PALAFOX, Pamela M.

BSN 2B

FEBRILE SIEZURE
I. OVERVIEW

A febrile seizure is a convulsion in a child caused by a spike in body temperature, often from an
infection. They occur in young children with normal development without a history of
neurologic symptoms. It can be frightening when your child has a febrile seizure, and the few
minutes it lasts can seem like an eternity. Fortunately, they're usually harmless and typically
don't indicate a serious health problem.

II. SIGN AND SYMPTOMS

Usually, a child having a febrile seizure shakes all over and loses consciousness. Sometimes, the
child may get very stiff or twitch in just one area of the body.

A child having a febrile seizure may:

* Have a fever higher than 100.4 F (38.0 C)

* Lose consciousness

* Shake or jerk arms and legs

Febrile seizures are classified as simple or complex:

* Simple febrile seizures. This most common type lasts from a few seconds to 15 minutes.
Simple febrile seizures do not recur within a 24-hour period and are not specific to one part of
the body.

* Complex febrile seizures. This type lasts longer than 15 minutes, occurs more than once
within 24 hours or is confined to one side of your child's body.

Febrile seizures most often occur within 24 hours of the onset of a fever and can be the first sign
that a child is ill

“When to see a doctor”

See your child's doctor as soon as possible after your child's first febrile seizure, even if it lasts
only a few seconds. Call an ambulance to take your child to the emergency room if the seizure
lasts longer than five minutes or is accompanied by:

* Vomiting
* A stiff neck

* Breathing problems

* Extreme sleepiness

III. CAUSES

Usually, a higher than normal body temperature causes febrile seizures. Even a low-grade fever
can trigger a febrile seizure.

Infection The fevers that trigger febrile seizures are usually caused by a viral infection, and less
commonly by a bacterial infection. Influenza and the virus that causes roseola, which often are
accompanied by high fevers, appear to be most frequently associated with febrile seizures.

Post-immunization seizures The risk of febrile seizures may increase after some childhood
immunizations. These include the diphtheria, tetanus and pertussis or measles-mumps-rubella
vaccinations. A child can develop a low-grade fever after a vaccination. The fever, not the
vaccination, causes the seizure.

IV. RISK FACTOR

Factors that increase the risk of having a febrile seizure include:

* Young age - Most febrile seizures occur in children between 6 months and 5 years of age, with
the greatest risk between 12 and 18 months of age.

* Family history- Some children inherit a family's tendency to have seizures with a fever.
Additionally, researchers have linked several genes to a susceptibility to febrile seizures.

V. COMPLICATION

Most febrile seizures produce no lasting effects. Simple febrile seizures don't cause brain
damage, intellectual disability or learning disabilities, and they don't mean your child has a more
serious underlying disorder. Febrile seizures are provoked seizures and don't indicate epilepsy.
Epilepsy is a condition characterized by recurrent unprovoked seizures caused by abnormal
electrical signals in the brain.

Recurrent febrile seizures - The most common complication is the possibility of more febrile
seizures. The risk of recurrence is higher if:

* Your child's first seizure resulted from a low fever.

* The period between the start of the fever and the seizure was short.

* An immediate family member has a history of febrile seizures.

* Your child was younger than 18 months at the time of the first febrile seizure.

VI. DIAGNOSIS

Febrile seizures occur in children with normal development. Your doctor will carefully review
your child's medical history and developmental history to exclude other risk factors for epilepsy.
In normally developing children, identifying the cause of your child's fever is the first step after a
febrile seizure.

Simple febrile seizures - Children who are current with their vaccinations who have a first
simple febrile seizure don't need testing. Your doctor can diagnose the febrile seizure based on
history. In children with delayed immunization or a compromised immune system, your doctor
may recommend tests to look for severe infections:

* A blood test

* A urine test

* A spinal tap (lumbar puncture), to find out if your child has a central nervous system infection,
such as meningitis.

