Recall Tim, 16 years old, in the opening scenario who was born with the tetralogy of Fallot congenital heart defect. Despite successful corrective surgery as an infant, he recently had a pacemaker placed to help manage the episodic slow ventricular heart rate Tim is the oldest of two children; his brother is 10 years old. Tim had been able to participate in all usual school and child- hood activities except sports until the past year. He has many friends, and he Is friendly with several girls. TIm Is becoming more aware of how different he is from his peers due to his heart defect and recent pacemaker implantation. His parents had previously made all of his health care decisions, but at the time the pacemaker was needed, Tim became more involved in the patient education and decision-making process. Now Tim is realizing that he must become much more involved in his health care, but does not know how to assume that responsibility.

1.       What is the potential explanation for the development of an arrhythmia so many years after the original heart surgery

2.         What emotional and behavioral responses should be expected from Tim when learning more about his physical limitations and future health care needs?

3.         Develop a teaching plan to educate Tim about his congnential heart condition and setf-management to maintain his health status.

4.        Develop a transition plan for Tim to begin taking primary responsibility for all aspects of his health care