A client has a child diagnosed with Tetralogy of Fallot (TOF) and is concerned about the child's symptoms.
Which of the following symptoms are characteristic of TOF?

Choice A rationale:

"I've noticed a bluish discoloration of my skin and lips" is not a typical symptom of an atrial septal defect (ASD).

ASD is a congenital heart defect that involves an abnormal opening between the atria of the heart, and it typically results in increased blood flow to the lungs, not cyanosis.

Choice B rationale:

"I find it hard to feed, and I'm not gaining weight as expected" can be related to ASD, but it is not a primary symptom.

The increased blood flow to the lungs in ASD may lead to congestive heart failure, which can cause poor feeding and inadequate weight gain.

Choice C rationale:

"I feel short of breath and tired during physical activities" is a likely symptom of ASD.

With ASD, there is an increased volume of blood being pumped into the lungs, which can lead to pulmonary congestion, shortness of breath, and fatigue.

Choice D rationale:

"The doctor mentioned hearing unusual heart sounds during the examination" is not a symptom but rather a sign of an atrial septal defect.

Unusual heart sounds, like a fixed split second heart sound, may be heard on auscultation.

Prepare for emergency surgery.

Choice A rationale:

Administer oxygen therapy immediately.

Administering oxygen therapy would provide temporary relief to the patient's cyanosis, but it does not address the underlying issue in Tetralogy of Fallot (TOF).

TOF is a congenital heart defect characterized by a combination of four heart abnormalities, one of which is a ventricular septal defect (VSD) that allows oxygen-poor blood to mix with oxygen-rich blood.

Administering oxygen will increase the oxygen saturation in the blood but will not fix the structural problem.

The immediate priority for a patient with TOF experiencing a hypercyanotic spell is to address the heart defect itself.

Choice B rationale:

Prepare for emergency surgery.

In Tetralogy of Fallot, hypercyanotic spells, also known as "tet spells," are a medical emergency.

These spells occur due to a sudden decrease in systemic vascular resistance, causing more blood to flow into the right ventricle, leading to increased right-to-left shunting, further decreasing oxygenation.

The most appropriate intervention is to prepare for emergency surgery to correct the underlying cardiac defects, such as closing the VSD and relieving right ventricular outflow obstruction.

Surgery is the definitive treatment for TOF and should be performed promptly during a tet spell to prevent severe hypoxia and potential long-term complications.

Choice C rationale:

Monitor vital signs closely.

While monitoring vital signs is essential in the care of a patient with TOF, it is not the most immediate response in the scenario of a hypercyanotic spell.

Monitoring alone will not address the critical need for intervention to improve oxygenation and prevent hypoxia.

Choice D rationale:

Administer prescribed medication.

Administering prescribed medication may be part of the overall management of a patient with TOF, but it is not the immediate response during a hypercyanotic spell.

Medications can help manage symptoms and stabilize the patient, but the definitive treatment for TOF is surgical correction.