Complex febrile seizures - To diagnose the cause of a complex febrile seizure, your doctor may
also recommend an electroencephalogram (EEG), a test that measures brain activity. Your doctor
may also recommend an MRI to check your child's brain if your child has:

* An unusually large head

* An abnormal neurological evaluation

* Signs and symptoms of increased pressure in the skull

* A febrile seizure that lasted an unusually long time

VII. PATHOPHYSIOLOGY

Although the mechanism of FS remains unclear, animal models are informative. First, elevated
brain temperature alters many neuronal functions, including several temperature-sensitive ion
channels. This influences neuronal firing and increases the probability of generating massive
neuronal activity, i.e., seizures. Also, an inflammatory process including secretion of cytokine in
the periphery and in the brain is known to be a part of the mechanism. Second, it was discovered
that fever and hyperthermia share common mechanisms in provoking seizures: the fever-
promoting pyrogen interleukin-1β contributes to fever generation and conversely, fever leads to
the synthesis of this cytokine in the hippocampus. In addition, interleukin-1β has been shown to
increase neuronal excitability, acting via both glutamate and GABA. In vivo, these actions of
interleukin-1β enhance the actions of seizure-provoking agents. The importance of endogenous
interleukin-1β in the occurrence of FS was supported by studies in mice that lacked the receptor
for this cytokine. Fever of specific infectious etiologies, specifically human herpes virus 6
(HHV6), might influence the probability of generation of FS31. Third, hyperthermia-induced
hyperventilation and alkalosis have been proposed as a pivotal element of FS generation in that
alkalosis of the brain provokes neuronal excitability and contributes to seizure pathophysiology.
However, human conditions associated with severe alkalosis, including prolonged crying and
pyloric stenosis of infants, are not associated with the generation of seizures.

VIII. PREVENTION

Most febrile seizures occur in the first few hours of a fever, during the initial rise in body
temperature.

Giving your child medications - Giving your child infants' or children's acetaminophen
(Children's Non-Aspirin Tylenol, others) or ibuprofen (Infants' Motrin, Children's Motrin,
others) at the beginning of a fever may make your child more comfortable, but it won't prevent a
seizure. Use caution when giving aspirin to children or teenagers. Though aspirin is approved for
use in children older than age 3, children and teenagers recovering from chickenpox or flu-like
symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome,
a rare but potentially life-threatening condition, in such children.

Prescription prevention medications - Rarely, prescription anticonvulsant medications are used

to try to prevent febrile seizures. However, these medications can have serious side effects that
may outweigh any possible benefit. Rectal diazepam (Diastat) or nasal midazolam might be
prescribed to be used as needed for children who are prone to long febrile seizures. These
medications are typically used to treat seizures that last longer than five minutes or if the child
has more than one seizure within 24 hours. They are not typically used to prevent febrile
seizures.

IX. TREATMENT

Most febrile seizures stop on their own within a couple of minutes. If your child has a febrile
seizure, stay calm and follow these steps:

* Place your child on his or her side on a surface where he or she won't fall.

* Start timing the seizure.

* Stay close to watch and comfort your child.

* Remove hard or sharp objects near your child.

* Loosen tight or restrictive clothing.

* Don't restrain your child or interfere with your child's movements.

* Don't put anything in your child's mouth.

If your child has a febrile seizure that lasts more than five minutes — or if your child has
repeated seizures — call for emergency medical attention.

More-serious episodes

A doctor may order medication to stop a seizure that lasts longer than five minutes. Your child's
doctor may hospitalize the child for observation if:

* The seizure is prolonged

* The seizure is accompanied by a serious infection

* The source of the infection can't be found But a hospital stay isn't usually necessary for simple
febrile seizures.

X. NURSING MANAGEMENT

Nursing goals for a child experiencing febrile seizures include maintain airway/respiratory
function, maintain normal core temperature, protection from injury, and provide family
information about disease process, prognosis, and treatment needs.

