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Nursing care for a child with Fallot's tetralogy
NEJDLOVÁ, Tereza
Tetralogy of Fallot (TOF) is a congenital heart defect which is classically understood to involve four anatomical abnormalities of the heart; pulmonary stenosis, right ventricular hypertrophy, overriding aorta and ventricular septal defect. This not common but life-threatening disease is found in about 3.4% newborns with congenital heart disease. TOF is a multifactorial disease both hereditary and influenced by surrounding environment. This bachelor thesis deals with anatomy and physiology of the heart, causes, symptoms, diagnostics and treatments of the disease as well as the role of the nurse during pre- and post-operative care, postoperative complications and life situation of children with TOF after surgery. The aim of this work is to map pre- and post-operational specifics of nursing care for children with TOF. These research questions were used: - Which are the specifics of pre-operational care for children with TOF? - Which are the specifics of post-operational care for children with TOF? Qualitative method of questioning and the in-depth interview technique with paediatric nurses from Child cardio centre at FN Motol hospital in Prague were used for the analysis of the research part of the thesis. Transcribed interviews were analysed by open coding, giving rise to following categories: Preoperational examination, monitoring, premedication, fasting, post-operational care, information on the heath condition, post-operational life. Subcategories with important encoded data were assigned to each category. Important within the preoperational examination are biology material testing, RTG of heart and lungs, EKG, ECHO and anaesthesiology examination. In Monitoring category belong according to the respondents the monitoring of physiological functions and the risk of hypoxia seizures. Information about the patients being administered Midazolam and Diazepam before surgery was categorised under Premedication. Fasting was shown to differ for nursing and older children. Post-operational care was shown to be a very wide category where monitoring of vital functions and the surgical wound is most important. EKG, blood testing, throat, nose and rectum samples are also performed. The child is given analgosedation, catecholamines, Korotrop and Dobutamine. Nutrition on surgery day consists of 5% glucoses. The category Information on health condition shows that all such information the responsibility of the doctor in charge. Parents are allowed to visit the child for a short while after performed surgery, when his/her state is stable they can spend all day at the ward. The last category dealing with Life after surgery summarises all medication administered to the child after release to home care. The conducted research shows that the respondents answered the individual question identically to the compared theoretical findings. Preoperational care demands several tests and post-operational care is rather demanding both for the nursing staff and the paediatric patient.
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