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
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