Patent ductus arteriosus

Patent Ductus Arteriosus PDA Nursing Care Plans Diagnosis and Interventions

Patent Ductus Arteriosus PDA NCLEX Review Care Plans

Nursing Study Guide on Patent Ductus Arteriosus

Patent ductus arteriosus (PDA) is a common congenital heart disease characterized by persistent opening of the ductus arteriosus.

The ductus arteriosus is an opening between the aorta and pulmonary artery. It is necessary in the normal development of fetus.

At birth, it typically constricts and closes within the first 10-15 hours of life. If this closure does not occur, the ductus arteriosus will remain open, which could lead to infant morbidity and mortality.  

Patent ductus arteriosus accounts for 5-10% of all congenital heart diseases in full term infants with a male to female ratio of 1:3.

It is also quite common in pre-term and low birth weight babies. About a third of patent ductus arteriosus cases will settle on its own and close spontaneously.

If the ductus arteriosus stays open, immediate medical treatment is required.

Signs and Symptoms of Patent Ductus Arteriosus

The clinical manifestations of patent ductus arteriosus greatly rely on the size of the opening of the ductus arteriosus and of the age of gestation at birth.

A small PDA does not typically present any symptoms and may be left unnoticed until later in life. In infants with large PDA, signs and symptoms of heart failure may show.

Additional symptoms of respiratory distress may also be noted in premature infants with large PDA. The following may be expected to be seen:

  • Failure to thrive
  • Poor feeding
  • Tachypnea
  • Dyspnea when feeding
  • Tachycardia
  • Apnea
  • Increasing mechanical ventilator requirement
  • Heart murmur

Causes of Patent Ductus Arteriosus

The main cause of patent ductus arteriosus is still unknown. It is believed that genetics play a role in its occurrence.

Patent ductus arteriosus occurs when the ductus arteriosus persistently remain open after birth. The ductus arteriosus is a normal opening between the aorta and pulmonary artery in fetus.

It serves as a channel to supply oxygenated blood from the maternal circulation to the fetus. At birth, it normally closes within the first 10-15 hours up to 2-3 days.

Failure for the ductus arteriosus to close at birth can lead to pulmonary overload and heart failure.

It is highly related to morbidity and mortality in preterm infants. An early diagnosis is essential in reducing the damage it can cause.

The following are the risk factors for having a patent ductus arteriosus:

  • Premature birth. Patent ductus arteriosus is common in preterm infants. About 45% of infants with <1750 grams birth weight and 70-80% in infants with <1200 grams birth weight.
  • Family history of other genetic conditions. History of heart defects and genetic condition, like Down syndrome, increases the risk of PDA.
  • Rubella infection during pregnancy. The infection with German measles of the mother during pregnancy predisposes the fetus to develop heart defects. The rubella virus responsible for German measles can cross the placenta and can damage the developing organs of the fetus.
  • Being born in high altitude. It is known that infants born above 10,000 feet have greater risk of having PDA.
  • Female. The male to female ratio of PDA is 1:3.

Complications of Patent Ductus Arteriosus

The following are the known complications of patent ductus arteriosus:

  • Pulmonary Hypertension. High blood pressure in the lungs occurs when there is too much blood circulating from the heart to the lungs through the patent ductus arteriosus. This can lead to permanent lung damage and Eisenmenger syndrome which is an irreversible type of pulmonary hypertension.
  • Heart Failure. In cases of patent ductus arteriosus, the amount of oxygenated blood pumped to the system is reduced as it ends up circulating the lungs instead. The heart then tries to compensate by pumping even harder, which in the long run, can tire the heart and lead to heart failure.
  • Endocarditis. Endocarditis is the inflammation of the inner lining of the heart. It may happen because of patent ductus arteriosus.

Diagnosis of Patent Ductus Arteriosus

  • Medical history – to check for the presence of risk factors.
  • Physical examination- signs of heart failure and respiratory distress may be noted.
  • Chest X-ray – to visualize the heart and lungs. If the PDA is small, the chest x-ray may appear normal. If the PDA is significant, imaging will show a prominent left atrium, left ventricle, and ascending aorta.
  • Electrocardiogram – to check the functioning of the heart. Similar to a chest X-ray, a normal report may be expected if the PDA opening is small. On the other hand, left ventricular hypertrophy may be noted if the patency of the ductus arteriosus is significant.
  • Echocardiogram – provides information on the following:
    • Size of the PDA
    • Flow velocity
    • Presence of heart enlargement
    • Presence of diastolic reversal of flow in the descending aorta
    • Presence of diastolic antegrade flow in the left pulmonary artery
  • Cardiac Catheterization – involves the insertion of a thin tube into the artery or vein to reach the heart. It is not commonly performed unless treatment will be carried out as well.

