A nurse is teaching the parents of an infant with tetralogy of Fallot. Which of the following actions should the nurse include to reduce the incidence of hypercyanotic spells? Select all that apply.

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11ecbfba_3717_c701_8458_39836670f0df_MD0009_11Tetralogy of Fallot is a complex heart defect that results in decreased pulmonary blood flow, mixing of oxygenated and unoxygenated blood, and inadequate blood flow into the left side of the heart. Hypercyanotic episodes (ie, "tet" spell) occur when unoxygenated blood enters the systemic circulation, resulting in cyanosis and hypoxemia. Tet spells usually occur during stressful or painful procedures; on waking; and with hunger, crying, and feeding. Home interventions to reduce the incidence of tet spells include: Providing a calm environment, particularly on waking (Option C) Soothing and quieting the infant when crying or distressed Offering a pacifier (Option B) Swaddling or holding the infant during procedures or times of stress (Option D) Providing frequent smaller feedings to reduce frustration due to hunger and limit sucking fatigue (Option A) During an acute tet spell, the infant may be placed in the knee-chest position to improve pulmonary blood flow by increasing systemic vascular resistance; older children may assume a squatting position. Intermittent oxygen can also be used to treat the spell, if necessary. (Option E) Tet spells occur more often during stressful situations or on waking, so sleep should not be interrupted whenever possible. Educational objective: Hypercyanotic or tet spells usually occur during stressful or painful procedures; on waking; and with hunger, crying, and feeding. Providing a calm environment; reducing hunger with small, frequent meals; and swaddling during procedures can help prevent hypercyanotic spells.

A Nurse Is Teaching the Parents of an Infant with Tetralogy