AUTISM AND ADHD

I. OVERVIEW

ADHD and autism can look a lot like each other. Children with either condition can have
problems focusing. They can be impulsive or have a hard time communicating. They may have
trouble with schoolwork and with relationships. Although they share many of the same
symptoms, the two are distinct conditions. Autism spectrum disorders are a series of related
developmental disorders that can affect language skills, behaviour, social interactions, and the
ability to learn. ADHD impacts the way the brain grows and develops. And you can have both.

II. SIGN AND SYMPTOMS

There are three main types of ADHD; Combined (both inattentive and hyperactive-impulsive),
Predominantly Inattentive and predominantly Hyperactive-Impulsive. Inattention includes things
like:

* lack of attention to detail, making careless mistakes

* difficulty sustaining attention (eg in class or at work)

* not listening when spoken to directly

* having trouble completing jobs and tasks

* having problems organising tasks

* avoiding or disliking sustained mental effort (eg filling out forms)

* losing things

* being easily distracted

* being forgetful in daily activities.  

Hyperactivity includes things like:

* being fidgety (hands or feet) or squirming in seat

* leaving seat when not supposed to

* being inappropriately restless or overactive

* having difficulty engaging in leisure activities quietly

* always being “on the go”

* talking excessively.  

Impulsivity includes things like:

* blurting out answers before the person’s finished asking the question

* having difficulty waiting in line or with taking turns

* interrupting others.

III. CAUSES

Because attention deficit hyperactivity disorder (ADHD) symptoms—inattention, impulsivity,

and/or hyperactivity—affect a child's ability to learn and get along with others, some people
think an ADHD child's behavior is caused by a lack of discipline, a chaotic family life, or even
too much TV. In fact, research suggests that ADHD is largely a genetic disorder. However, some
environmental factors may play a role as well. Here, we separate fact from fiction about the
causes of ADHD. The cause of the disorder is unclear: developmental lag, biochemical disorders,
and food sensitivities are all theories under consideration.

* Developmental lag. Children with ADHD experience a developmental delay in areas of the
brain important for controlling action and attention.
* Biochemical changes. A new study at Örebro University in Sweden shows that children with
ADHD have nearly 50 percent less of a protein that is important for attention and learning; the
finding may mean that there are other biochemical disturbances in the brains of individuals with
ADHD than was previously believed.

* Food sensitivities. Dietary studies have found a strong connection between food and ADHD
symptoms, these studies are small and have their limitations, as most nutrition studies do, but
they all produce remarkable results. Risk factors

IV. RISK FACTORS:

* Blood relatives, such as a parent or sibling, with ADHD or another mental health disorder

* Exposure to environmental toxins — such as lead, found mainly in paint and pipes in older
buildings

* Maternal drug use, alcohol use or smoking during pregnancy

* Premature birth - Although sugar is a popular suspect in causing hyperactivity, there's no

reliable proof of this. Many issues in childhood can lead to difficulty sustaining attention, but
that's not the same as ADHD.

V. COMPLICATIONS

ADHD can make life difficult for children. Children with ADHD:

* Often struggle in the classroom, which can lead to academic failure and judgment by other
children and adults

* Tend to have more accidents and injuries of all kinds than do children who don't have ADHD

* Tend to have poor self-esteem

* Are more likely to have trouble interacting with and being accepted by peers and adults

* Are at increased risk of alcohol and drug abuse and other delinquent behavior

Coexisting conditions ADHD doesn't cause other psychological or developmental problems.

