Patent ductus arteriosus (PDA) is a persistence of the fetal connection (ductus arteriosus) between the aorta and pulmonary

artery after birth.

Ductus Arteriosus remains patent after birth Indomethacin

Etiology: Premature neonates, high prostaglandin E A prostaglandin inhibitor
level, other congenital defects Diagnostic Test: that induces ductus
Echocardiography- classifying PDA as spasm and closure.
Aortic pressure > pulmonary artery pressure silent, small, moderate, or large. I and
Modifiable Risk Factors: Rubella infection, poorly evaluate other associated cardiac defects. **Watch for possible adverse
controlled diabetes, drug or alcohol use or exposure effects, such as diarrhea, jaundice,
bleeding, and renal dysfunction.
Shunting of oxygen-rich blood from arota to pulmonary artery via PDA
Non-modifiable Risk Factors: Genetics, age, gender LEFT TO RIGHT SHUNT

Decreased cardiac output related to dynamic change in blood flow Increase blood volume in lungs, left atrium, and left ventricle and Backflow of blood to the left ventricle
as evidenced by tachycardia, hypotension, feeling of breathlessness goes out to the aorta then shunts back to pulmonary artery
Physical
Compensation of the cardiac muscle Assessment:
Diagnostic Test: Tachycardia
Chest X-ray- cardiomegaly with Continuous repetition of the cycle of shunting
signs of left atrial and left ventricular
enlargement & increased pulmonary Bulging of the aorta and pulmonary artery Diagnostic Test:
vascular markings Left Ventricular Hypertrophy Electrocardiography
Continuous increase of blood volume (ECG)
circulating in the lungs
Physical Assessment: Pressure difference between the aorta and
Machine-like pulmonary artery (greatest during systole), and
consequently continuous flow through the PDA Congestive Loss of ability to efficiently pump blood Diagnostic Test:
murmur to the aorta and systemic circulation Complete Blood Count (CBC)
Pulmonary congestion Heart
Failure 1. Low RBC
2. Low Hemoglobin level
3. Low Hematocrit Level
Pulmonary artery pressure >
aortic pressure Increased pressure in Physical Assessment: Decreased oxygenated blood
the lungs Respiratory distress
Antibiotics
Before surgery, children with
PDA require antibiotics to protect High pulmonary blood flow, Ineffective tissue
Decreased Increased oxygen perfusion
against infective endocarditis. Low systemic blood flow Pulmonary functioning of the Compensation demand
Ineffective breathing pattern by increasing related to
hypertension related to extravasation of immune system hypoxemia as
fluid in lungs as evidenced to resist infection ventilation
Cardiac catheterization tachypnea, use of accessory evidenced by
A plug or coil is deposited in the and of the pale skin color,
Physical Assessment: muscles, and nasal flaring respiratory Easy fatigability
ductus to stop the shunting. 1. Wide systemic, decrease in
system to expel peripheral
pulse pressure offending Tachypnea/
2. Tachycardia breathlessness pulses, capillary
Surgery microorganisms refill time > 3
3. Hypotension Eating poorly
Ligation Fluid restriction secs., and SpO2
The DA is manually tied shut, or Fluids should be restricted 90%
with intravascular coils or plugs or controlled to avoid
that leads to formation of a overloading the heart. Frequent Respiratory Infections
thrombus in the DA. Growth impairment

LEGEND: Etiologic/Risk Factors Pathophysiology Signs & Symptoms Laboratory Findings Complications Nursing Diagnoses, Goals, & Interventions Medical (Surgical/Pharmacological) Management
 Nursing Goals & Interventions
Nursing Diagnosis: Ineffective breathing pattern related to
extravasation of fluid in lungs as
evidenced tachypnea, use of accessory
muscles, and nasal flaring
Nursing Goal: The client will establish a normal, effective
respiratory brething pattern as evidenced by absence of
signs of hypoxia
Independent Nursing Interventions:
1. Assess client's awareness and cognition
2. Evaluate client's respiratory status (Rate & depth of
respiration, characteristic of breathing pattern ,
adventitious breath sound
3. Frequently assess vital signs, ECG, electrolyte levels,
and intake and output.s, chest size and symmetry of
movement)
4. Monitor pulse oximetry, as indicated
Collaborative:
1. Administer oxygen at the lowest concentration
indicated and prescribed medication
2. Direct client in breathing efforts as needed. Encourage
slower and deeper respirations and use of the pursed-
lip technique
Health Teaching:
1. Emphasize the importance of good posture and
effective use of accessory muscles
2. Instruct and reinforce breathing retaining
3. Reccommend energy conservation techniques and
pacing of activities
4. Encourage adequate periods between activities
Nursing Diagnosis: Ineffective tissue perfusion related to
hypoxemia as evidenced by pale skin color,
decrease in peripheral pulses, capillary refill
time > 3 secs., and SpO2 90%
Nursing Goal: The client will demonstrate increased
perfusion as evidenced by skin warm and dry, peripheral
pulses present with arterial blood gas (ABG) within client's
normal range.
Independent Nursing Interventions:
1. Assess skin color, temperature, moisture, and whether
changes are widespread or localized
2. Measure capillary refill and palpate arterial pulses
3. Assess motor and sensory function
4. Administer medications such as antiplatele agents,
thrombolytics, antibiotics
5. Administer nitroglycerin (NTG) sublingually for
complaints of angina.
6. Maintain oxygen therapy as ordered.
Collaborative:
1. Collaborate in treatment of underlying conditions such
as cardiopulmonary condition
2. Administer fluis, electrolytes, nutrients, and oxygen as
indicated
Health Teaching:
1. Educate client/significant other in reportable
symptoms, including any changes in pain level, non
healing wounds
2. Review medication regimen and possible harmful side
effects
Nursing Diagnosis: Decreased cardiac output related to
dynamic change in blood flow as
evidenced by tachycardia, hypotension,
feeling of breathlessness
Nursing Goal: The client will display hemodynamic stability
and demonstrate and increase in activity tolerance.
Independent Nursing Interventions:
1. Place client in semi-fowler's position
2. Determine vital signs/ hemodynamic parameters
including cognitive status.
3. Assess and monitor for client reports of chest pain. Note
location, intensity, characteristics, and radiation of pain.
4. Provide bed rest
5. Instruct client to avoid/limit activities that may stimulate
a valsalva response
6. Restrict or administer fluids (IV/PO), as indicated
7. Monitor intake/output and calculate 24-hr fluid balance
8. Provide diet restrictions (low sodium, bland, soft, low
calorie diet with frequent small feddings), as indicated
Collaborative:
1. Administer oxygen via face mask or ventilator, as
indicated
2. Administer fluids, diuretics, inotropic drugs,
antidysrhythmics, steroid, vasopressors, and/or dilators,
as indicated
Health Teaching:
1. Review specifics of drug regimen, diet, activity plan.
Emphasize necessity for long-term management of
cardiac conditions
2. Discuss significant signs/symptoms that require prompt
reporting to healthcare provider