ERA UNIVERSITY

ERA COLLEGE OF NURSING

LESSON PLAN

ON

“PATENT DUCTUS ARTERIOSUS (PDA)”

Submitted To: Submitted By:
Ms. Swastika Das Archana Devi
Assistant Professor M.Sc.(N) 2ND Year
Era College Of Nursing
Lucknow
Submitted on: 02/08/2021
Name of the student : Archana Devi

Course : M.Sc. (N) 2nd Year

College : Era College of Nursing

Name of the subject : Medical Surgical Nursing

Name of the topic : Patent Ductus Arteriosus (PDA)

Unit : Unit 10th

Name of the supervisor : Ms. Swastika Das

Group : M. Sc. (N) 2nd year student

Vanue : Class room

Date and time : 02 -08 -2021

Methods of teaching : Lecture cum discussion

A.V. aids used : Power point presentation, white board, handout, chart, leaflet, pamphlets.

Previous knowledge : Students have some knowledge regarding embryological development of heart and fetal circulation.

General Objectives : At the end of class, the students will be able to gain in depth knowledge regarding Patent Ductus Arteriosus
(PDA) and develop favorable attitude towards client with Patent Ductus Arteriosus (PDA).
Specific Objective : at the end of class students will be able-
 Introduce patent ductus arteriosus.
 Define patent ductus arteriosus.
 Know the incidence of patent ductus arteriosus.
 Enlist risk factors of patent ductus arteriosus.
 Enumerate causes of patent ductus arteriosus.
 Explain pathophysiology of patent ductus arteriosus.
 Discuss clinical manifestation of patent ductus arteriosus.
 Find out diagnostic evaluation of patent ductus arteriosus.
 Know the complications of patent ductus arteriosus.
 Describe management of patent ductus arteriosus
o research input
o summarization
o conclusion
o bibliography
o assignment
Sl/No. Specific Duration Content Teaching Learning AV Evaluation
Objective Activity Activity Aids
1 Introduce 2 min INTRODUCTION : Lecture Listening Ppt What do you
patent ductus Patent ductus arteriosus is one of the more Cum understand
arteriosus. common congenital heart defects. During discussion by
antenatal period the fetus`s blood does not Patent
need to go to the lungs to get oxygenated. ductsus
That time , The ductus arteriosus allows the arteriosus?
blood to skip the circulation to the lungs.
However, when the baby is born, the blood
must receive oxygen in the lungs and ductus
arteriosus is supposed to close. If the ductus
arteriosus is still open (patent) the blood
may skip this necessary step of circulation
and symptoms may develop in baby`s body.
Functional closure of ductus arteriosus
usually occurs spontaneously during first
10-15 hours after birth , permanent closure
occurs within 5-7 days in most of infants but
may take up to several weeks. If closure of
ductus arteriosus does not occur even by 2-3
weeks of age it is known as patent ductus
arteriosus.
2 Define patent 3 min DEFINITION : Lecture and Listening Ppt What is
ductus “Patent ductus arteriosus is defined as a discussion patent ductus
arteriosus. persistent opening between two major blood arteriosus?
vessels leading from the heart. The opening,
called the ductus arteriosus is a normal part
of a fetal heart circulatory system before
birth that usually closes shortly after birth. If
 it remains open after birth also called patent
ductus arteriosus”.

“Before baby`s born, the fetus`s blood does

not need to go to the lungs to get
oxygenated. The ductus arteriosus is a hole
that allows the blood to skip the circulation
to the lungs. However, when the baby is
born, the blood must receive oxygen in the
lungs and this hole is supposed to close. If
ductus arteriosus is still open (patent) the
blood may skip this necessary step of
circulation. The open hole is called patent
ductus arteriosus”.
American heart association

3. Know the 1 min INCIDENCE: Lecture and Listening Ppt Which age
incidence of  5-10% of all congenital cardiac discussion group
patent ductus defects. womens are
arteriosus  Male : female- 1:2 more affected
 1 in 1600 term live births with patent
 Incidence higher in preterm babies- ductus
20-30% arteriosus?

