hey everyone it's sarah thread sterner sorry and comment in this video i'm going to be going over tetralogy of below in this video is part of an ink lex review series over pediatric nursing and as always after you watch this youtube video you can access the free quiz that will test you on this condition so let's get started what is tetralogy of below it is a congenital heart defect that is characterized by four structural defects of the heart now some quick facts about tetralogy of flow is that it is one of the most common complex congenital heart defects and it occurs whenever the baby is developing in its mother's womb so some parts of the heart do not form correctly and according to the cdc gov in every 2518 births one baby in the US will be born with this condition and it's known as a cyanotic heart defect which means that there is going to be decreased pulmonary blood flow going to the lungs so that blood can become oxygenated so in other words that baby or child is not going to be receiving nice oxygenated blood which is going to cause the organs the tissues to suffer so they can have this bluish type tint to them called cyanosis now to easily understand tetralogy of flow you'll want to know the basic anatomy of the heart and how the blood normally flows through it because as you're studying all those other congenital heart defects it's just gonna make sense and there's really not a lot of memorizing you have to do it because once you can see how that blood flows you're gonna see okay I see why this person's having these signs and symptoms and what's going on so first let me cover the normal blood flow through the heart and then we're gonna compare it to a person who has tetralogy of flow and talk about these different structural defects okay so how I like to look at blood flow is I like to divide it up into two parts we have the right side of the heart and we have the left side of the heart and everything starts in the right side of the heart now the goal of the right side of the heart is to take that an oxygenated blood that exhausts of blood that your body just used up and get it to the lungs so we can get oxygenated and then it'll come to the left side of the heart and the goal the left side of the heart is to take that nice rich oxygenated blood and get it to your organs in your tissues because your body wants real oxygenated blood it doesn't want this mixing of an oxygenated with oxygenated just doesn't work and it doesn't like that okay so your body's used up this blood it's gonna drain it back through the superior and inferior vena cava hence it's represented in blue it's uh Knox agente 'td at first it's gonna flow down through the right atrium then the blood as this valve right here which is called the tricuspid valve it's gonna open up and let it flow down through the right ventricle now you have the tricuspid valve in the bicuspid valve tricuspid valve is on the right side of the heart and the bicuspid valve which is also called the mitral valve it's on the left side of the heart don't let the to confuse you how I remember it is a little saying try before you buy so try tricuspid by bicuspid over here so the right ventricle hearts going to contract it's going to squeeze and pump that an oxygenated blood up through the pulmonic valve then through the pulmonary artery which is going to go to the lungs and you have capillary beds on your alveoli sacs and oxygen that you just inhaled is going to cross over into this blood and carbon dioxide is going to cross over for you to exhale and that blood is going to be replenished again with oxygen so nice oxygenated blood then is going to go into the left side of the heart through the pulmonary vein then it's going to go down through the left atrium down through the bicuspid valve which is the mitral valve then to the left ventricle it's almost to the body then it's going to get squeezed up and if we could see behind this area you would see part of that a wordham it's going to go up through the aortic valve be squeezed up through there and then into the aorta and then shot throughout the body and it's going to replenish those organs and shoes however with tetralogy of flow this is not how the heart is set up there structural defects which is going to alter the way that the blood flows and like I said at the beginning the lecture that how many structural defects are there there's going to be four and to help us remember those let's remember the word wraps okay this person is going to have r4 right ventricular hypertrophy they're gonna have a 4a organ displacement p4 pulmonary stenosis and then s4 a septal defect specifically a ventricular septal defect so let's look at it okay here we have our heart let's go through just like how the blood should flow and talk about what's happening okay so with these patients what's going to flow in the normal way everything starts at the right side so superior inferior vena cava is bringing that exhausted enough oxygenated blood to the right side of the heart which it's trying to get it to the lungs to get oxygenated so it's going to go down through the right atrium down through the tricuspid valve and then down through the right ventricle this is where our problem begins okay normally and our last picture if you notice the right and left ventricle was separated by like a septal wall because we should have our blood that goes into a right ventricle and our left ventricle to mix but unfortunately we have a septal wall defect so there's gonna be this big hole right here allowing this blood to mix together now our problem continues what did I say that the right ventricle would does and whenever it receives its blood it squeezes it up through the pulmonic valve through the pulmonary artery to get to the lungs ain't happenin here because our pulmonic valve is going to be stenosis it's gonna be real narrow and that arteries gonna be really narrow so the right ventricle isn't going to be able to successfully pump that uh Knox generated blood to the lungs so you're gonna have decreased pulmonary blood flow so you're not gonna get a lot of blood that's becoming oxygenated so we have pulmonary stenosis now that's going to lead to another issue that right Interpol has to pump against so much resistance against that narrow pulmonary valve artery what happens to a muscle when you give it so much resistance it starts to enlarge so that's what happens right ventricular hypertrophy so a right ventricle is going to enlarge instead of being normal-sized so another thing because we have four problems this a or de we're gonna have a or de displacement so here we have a Orting valve on our other drawing it was nice up here wasn't enlarged but here with these patients it's enlarged and what happens is that this moves the aorta and unfortunately what happens is that it moves the aorta right over this septal wall defect opening so as you can see you have this uh Noxon aidid blood that's mixing with this oxygenated blood together and it's getting an ascent sucked up through the aorta is going throughout the body so this person's receiving all this uh Knox native blood that way and the right side of the heart is limited in how much blood it can get to the lungs to become oxygenated because this Pullman pulmonic artim artery and valve is so narrow so really it's all just going up through this area so you have what's called a right-to-left shunt all the blood from the