However, children with ADHD are more likely than others to also have conditions such as:

* Oppositional defiant disorder (ODD), generally defined as a pattern of negative, defiant and
hostile behavior toward authority figures

* Conduct disorder, marked by antisocial behavior such as stealing, fighting, destroying

property, and harming people or animals

* Disruptive mood dysregulation disorder, characterized by irritability and problems tolerating

frustration

* Learning disabilities, including problems with reading, writing, understanding and

communicating

* Substance use disorders, including drugs, alcohol and smoking

* Anxiety disorders, which may cause overwhelming worry and nervousness, and include
obsessive compulsive disorder (OCD)

* Mood disorders, including depression and bipolar disorder, which includes depression as well
as manic behavior

* Autism spectrum disorder, a condition related to brain development that impacts how a person
perceives and socializes with others

* Tic disorder or Tourette syndrome, disorders that involve repetitive movements or unwanted
sounds (tics) that can't be easily controlled

VI. DIAGNOSIS

Parents and caregivers who are concerned that their child may have ADHD, autism, or both
should talk to their family doctor or pediatrician. The doctor may recommend referring the child
to a child behavior disorder specialist. A doctor will base an ADHD diagnosis on symptoms that
have been present in the past 6 months. If a doctor suspects autism, they may look into a child’s
behavior and development over previous years. In either case, they may wish to hear from
teachers and other caregivers, as well as parents. The doctor will also want to rule out conditions
that can cause symptoms similar to those of autism or ADHD. These issues include:

* hearing problems

* learning difficulties

* sleep disorders

In addition, the doctor may uncover symptoms of co-occurring disorders, such as:

* social anxiety disorder

* oppositional defiant disorder According to a 2010 study that looked at data from more than
2,500 autistic children in the U.S., 83% of the children also had at least one other developmental
disorder, while 10% had at least one psychiatric disorder.

VII. PATHOPHYSIOLOGY
In general, neuroanatomical studies support the concept that autism may involve a combination
of brain enlargement in some areas and reduction in others. These studies suggest that autism
may be caused by abnormal neuronal growth and pruning during the early stages of prenatal and
postnatal brain development, leaving some areas of the brain with too many neurons and other
areas with too few neurons. Some research has reported an overall brain enlargement in autism,
while others suggest abnormalities in several areas of the brain, including the frontal lobe, the
mirror neuron system, the limbic system, the temporal lobe, and the corpus callosum. In
functional neuroimaging studies, when performing theory of mind and facial emotion response
tasks, the median person on the autism spectrum exhibits less activation in the primary and
secondary somatosensory cortices of the brain than the median member of a properly sampled
control population. This finding coincides with reports demonstrating abnormal patterns of
cortical thickness and grey matter volume in those regions of autistic persons' brains.

VIII. PREVENTION

To help reduce your child's risk of ADHD:

* During pregnancy, avoid anything that could harm fetal development. For example, don't
drink alcohol, use recreational drugs or smoke cigarettes.

* Protect your child from exposure to pollutants and toxins, including cigarette smoke and lead
paint.

* Limit screen time. Although still unproved, it may be prudent for children to avoid excessive
exposure to TV and video games in the first five years of life.

IX. TREATMENT

The first step in helping your child get the proper treatment is getting a correct diagnosis. You
may need to seek out a child behavior disorder specialist. A lot of pediatricians and general
practitioners don’t have the specialized training to understand the combination of symptoms.
Pediatricians and general practitioners may also miss another underlying condition that
complicates treatment plans. Managing the symptoms of ADHD can help your child manage the
symptoms of ASD, too. The behavioral techniques your child will learn may help lessen the
symptoms of ASD. That’s why getting the proper diagnosis and adequate treatment is so vital.
Behavioral therapy is a possible treatment for ADHD, and recommended as the first line of
treatment for children under the age of 6. For children over the age of 6, behavioral therapy is
recommended with medication. Some medications commonly used to treat ADHD include:

* methylphenidate (Ritalin, Metadate, Concerta, Methylin, Focalin, Daytrana)

* mixed amphetamine salts (Adderall)

* dextroamphetamine (Zenzedi, Dexedrine)

* lisdexamfetamine (Vyvanse)

* guanfacine (Tenex, Intuniv)

* clonidine (Catapres, Catapres TTS, Kapvay)

Behavioral therapy - is also often used as a treatment for ASD, too. Medication may also be
prescribed to treat symptoms. In people who have been diagnosed with both ASD and ADHD,
medication prescribed for symptoms of ADHD may also help some symptoms of ASD. Your
child’s doctor may need to try several treatments before finding one that manages symptoms, or
there may be multiple treatment methods used simultaneously.

