal of management of heart failure to relieve patient symptoms, to improve functional status and quality of life and to extend survival.

medical management based on type , severity and cause of heart failure

specific objectives of medical management includes the following

eliminates or reduce any etiologic contributory factors such as controlled hyprtension or aterial fibrillation with a rapid ventricular

during the day

gastro intestinal:

no significance

DIAGNOSTIC EVALUATIONS

history collection and physical examination

Hemoglobin Total White Blood Count Direct count –P;L;E Platelet count Bilirubin urea Serum creatinine ECG Chest x- ray Routine urinalysis

MEDICAL MANAGEMENT

Inj. Dytor 20- 1gm, IV,BD Inj. Taxim 1grm, IV 8th hrly Inj. PNZ 40mg, IV, OD T. IVAS10mg oral, BD T. Metoprolo 25mg, oral, OD Continuous O2 inhalation Floret Nitrofix nebulisation duolin

response optimize pharmacologic and other

therapeutic regimens reduce the work load on the heart

by reducing preload and after load promote a life style conducive to

cardiac health prevent episodes of acute

decompensate heart failure managing the patient with heart

failure includes providing comprehensive education and counselling to the patient and family

it is important that patient and family understand the nature of heart failure and the importance of their participation in the treatment regimen

life style recommendations include restriction of dietary sodium, avoidance of excessive fluid intake, alcohol and smoking weight reduction when indicates and regular exercises

pharmacologic therapy

angiotensin I- converting enzyme inhibitors

angiotensin II receptor blockers hydralazine and isosorbid dinitrate betablockers and calcium channel

blockers diuretics digitalis intravenous infusion

- nesiritide- milrinome- dobutamine

medications for diastolic dysfunction

other medications for heart failure:

anticoagulants non steroidal inflammatory drugs

Nutritional therapy:

a low sodium (2-3g/day) diet and avoidance of drinking excessive amount of fluid are usually recommended

dietary restriction of sodium reduces fluid retention and the symptoms of peripheral and pulmonary congestion

diet needs to be made with consideration of good nutirion as well s the patients likes and dislikes and cultural food patterns

Additional therapy:

supplemented oxygen other interventions coronary artery revascularization

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 nasal

cannula rest activity period drug therapy daily weights

Nutritional therapy:

Provided a low sodium (2-3g/day) diet and avoidance of drinking excessive amount of fluid are usually recommended

dietary restriction of sodium reduces fluid retention and the symptoms of peripheral and pulmonary congestion

diet needs to be made with consideration of good nutirion as well s the patients likes and dislikes and cultural food patterns

Additional therapy:

supplemented oxygen

sodium restricted diet circulatory assisted devices cardiac resynchronization therapy

with internal cardio ventricular defibrillator

cardiac transplantation

Complication:

based on assessment data, potential complication that may develop including the following :

hypotension, poor perfusion and cardiogenic shock

dysrhythmias thrombo embolism pericardial effusion and cardiac

tamponade.

NURSING MANAGEMENT:

Assessment:

Subjective data:

importance health informationPast health history: CAD,HTN, cardiomyopathy, congenital heart disease or valvular, DM, thyroid or lung disease rapid or irregular heart rate.

medications: use of an compliance with any cardiac medications, use of diuretics, estrogens, corticosteroids, non steroidal inflammatory drugs, over the counter drug, herbal supplements.

Functional health pattern:

COLLABORATIVE THERAPY:

treatment for underlying cause o2 therapy at 2-6l/min by nasal

cannula rest activity period drug therapy daily weights

sodium restricted diet

Complication:

not significant

NURSING MANAGEMENT:

Assessment:

Subjective data:

importance health information

Health perception –health management:- fatigue, anxiety, depression.

Nutritional metabolic- usual sodium intake, nausea, vomiting, anorexia, stomach bloating, weight gain, ankle swelling

Elimination: nocturia, decreased day time urinary output, constipation

Activity exercises: dysnea, orthopne, cough, palpitations, dizziness, fainting

Sleep and rest: number of pillows used for sleeping, paroxysmal nocturnal, dysnea, insomnia.

Cognitive perceptual: chest pain or heaviness, abdominal discomfort; behavioural changes; visual changes.

objective data:

Integumentary: cool, diaphoretic skin, cyanosis or pallor, peripheral oedema.