right is being shunted over here and just going up through the aorta and it's an oxygenated blood now let's talk about the signs and symptoms that you can see in these patients who have tetralogy up below and to help us remember those signs and symptoms let's remember the word afflict now we know all these signs and symptoms are gonna go along with that decrease pulmonary blood flow because that blood is not being able to be oxygenated and go to the organs and tissues so our signs and symptoms are really going to correlate with so be thinking in that realm so a for activity any activity that this patient does we're talking about children babies like crying there ceding their plane it's gonna put a lot of stress and demand on that heart and as we just seen the structural defects don't allow the heart to be able to work correctly under those type of conditions so it can't replenish the blood with oxygen so any type of activity can stress the heart out leading to what's called a Tet spell if you can't remember anything about tetralogy of flow remember Tet spell and need a chest position or squatting just remember that because it's a big takeaways from this lecture for your exams so they have these Tet spells and this is where they start to become cyanotic that skin will have a bluish tint shortness of breath increased respiratory right and here in a moment we'll talk about your role during a test spell for fingernail changes which will represent clubbing of the nails and this is from where they have chronic hypoxia that chronic low oxygen in the blood causes those nails to have an abnormal appearance which is similar to these image this image right here and as the nurse you may notice this around six months of age in your patients our next F for fatigue slash faints easily and again this is related to those chronic low oxygen levels and especially during a tent spell the patient can feign so you'll want to be aware that we don't really want them to get to that point so whenever you're thinking of your plan of care for this patient nursing diagnosis a great one would be activity intolerance patients who have this can't do the normal things like other children can so in your plan of care you would want to make sure your nursing interventions and your goal goals for those patients are appropriate okay l4 lift knee to chest position or squat squatting and notice I have three asterisks by that because I really want you to remember this so anytime a patient is having a Tet spell what you want to do say you get a test question that says you're feeding an infant with tetralogy of flow you notice while you're feeding the infant they start their skin starts to turn like a bluish color and the respiratory rate has increase what your nest next nursing action well this is a tat spell so you'll be thinking in that realm what you want to do is stop feeding that infant and put them in the need to chest position give them oxygen and calm them some physicians may order medications to help keep the infant calm or IV fluids now why IV fluids well IV fluids can help decrease that right-to-left shunt which ties it in with the squatting some parents may ask you you know my kid to one and a half they noticed whenever they're playing with others all of a sudden they'll just squat why are they squatting what's the purpose of that well it goes along with the knee to chest position and the squatting IV fluids it helps what it does is it increases systemic vascular resistance and whenever you have that what that's going to do is that's going to decrease that right to left shunting which is going to help improve blood flow and help increase the oxygen level so that is what that is doing which is really need that the child just in a sense naturally knows just a squat to do that so that's the purpose of that and if you see that again you'll know okay i-4 inability to grow these patients will usually be smaller for their age and again it's just tying back to our body whenever a child is growing they need oxygen to grow to their tissues their bones everything like that so they'll have the inability to grow right see for cardiac sounds these patients are going to have abnormal cardiac sounds what are you gonna hear when they you in here is a harsh systolic murmur and you could feel a systolic thrill now where are you going to hear this murmur well where is it coming from what's causing it remember the pulmonic valve is stenosis it's narrow so you're gonna hear it where you would hear your pulmonic valve which think back to health assessment where do you hear that pulmonic valve you hear it at the left of the sternal border and that second intercostal space so a harsh systolic murmur and is from pulmonary stenosis and then tea or last part of our mnemonic trouble feeding and thriving so these patients another nursing diagnosis some of these patients could have is failure to thrive because of what's going on with oxygen levels so they can have low weights because they're not growing they'll be small for their age and they will have a decrease in meeting their developmental milestones compared to their peers now let's quickly go over the treatment for this condition okay this condition requires surgery to fix these structural defects now cases vary of tetralogy of blow some patients have very severe cases with worst-case-scenario so it'll vary on why each patient will get but they can have a temporary surgery which is like a palliative surgery until they can have complete surgery whenever they're really young and a shunt can be placed to shunt blood so you're increasing the pulmonary blood flow to the lungs or a stick can be placed to open up that narrowing of the pulmonary artery in the pulmonic valve to help increase the pulmonary blood flow then a complete repair can be done this is usually around six to twelve months of age whenever the child is a little bit older and they can place a patch to correct the VSD that ventricular septal defect because remember we don't want the blood mixing here so they can place a patch here to prevent that blood from mixing together now one drug I want to point out to you just so you can be familiar with it it's called our prosody which is a prostaglandin a medication and what this medication does is it keeps the ductus arteriosus um open and we're talking about newborn babies here a lot of times babies who are born with tetralogy of flow if they have a major defect to that pulmonary valve where they are literally just not getting any blood flow to those lungs we're gonna have issues they're gonna have like major cyanosis at birth and that can be started on this and food infusion and what it's going to do is it's going to keep this ductus arteriosus I'm open because after birth normally that will close shortly after birth so we don't want to close in this condition because what it can do it's normally about right here it allow blood to flow into this pulmonary artery which is going to increase blood flow to the lungs and we can get more hopefully oxygenated blood throughout the body so just be familiar with that drug and patients who receive that will get that it as an infusion and then they can have a temporary surgery until they're old enough to have complete repair okay so that wraps up this review over tetrology of below thank you so much for watching don't forget to take the free quiz and to subscribe to our channel for more videos