X. NURSING MANAGEMENT

The nurse‘s role in caring for the patient with ADHD involves the following interventions:

* Approach the child at his current level of functioning. Do not use baby talk nor direct him as to
his chronological age; encourage him to express his thoughts or emotions and respond to him
therapeutically.

* Use simple and direct instructions. You may repeat your instructions more than once and at
times, you may utilize visual aids or pictures in order for him to relate well; in educating the
child, the lessons should only be brief in duration due to his short attention span.

* Implement scheduled routine every day. Make his routine predictable and something like
ritualistic so that it will only be easy for him to grasp for his independent functioning.

* Avoid stimulating or distracting settings. Ensure to involve the child in his daily activities in a
quiet and non-stimulating area to prevent him from becoming easily distracted and hyperactive.

* Give positive reinforcements. Every good deed done should be rewarded even with a simple
smile, nod or a star’ praise him for achieving his goals for the day or a task that was finished; it is
also advisable to provide immediate reinforcement since they sometimes have decrease tolerance
to frustration.

* Encourage physical activity. You may encourage him to join a physical activity that he likes as
this may also help him make friends with other children; allow him to exert his energy
productively but do not let him get over fatigued, too; physical activity helps in getting good
sleep but over fatigue might as well make him uneasy and irritable.

TETRALOGY OF FALLOT
I. OVERVIEW

Tetralogy of Fallot (teh-TRAL-uh-jee of fuh-LOW) is a rare condition caused by a combination

of four heart defects that are present at birth (congenital). These defects, which affect the
structure of the heart, cause oxygen-poor blood to flow out of the heart and to the rest of the
body. Infants and children with tetralogy of Fallot usually have blue-tinged skin because their
blood doesn't carry enough oxygen. Tetralogy of Fallot is often diagnosed during infancy or soon
after. However, tetralogy of Fallot might not be detected until later in life in some adults,
depending on the severity of the defects and symptoms. With early diagnosis followed by
appropriate surgical treatment, most children and adults who have tetralogy of Fallot live
relatively normal lives, though they'll need regular medical care throughout life and might have
restrictions on exercise.

II. SYMTOMS

Tetralogy of Fallot symptoms vary, depending on the extent of obstruction of blood flow out of
the right ventricle and into the lungs. Signs and symptoms may include:

* A bluish coloration of the skin caused by blood low in oxygen (cyanosis)

* Shortness of breath and rapid breathing, especially during feeding or exercise

* Loss of consciousness (fainting)

* Clubbing of fingers and toes — an abnormal, rounded shape of the nail bed

* Poor weight gain

* Tiring easily during play or exercise

* Irritability

* Prolonged crying

* A heart murmur

Tet spells Sometimes, babies who have tetralogy of Fallot will suddenly develop deep blue skin,
nails and lips after crying or feeding, or when agitated. These episodes are called tet spells and
are caused by a rapid drop in the amount of oxygen in the blood. Tet spells are most common in
young infants, around 2 to 4 months old. Toddlers or older children might instinctively squat
when they're short of breath. Squatting increases blood flow to the lungs.

“When to see a doctor Seek medical help if you notice that your baby has the following
symptoms”

* Difficulty breathing
* Bluish discoloration of the skin

* Passing out or seizures

* Weakness

* Unusual irritability If your baby becomes blue (cyanotic), place your baby on his or her side
and pull your baby's knees up to his or her chest. This helps increase blood flow to the lungs.

