Patent Ductus Arteriosus

Definiton Signs and Symptoms

-A condition where the opening between the  Heart murmur
two major blood vessels leading from the  Rapid heartbeat
heart fail to close after birth. In the womb, the  Breathlessness
opening (ductus arteriosus)is the normal part  Fast breathing
of the circulatory system of the baby.  Poor feeding
 Slow growth
Risk Factors  Low weight
- Girls  Cardiomegaly (enlarged heart)
- Preterm infants
- Family history Complications
- Rubella infection - Right ventricle hypertrophy (RVH)
-Chromosomal abnormalities - Pulmonary hypertension
-Genetic conditions such as Wiedemann- - Heart failure
Steiner syndrome, Loeys-Dietz syndrome - Endocarditis

Causes Laboratory tests/Diagnoses

-The ductus arteriosus is an accessory fetal  Auscultation: The doctor listens to sounds

structure that connects the pulmonary artery from the heart and lungs using a

to the aorta. If it fails to close at birth, blood stethoscope.

will shunt from the aorta (oxygenated blood)

to the pulmonary artery (deoxygenated blood)  Echocardiogram: Shows any abnormality

because of the increased pressure in the in the blood flow and the size of the

aorta. heart.

 Prematurity. PDA is most prevalent in  Electrocardiogram (ECG or EKG): Records

premature neonates, probably as a result the electrical activity of the heart and will

of abnormalities in oxygenation. detect irregular heart rhythms. It can also

 Prostaglandin E. The relaxant action of identify an enlarged heart.

prostaglandin E prevents ductal spasm

and contracture necessary for closure.  X-ray: Chest X-ray is done to visualize the

 Other congenital defects. PDA commonly overall heart size and appearance of

accompanies rubella syndrome and may blood flow to the lungs

be associated with other congenital

defects, such as coarctation of the aorta, Medical Management

ventricular septal defect, and pulmonary Procedures

and aortic stenosis.

 Thoracotomy or Cardiac surgery: To Nursing Diagnosis
correct the defect if the opening is large.  Activity intolerance related to imbalance
Usually done for children above 6 months between oxygen consumption of the
of age. body and supply of oxygen to the cells.
 Anxiety related to hospital care or lack of
 Catheter assisted procedure: A device, support system.
inserted through a catheter, on the  Deficient knowledge related to the
opening of femoral artery blocks flow of condition and treatment needs.
blood through the opening restoring
normal blood flow. Nursing Care Planning & Goals
 ductal ligation- The DA may be closed by  Maintain adequate cardiac output.
ligation, wherein the DA is manually tied  Reduce the increase in pulmonary
shut, or with intravascular coils or vascular resistance.
alseplugs that leads to formation of a  Maintain adequate levels of activity.
thrombus in the DA.  Provide support for growth and
development.
Medication  Maintain appropriate weight and height
 IV indomethacin (Indocin)- Inhibits development.
prostaglandin synthesis.
 Ibuprofen( Drug of choice)- it works by Prognosis
blocking your body’s production of Ductus arteriosus closing on their own is rare
certain natural substances that cause in babies older than 3 months however there
inflammation. is 72-75% of chances in premature infants
Nursing Management younger than 11-13 weeks. Approximately
Indomethacin 28% of infants developing patent ductus
• Administer reconstituted solution arteriosus are treated conventionally with
intravenously over medicines and medical studies show a 94%
5 to 10 seconds. closure rate
• Space doses at specified intervals.
• Educate the parents about the rationale
for using
the drug.
• Observe the child closely for adverse
effects. Check the infusion site carefully for
signs of oozing or bleeding indicative of Tetralogy of Fallot
impaired clotting. Also assess vomitus or urine Definition:
for bleeding - A congenital heart condition presenting a
combination of four defects in the structure of
the heart. The most common symptoms is
bluish color of the skin in the new-born.It is
called a tetralogy because four anomalies are
present: pulmonary stenosis, VSD (usually
large), dextroposition (overriding) of the aorta,
and hypertrophy of the right ventricle.
Risk factors
A viral illness during pregnancy, such as ;
 Rubella (German measles)
 Alcoholism during pregnancy.
 Poor nutrition during pregnancy
 Presence of down syndrome
 Maternal diabetes
 If mother’s age is more than 40 years
Causes
- Unknown
 If not treated at time, it might result into
death
Laboratory tests/Diagnoses
 Echocardiogram: High wave sound images
are used to get the image of heart.
 Electrocardiogram (ECG or EKG): It is
performed to record the electrical activity
of heart every time it contracts.
 X-ray: Chest X-ray shows the structure of
heart and lungs.
 Oxygen level measurement: It is used to
know the amount of oxygen in blood.

Signs and Symptoms/ Manifestations

 Cardiac catheterization: A catheter is
 Bluish coloration of the skin due to the
inserted to evaluate the structure and
reduced amount of oxygen in blood
function of the heart.
 Difficulty in breathing especially while
breast feeding or exercising
Medical Management
 Shortness of breath
 Propanolol (Inderal, a beta-blocker)
 Growth of skin and bones around the
metoprolol
fingernails or toes (Clubbing)
 Blalock-Taussig procedure
 Poor weight gain
 Brock procedure
 Loss of consciousness
 Problems with eating
 Prolonged crying
 Developmental delay
 Irritability Nursing Management

 Heart murmur  Place the patient on their left side,

Complications knees to chest.
 Risk of infective endocarditis  Cautiously administer oxygen therapy
 Delayed growth and development as prescribed.
 Irregular heart rhythms  placing the baby in a knee–chest
 Seizures due to lack of oxygen
position
Prognosis

Infants with normal oxygen levels or only mild

cyanosis are usually able to go home in the
first week of life. Complete repair is usually
done electively when children are about 6
months of age, as long as the oxygen levels
remain adequate.