Treatment of Patent Ductus Arteriosus

The treatment options for PDA commonly depend on the age of the person being treated. In cases of a small PDA, there may be no symptoms noted, hence, no treatment is necessary.

  1. Close Monitoring. About a third of infants with PDA will have the shunts to close on their own. Close monitoring is required to make sure that this happen and that no harmful complications will arise.
  2. Medications. Certain medications are used to help treat PDA. In premature infants, a non-steroidal anti-inflammatory drug (NSAID) can be used to help close the opening. NSAIDs are known to block the hormone-like chemicals that keep the ductus arteriosus open. However, this drug is not effective in closing the PDA in full term infants or adults.
  3. Surgical Closure of the PDA. If other treatments are not working, the doctor may opt for a surgical closure of the ductus arteriosus. The cut will be made on the infant’s chest to reach for the heart. A few weeks stay in the hospital is needed after the surgery to closely monitor the infant.
  4. Catheter Procedures. Catheterization is not recommended for preterm babies. If no severe health problems are noted, this procedure is postponed until a pre-mature baby grows full-term. Cardiac catheterization is a lesser invasive procedure than a surgical closure of the PDA. It involves the insertion of a thin catheter through the blood vessel of the infant, into the heart. A plug or a coil is then inserted to cover the opening. This procedure can be done in an outpatient setting and will only require an overnight stay in the hospital.

Nursing Care Plans for Patent Ductus Arteriosus

Nursing Care Plan 1

Nursing Diagnosis: Risk for Decreased Cardiac Output secondary to patent ductus arteriosus

Desired outcome: The patient will be able to maintain adequate cardiac output.

InterventionsRationales
Assess the patient’s vital signs and characteristics of heart beat at least every 4 hours. Assess breath sounds via auscultation. Observe for signs of decreasing peripheral tissue perfusion such as slow capillary refill, facial pallor, cyanosis, and cool, clammy skin.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. Breath sounds of crackles/rales are important signs of heart failure, which is a severe complication of patent ductus arteriosus. The presence of signs of decreasing peripheral tissue perfusion indicate deterioration of the patient’s status which require immediate referral to the physician.
Administer the medications as prescribed.  To treat the underlying condition (PDA) using non-steroidal anti-inflammatory drugs (NSAIDs), which have been found effective in blocking the hormone-like chemicals that prevent the PDA from closing. It is important to note that NSAIDs are used for premature babies and are not effective in PDA patients who are full-term babies or adults.  
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value within target range.
Prepare the infant for surgical intervention if indicated.To surgically close the PDA using clips or stitches.  
Prepare the patient for catheter procedure if indicated.Premature babies are usually too small for the correct of PDA using catheter method. The physician will advise the parents to wait until the baby reaches full-term and is eligible for the catheter procedure. After insertion of the thin catheter, a coil or plug is inserted through the tube to facilitate closure of PDA.

Nursing Care Plan 2

Nursing Diagnosis: Deficient Knowledge related to new diagnosis of patent ductus arteriosus as evidenced by patient’s mother’s verbalization of “I want to know more about my baby’s diagnosis and care”

Desired Outcome: At the end of the health teaching session, the patient’s mother will be able to demonstrate sufficient knowledge of PDA and its management.

InterventionsRationales
Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits)To address the patient’s cognition and mental status towards the new diagnosis of PDA and to help the patient overcome blocks to learning.
Explain what PDA is, and how it affects the vital organs such as the heart. Avoid using medical jargons and explain in layman’s terms.To provide information on PDA and its pathophysiology in the simplest way possible.
Inform the carer the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) for PDA.To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and administration details.
Educate the parent/guardian about the need for surgery or catheter procedure for the baby before getting the consent.To close the PDA either surgically using clips or stitches or using the catheter-and-plug method.
Inform the parent or guardian about the importance of life-long follow up care.Even after the closure of PDA, the child is deemed at risk for cardiac complications.

Other possible nursing diagnoses:

  • Failure to thrive
  • Imbalanced Nutrition: Less than Body Requirements related to poor feeding

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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