5. Enlist risk 2 min RISK FACTORS: Lecture and Listening Ppt What are the
factors of Non Modifiable Risk Factors discussion risk factors
patent ductus  Premature birth for patent
arteriosus  Family history ductus
 Other genetic condition such as, arteriosus?
down syndrome
 Baby with other congenital heart
problem
 Modifiable Risk Factors
 Harmful substance like alcohol,
cigarettes smoking and drugs.
 Babies whose mothers had rubella
during first trimester.
6. Enumerate 3 min CAUSES: Lecture Listening Ppt What are the
causes of Premature infants cum causes of
patent ductus Infant with genetic disorders, such as discussion patent ductus
arteriosus Down Syndrome. arteriosus?
Babies whose mothers had rubella
during pregnancy.
In some congenital heart problem,
PDA is common such as hypo plastic
left heart syndrome, transposition of
great vessels, and pulmonary
stenosis.
7. Explain 5 min. PATHOPHYSIOLOGY: Lecture Listening Ppt How to
Pathophysiolo  Due genetic factor, premature birth, cum progression
gy of patent presence of other congenital heart discussion of patent
ductus defect, Drugs or alcohol used by ductus
arteriosus mother, rubella infection in mother arteriosus?
during 1 trimester.
 Leads to ductus arteriosus
 Which leads to shunting of
oxygenated blood from the high
pressure aorta to the low pressure
pulmonary artery.
 That leads decrease blood flow to the
descending aorta then decreased
tissue perfusion in the lower body
part and cyanosis seen in lower body
part.
  Another way increased volume of
blood passing through pulmonary
artery to the lungs.
 That leads extra volume of the blood
returning to the left atrium through
pulmonary veins.
 Increased volume of blood pumped
to the aorta from left ventricle and
moves to the pulmonary artery
through ductus arteriosus.
 This repeated process causes
pulmonary hypertension and right
ventricle hypertrophy.
 And later it can cause right sided
heart failure.
8. Discuss 5 min CLINICAL MANIFESTATION: Lecture listening Ppt What are the
clinical The clinical features of PDA is depends on cum clinical
manifestation the size of the PDA and age of infant, A discussion manifestation
of patent small PDA may not causes any symptoms. s of patent
ductus Some infants have symptoms such as: ductus
arteriosus.  Fast breathing arteriosus?
 Poor feeding habits
 Tachycardia
 Rapid pulse
 Respiratory problem
 Heart murmur (usually from aorta to
the pulmonary artery, with higher
flow during systole and lower flow
during diastole)
 Cardiomegaly
 Shortness of breath
 Sweating while feeding
  Tiring very easily (left subclavicular
thrill- dialatation of ascending aorta)
 Bonding pulse
 Widened pulse pressure (reflected by
bounding peripheral pulses due to
systemic leak from aorta to
pulmonary artery)
 Poor growth or growth retardation.
 Cyanosis, that is cyanosis of the
lower extremities but not of the
upper body.

9. Find out 5 min DIAGNOSTIC EVALUATION: Lecture listening Ppt How we can
diagnostic  History collection cum diagnose
evaluation of  Physical examination discussion patent ductus
patent ductus  Electrocardiogram (ECG) arteriosus?
arteriosus.  Chest X- rays
 Echocardiogram
 Blood tests
 Right- Heart Catheterization
 MRI & CT scan
10. List out the 4 min COMPLICATIONS: Lecture Listening Ppt What are the
complications  Pulmonary hypertension cum complications
of patent  Congestive heart failure discussion of patent
ductus  Infective endarteritis ductus
arteriosus. arteriosus?
11. Describe 5 min MEDICAL MANAGEMENT: Lecture listening Ppt How will you
management Pharmacological Management: cum manage
of patent Cyclo- oxygenase inhibitor like discussion patent ductus
ductus Indomethacin or ibuprofen are used to close arteriosus?
arteriosus. the PDA during the 2nd week of life. What is the
 1. Indomethacin medical
2. Ibuprofen management
of patent
Interventional Management: ductus
 Oxygen Therapy arteriosus?
 Ventilator
 Catheter-Based Procedures What is
surgical
Surgical Management: management
Surgical closure or Patent Ductus Arteriosus for patent
(PDA) ligation. ductus
arteriosus?
Nursing Management:

Nursing assessment:
A) Nursing history & to become familiar
with the child & family.
B) Childs growth & development.
C) Level of exercise tolerance.
D) Observe for chest deformities &
pericardial bulge.
E) Palpate for pulse in all extremities &
neck.
F) Observe for skin & mucous membrane
for color & temperature changes.
Observe for clubbing specially after 1 yr of
age.
H) Auscultate the child’s heart
I) Record vital signs, apical pulse, BP,
Respiration
J) Look for & record any other congenital
defects.
Nursing Diagnosis:

1) Decreased Cardiac Output related to

malformations of the heart.
2) Impaired Gas Exchange related to
pulmonary congestion.
3) Activity Intolerance related to
imbalance between oxygen
consumption by the body and
oxygen supply to the cells.
4) Delayed Growth and Development
related to an inadequate supply of
oxygen and nutrients to the tissues.
5) Imbalanced Nutrition Less than
Body requirements related to fatigue
at mealtime and increased caloric
needs.
6) Risk for Infection related to
decreased health status.

Nursing Interventions:

A. Relieving respiratory distress.

B. Improve cardiac output.
C. Improve oxygenation & activity
tolerance.
D. Provide adequate nutrition.
E. Preventing infection.
F. Reducing fear of parents.
 PREVENTION:
 Immunization against rubella
 Reduce the preterm births
 Prompt treatment of preterm infant
with surfactant
 Use of high oscillation ventilators for
lung diseases
 Early recognition of PDA
 Repeated infusions are used with
Caution

12. Research Input 2 min. RESEARCH INPUT:

A systematic review and meta analysis

conducted by chang liu, xingwang zhu,
dinggang li (5 january 2021) to assess
related factors of Patent Ductus Arteriosus
in preterm infants. Comprehensive literature
review was conducted in PubMed,
EMBASE, and Web of Science. Study
included 45 studies with 87,419 individuals.
After the primary analysis and a series of
adjustments, results showed
chorioamnionitis, lower gestational age,
lower birth weight, bronchopulmonary
dysplasia, intraventricular hemorrhage,
necrotizing enterocolitis, respiratory distress
syndrome, sepsis, surfactant treatment,
ventilation, and lower platelet count had a
positive correlation with PDA, While small
 for gestational age decreased the incidence
of PDA in preterm infants.

13. Summarization 2 min. SUMMARY:

of
presentation. The patent ductus arteriosus (PDA) is a
vascular structure that connects the proximal
descending aorta to the roof of the main
pulmonary artery near the origin of the left
branch pulmonary artery. This essential fetal
structure normally closes spontaneously
after birth. After the first few weeks of life,
persistence of ductal patency is abnormal.
The physiological impact and clinical
significance of the PDA depend largely on
its size and the underlying cardiovascular
status of the patient. Regardless of the size,
complications may arise, and it is important
for both pediatric and adult cardiologists to
have an understanding of the
pathophysiology, clinical implications, and
management of PDA.

13. Conclusion 1 min. CONCLUSION:

Patent ductus arteriosus (PDA) is one of the

most common congenital heart defects. A
PDA, defined as failure of the ductus
arteriosus (DA) to close within 72 hours
after birth, may result in significant infant
morbidity and mortality rates that approach
30%. Potential complications of a
 persistently patent DA after birth include
heart failure, renal dysfunction, necrotizing
enterocolitis (NEC), intraventricular
hemorrhage, and altered postnatal nutrition
and growth. In addition, PDA is a risk factor
for the development of chronic lung disease
(CLD).
14. Bibliography BIBLIOGRAPHY:

 Sharma Rimple. Essentials of

Pediatric Nursing, Patent Ductus
Arteriosus. Jaypee Brothers Medical
Publisher:2013; New Delhi. Page no-
416-417.
 Behrman, kliegman, jenson.
Textbook of pediatrics, nelson
publication:16th edition.

 https://www.scribd.com/presentation
/233555215/Patent-Ductus-
Arteriosus
 https://www.scribd.com/doc/240023
07/PDA-CASE-STUDY
 Nursing Care Plan: Nursing
Diagnosis and Interventions For
Patent Ductus Arteriosus(PDA)….
https://nanda-nursing-care-
plan.blogspot.com/2013/05/nursing-
diagnosis-and-interventions-
for.html?m=1
 Patent Ductus Arteriosus
Circulation- AHA Journals
 https://www.ahajournals.org>doi>CI
RCULATIONAHA...
 Patent Ductus Arteriosus- Medindia
https://www.medindia.net>patent.....
 Related Factors of Patent Ductus
Arteriosus in Preterm….-Frontiers
https://www.frontiersin.org>articles

Assignment Learn about ventilator in detail.