Tetralogy? Shouldn't it be quadrology?
Well no, quadrology isn't a word. But isn't quad four? Yes but tetra according to Merriam-Webster is "2 of 2 combining form : having four parts". Now that we have that sorted out, what about Fallot? The French keep dropping letters from their words but I prefer to pronounce them in a bad southern accent while keeping the T in there. Regardless, ever noticed how many conditions were named after French doctors and scientists? Heck, we named out fried potato sticks after them. What was this post about?
Yes. Tetralogy of Fallot which I will call ToF, a congenital heart defect that includes a foursome of cardiac defects; pulmonary stenosis (narrowing), ventricular septal defect (a hole in the wall), right ventricular hypertrophy (getting swole but not at the gym), and overriding aorta (its too darn big). The etiology is unknown with a certain portion being attributed to untreated maternal diabetes, ketonic acid, PKU, trisomy 21 and other genetic mutations, and everyone's two favorites drinking and smoking while pregnant. Side note, smoking causes everything so just stop ok? The human heart begins development at or about the 20th day of gestation so getting something wrong at this point can be disastrous. Think about if you were to try and cut down some trees for a field, if they are 100 year old oaks it would be harder than pulling them up as saplings. Same concept. At least to me it is, things are more vulnerable in the beginning.
Enough about how, why do I care? Because I told you to care thats why. Let's start with because ToF mixes oxygenated and deoxygenated blood together. Fun fact, you need oxygen to live, so does the person with ToF. This deoxygenation varies depending on the severity of the defect so it might not be noticeable right away. The baby with ToF could be cyanotic, or not, maybe have a heart murmur, or not, may have failure to gain weight, or not, delayed growth and development, or not, and clubbing of the digits, or not. Its almost like they didn't read the text book on how they are supposed to present with ToF.
You can probably guess why these are bad but let me explain anyway. A tet spell is an acute hypoxic spell that can cause from cyanosis to syncope. Interestingly, and I just learned this, is that by squatting the systemic vascular pressure increases and the shunt in the heart is reversed, leading to less mixing of oxygenated and deoxygenated blood. Pretty cool.
We just reviewed this in preparation for the NCLEX-RN so it is still stuck in my mind and talking about it helps it stick longer. Which I need because I do not do baby stuff, nope. However, as a soon to be nurse and really anyone, supporting the development of these children is of the utmost importance. I won't be doing a surgical repairs but I can promote nutrition for the kiddos and educate the parents. A great meta-analysis from Medicine looks at the effects of nursing interventions on children with ToF and other congenital heart disease "This meta-analysis confirms the beneficial effects of comprehensive nursing interventions in terms of reduced complication rates and shorter hospital stays. The effectiveness of comprehensive nursing in reducing anxiety and pain levels was also demonstrated".
There is a great chart on what those interventions were, such as: education of the child and caregivers, post-op education, respiratory training and education, promoting and enabling gentle exercise programs, therapeutic play with the child, and encouragement of increased nutritional intake just to name a few.
That ends my spiel on ToF. At least I found it interesting so thats all that matters in the end. But I sincerely hope you at least learned one thing. Catch you later.
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