III. CAUSES

Tetralogy of Fallot occurs during fetal growth, when the baby's heart is developing. While
factors such as poor maternal nutrition, viral illness or genetic disorders might increase the risk
of this condition, in most cases the cause of tetralogy of Fallot is unknown. The four
abnormalities that make up the tetralogy of Fallot include:

* Pulmonary valve stenosis - Pulmonary valve stenosis is a narrowing of the pulmonary valve —
the valve that separates the lower right chamber of the heart (right ventricle) from the main blood
vessel leading to the lungs (pulmonary artery).Narrowing (constriction) of the pulmonary valve
reduces blood flow to the lungs. The narrowing might also affect the muscle beneath the
pulmonary valve. In some severe cases, the pulmonary valve doesn't form properly (pulmonary
atresia) and causes reduced blood flow to the lungs.

* Ventricular septal defect - A ventricular septal defect is a hole (defect) in the wall (septum) that
separates the two lower chambers of the heart — the left and right ventricles. The hole allows
deoxygenated blood in the right ventricle — blood that has circulated through the body and is
returning to the lungs to replenish its oxygen supply — to flow into the left ventricle and mix
with oxygenated blood fresh from the lungs.Blood from the left ventricle also flows back to the
right ventricle in an inefficient manner. This ability for blood to flow through the ventricular
septal defect reduces the supply of oxygenated blood to the body and eventually can weaken the
heart.

* Overriding aorta - Normally the aorta — the main artery leading out to the body — branches
off the left ventricle. In tetralogy of Fallot, the aorta is shifted slightly to the right and lies
directly above the ventricular septal defect.In this position the aorta receives blood from both the
right and left ventricles, mixing the oxygen-poor blood from the right ventricle with the oxygen-
rich blood from the left ventricle.

* Right ventricular hypertrophy - When the heart's pumping action is overworked, it causes the
muscular wall of the right ventricle to thicken. Over time this might cause the heart to stiffen,
become weak and eventually fail. Some children or adults who have tetralogy of Fallot may have
other heart defects, such as a hole between the heart's upper chambers (atrial septal defect), a
right aortic arch or abnormalities of the coronary arteries.
IV. RISK FACTORS

While the exact cause of tetralogy of Fallot is unknown, various factors might increase the risk
of a baby being born with this condition. These risk factors include

* A viral illness during pregnancy, such as rubella (German measles)

* Alcoholism during pregnancy

* Poor nutrition during pregnancy

* A mother older than age 40

* A parent who has tetralogy of Fallot

* The presence of Down syndrome or DiGeorge syndrome

V.COMPLICATION

All babies who have tetralogy of Fallot need corrective surgery. Without treatment, your baby
might not grow and develop properly. Your baby may also be at an increased risk of serious
complications, such as infective endocarditis — an infection of the inner lining of the heart or
heart valve caused by a bacterial infection. Untreated cases of tetralogy of Fallot usually develop
severe complications over time, which might result in death or disability by early adulthood.

VI. DIAGNOSIS

Your or your baby's doctor might suspect tetralogy of Fallot if he or she notices you or your baby
has blue-tinged skin or a heart murmur — an abnormal whooshing sound caused by turbulent
blood flow. Your or your baby's cardiologist will conduct a physical examination and use several
tests to confirm the diagnosis. Tests may include

* Echocardiography - Echocardiograms use high-pitched sound waves to produce an image of

the heart. Sound waves bounce off the heart and produce moving images that can be viewed on a
video screen.This test is generally used to diagnose tetralogy of Fallot. It allows your or your
baby's doctor to determine if there is a ventricular septal defect and where it's located, if the
structure of the pulmonary valve and pulmonary artery is normal, if the right ventricle is
functioning properly, if the aorta is positioned properly, and if there are any other heart defects.
This test can also help your or your baby's doctor to plan treatment for the condition.