Respiration: tachypnea, crackles, rhonchi, wheezes, frothy, blood tinged sputum.

Cardiovascular: tachycardia, s3

&s4 murmurs, pulses alterations, PMI displaced inferiorly and posterior jugular vein distension

Gastro intestinal: abdominal distension, hepatosplenomegaly, ascites.

Neurologic: restlessness, confusion, decreased alteration or memory.

Past health history: CAD,HTN, rapid or irregular heart rate.

medications: use of an compliance with any cardiac medications, use of diuretics, corticosteroids, non steroidal inflammatory drugs, over the counter drug

Functional health pattern: Health perception –health

management:- fatigue, anxiety, depression.

Nutritional metabolic- usual sodium intake, ankle swelling

Elimination: decreased day time urinary output, constipation

Activity exercises: dysnea, cough, palpitations, dizziness, fainting

Sleep and rest: dysnea, insomnia. Cognitive perceptual: chest pain

or heaviness, abdominal discomfort; behavioural changes;visual changes.

objective data:

Integumentary: cool, peripheral

oedema. Respiration: tachypnea, wheezes,

tinged sputum. Cardiovascular: tachycardia, s3

&s4 murmurs, pulses alterations, increased jugular vein pressure

Gastro intestinal: abdominal distension

Neurologic: restlessness, confusion, decreased alteration or memory.

NURSING DIAGNOSIS:

1. Risk for Decreased cardiac output related to structural abnormalities of

the heart.

2. Activity Intolerance related to imbalance in the fulfillment of oxygen to

the body's needs.

3. Impaired growth and development related to inadequate oxygenation,

tissue nutrisis needs, social isolation.

4. Risk for infection related to the general conditions is inadequate.

Theory application Roy’s adaptation model

Introduction:

Sister callista Roy began her nursing career in 1963. After receiving B.Sc(N)

noting from moult saint marry college.

1960receives Ms in nursing

1977 her doctorate in sociology

Roy’s model is characterised as a system theory with a strong analogies of

intervention.

General system:

Due to set of organized components released to form a whole employee

feedback cycle of input, through put, output.

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 person’s 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 person’s 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 person’s effort to creativity use his or her coping

mechanism.

INPUT THROUGH PUT OUT PUT

Feed back

NURSES NOTES

Name of the patient: M. Harish Ward: CICU

Age: 1years Diagnosis: tetralogy of fallot

Sex: Female Dr. Name: Dr. Naveen

E.p no: 794143 Bed. no: 1

Time Diet Medication Nurses Care Plan

730

830

800

Idly with

chutney

water 50ml

coconut

water

1/4/1

3

Inj. Dytor 20 1gm IV BD

Inj. Taxim 1gm IV 8th hrly

Inj. PNZ 40mg IV OD

observation:

Patient is very thin & less activity

and weakness; cough; fever;

breathlessness.

Monitored vital signs

Temp:98.60 F

Demoraghpical variables of the patient

name age, sex, education, occupation income

- Early detection and screening programs

-monitor the vital signs

-Administer continuous oxygen & medication

- health education about disease condition

-The client will have knowledge regarding disease process

Adequate knowledge in disease process

Rehabilitation & follow up

1030

100ml

rice porage

1 cup

T.Ivas 10mg oral BD

T. Metoprolo 25mg Oral

OD

floret}

nitrofix} nebulisation

duolin}

o2 inhalation

Pluse:92b/min

Resp:22b/min

Blood pressure:120/60mmhg

SpO2: 93%

Provide position changing

frequently

Provide complete bed rest

Provide calm environment

Administer medication as per

physician prescribed

Administered O2

Provide nebulisation

History collection and performed

physical examination

Provide psychological support

Provided health education about

Diet

Exercises

Personal hygiene

Relaxation therapy.

lakshmi/St.N

HEALTH EDUCATION

Bibliography:

Brunner &Suddarth’s “text book of Medical Surgical Nursing”, 12 th edition;

volume:1; page no:825-838 & 685-690

Lewis “text book of Medical Surgical Nursing”, Elsevier publication; page

no:820-837

Joyce. M. Black “text book of Medical Surgical Nursing”, 7th edition;

volume:2; page no:1649-1669 & 1548-559

Ross & Willison “anatomy & physiology” 2nd edition,2001; pageno:678-682.

Mosby doug consult for nurses, 2006, mosby publication