* Electrocardiogram - An electrocardiogram records the electrical activity in the heart each time
it contracts. During this procedure, patches with wires (electrodes) are placed on your or your
baby's chest, wrists and ankles. The electrodes measure electrical activity, which is recorded on
paper.This test helps determine if the right ventricle is enlarged (right ventricular hypertrophy), if
the right atrium is enlarged and if the heart rhythm is regular.
 * Chest X-ray - A chest X-ray can show the structure of the heart and lungs. A common sign of
tetralogy of Fallot on an X-ray is a "boot-shaped" heart, because the right ventricle is enlarged.

* Oxygen level measurement (pulse oximetry) - This test uses a small sensor that can be placed
on a finger or toe to measure the amount of oxygen in the blood.

* Cardiac catheterization - Doctors may use this test to evaluate the structure of the heart and
plan surgical treatment. During this procedure, your or your baby's doctor inserts a thin, flexible
tube (catheter) into an artery or vein in the arm, groin or neck and threads it up to the heart.Your
or your baby's doctor injects a dye through the catheter to make the heart structures visible on X-
ray pictures. Cardiac catheterization also measures pressure and oxygen levels in the chambers of
the heart and in the blood vessels.

VII. PATHOPHYSIOLOGY

The figure below compares the normal anatomy and blood flow of the heart to that found in
Tetralogy of Fallot. The initial defect in TOF is a narrowing of the right ventricular outflow tract
into the pulmonary artery. This prevents deoxygenated blood from entering the pulmonary
circuit. In response to this outflow obstruction, the myocardium of the right ventricle
hypertrophies in order to contract forcefully enough to push blood past the stenosis.
Additionally, patients have a large ventricular septal defect which allows shunting of blood
between the ventricles. In a patient with an isolated VSD, the blood flow is shunted initially from
left‐to‐right. However, in TOF, the right ventricular outflow obstruction may impede the normal
blood flow so significantly that the left side of the heart becomes the path of least resistance.
Blood from the right ventricle is then forced into the left ventricle, creating a right‐to‐left shunt
and subsequent cyanosis. Finally, the aorta overrides the ventricular septal defect, straddling the
VSD. This allows deoxygenated blood shunted from the right ventricle to immediately exit the
heart mixed with blood from the left ventricle.

VIII. PREVENTION

Lifestyle and home remedies After treatment, you might have some concerns about how best to
manage your or your child's condition, including:

* Preventing infection - A child, adolescent or adult who has severe heart defects might need to
take preventive antibiotics before certain dental and surgical procedures. Your or your child's
doctor can tell you if this is necessary. Maintaining good oral hygiene and getting regular dental
checkups are excellent ways to help prevent infection.

* Exercising - Parents of children or adolescents with congenital heart defects or adults who
have congenital heart defects often worry about the risks of vigorous activity even after
successful treatment.Although some children, adolescents or adults might need to limit the
amount or type of exercise, many can lead normal or near-normal lives. Decisions about exercise
need to be made on a case-by-case basis, so ask your or your child's doctor which activities are
safe for you or your child.

IX. TREATMENT

The only effective methods of treatment for Tetralogy of Fallot is surgery. Surgical procedures
may include:

Temporary Surgery - Sometimes, babies have to go through a temporary surgery in order to

proceed to intracardiac repair.

Intracardiac Repair - This is an open heart surgery in which the surgeon places a patch over the
ventricular septal defect to close the hole between the lower chambers of the heart.  

X. NURSING MANAGEMENT

Pain medications, such as acetaminophen or ibuprofen, may be recommended to keep your child
comfortable at home. Your child's physician will discuss pain control before your child is
discharged from the hospital. After surgery, older children usually have a fair tolerance for
activity. Your child may become tired easily, and sleep more right after surgery, but, within a
few weeks, your child should be fully recovered. Long-term outlook after tetralogy of Fallot
surgical repair Most children who have had a tetralogy of Fallot surgical repair will live healthy
lives. Activity levels, appetite, and growth will eventually return to normal in most children.
Your child's cardiologist may recommend that antibiotics be given to prevent bacterial
endocarditis after discharge from the hospital. Consult your child's physicians regarding the
specific outlook for your child.