Patent Ductus Arteriosus Nursing Diagnosis & Care Plan

Patent ductus arteriosus (PDA) is a congenital heart defect where the ductus arteriosus, a fetal blood vessel connecting the pulmonary artery to the aorta, fails to close after birth. This condition can lead to various complications, including heart failure and pulmonary hypertension. Nursing diagnosis and care planning are crucial for managing patients with PDA effectively.

Causes (Related to)

Patent ductus arteriosus can result from various factors that prevent the normal closure of the ductus arteriosus after birth. Common causes include:

• Premature birth (most common cause)
• Genetic factors or chromosomal abnormalities
• Maternal rubella infection during pregnancy
• Fetal alcohol syndrome
• Exposure to certain medications during pregnancy
• High altitude birth
• Congenital rubella syndrome

Signs and Symptoms (As evidenced by)

The signs and symptoms of PDA can vary depending on the size of the opening and the age of the patient. In a physical assessment, a patient with PDA may present with one or more of the following:

Subjective: (Patient or caregiver reports)

• Shortness of breath or rapid breathing
• Poor feeding and failure to thrive (in infants)
• Fatigue or weakness
• Recurrent respiratory infections

Objective: (Nurse assesses)

• Continuous heart murmur (machine-like or “washing machine” murmur)
• Bounding peripheral pulses
• Widened pulse pressure
• Tachycardia
• Tachypnea
• Hepatomegaly (in severe cases)
• Poor weight gain in infants
• Cyanosis (in severe cases)
• Abnormal chest X-ray findings
• Echocardiogram confirming PDA

Expected Outcomes

The following are common nursing care planning goals and expected outcomes for patients with patent ductus arteriosus:

• The patient will maintain adequate oxygenation and tissue perfusion
• The patient will demonstrate improved feeding patterns and weight gain (in infants)
• The patient will show signs of decreased work of breathing
• The patient will have stable vital signs within normal limits for age
• Patient/caregiver will verbalize understanding of PDA and its management
• The patient will demonstrate improved exercise tolerance (in older children and adults)
• The patient will have no signs of complications (e.g., heart failure, endocarditis)

Nursing Assessment

The nursing assessment is crucial for identifying the severity of PDA and its impact on the patient’s overall health. Here are key components of the nursing assessment for PDA:

1. Obtain a comprehensive health history
   Review prenatal, birth, and developmental history. Note any family history of congenital heart defects or genetic disorders.
2. Perform a thorough physical examination.
   Assess for signs of respiratory distress, cyanosis, and poor perfusion. Evaluate infants’ and children’s growth and development.
3. Auscultate heart sounds
   Listen for the characteristic continuous “machinery” murmur of PDA, typically heard best in the left upper sternal border or infraclavicular area.
4. Monitor vital signs
   Pay close attention to heart rate, respiratory rate, blood pressure, and oxygen saturation. Note any abnormalities or trends.
5. Assess feeding patterns and weight gain.
   In infants, evaluate feeding difficulties, duration of feedings, and weight gain over time.
6. Observe for signs of heart failure.
   Look for tachypnea, increased work of breathing, hepatomegaly, and peripheral edema.
7. Evaluate exercise tolerance
   Assess activity levels and any limitations due to fatigue or shortness of breath in older children and adults.
8. Review diagnostic test results.
   Analyze chest X-rays, echocardiograms, and other relevant studies to understand the size and hemodynamic significance of the PDA.
9. Assess psychosocial factors
   Evaluate the patient’s and family’s understanding of PDA, their coping mechanisms, and support systems.
10. Monitor for signs of complications.
    Be vigilant for symptoms of endocarditis, pulmonary hypertension, or other PDA-related complications.

Nursing Interventions

Effective nursing interventions are essential for managing patients with patent ductus arteriosus and promoting optimal outcomes. Here are the interventions:

1. Maintain optimal oxygenation
   Administer oxygen as prescribed and monitor oxygen saturation levels. Position the patient to optimize breathing and reduce work of breathing.
2. Support adequate nutrition
   For infants, assist with feeding techniques to conserve energy. Consider specialized feeding plans or supplementation as ordered.
3. Monitor fluid balance
   Carefully track intake and output. Administer diuretics as prescribed to manage fluid overload in heart failure.
4. Provide cardiac monitoring
   Continuously monitor heart rate, rhythm, and blood pressure. Report any significant changes or arrhythmias.
5. Administer medications as ordered.
   This may include prostaglandin inhibitors (e.g., indomethacin, ibuprofen) to promote PDA closure in premature infants or other cardiac medications as needed.
6. Prepare for and assist with procedures.
   This may include catheter-based closure or surgical ligation of the PDA. Provide pre-and post-procedure care and monitoring.

Nursing Care Plans

Here are five detailed nursing care plans for patients with patent ductus arteriosus:

Care Plan 1: Decreased Cardiac Output

Nursing Diagnosis: Decreased Cardiac Output related to left-to-right shunting through patent ductus arteriosus as evidenced by tachycardia, bounding pulses, and widened pulse pressure.

Related factors/causes:

• Abnormal blood flow through the patent ductus arteriosus
• Volume overload in the pulmonary circulation
• Increased workload on the left ventricle

Nursing Interventions and Rationales:

1. Monitor vital signs, especially heart rate and blood pressure, every 2-4 hours or as ordered.
   Rationale: Helps detect changes in cardiac function and effectiveness of interventions.
2. Assess peripheral pulses and capillary refill time every 4 hours.
   Rationale: Provides information about cardiac output and tissue perfusion.
3. Auscultate heart sounds and note the characteristics of the PDA murmur every shift.
   Rationale: Changes in murmur intensity can indicate alterations in PDA status or cardiac function.
4. Position the patient with the head elevated 30-45 degrees if tolerated.
   Rationale: Improves venous return and reduces cardiac workload.
5. Administer medications (e.g., diuretics, inotropes) as prescribed.
   Rationale: Helps manage symptoms and improve cardiac function.
6. Monitor for signs of heart failure (e.g., increased work of breathing, hepatomegaly).
   Rationale: Early detection allows prompt intervention to prevent complications.

Desired Outcomes:

• The patient will maintain heart rate and blood pressure within normal limits for age.
• The patient will demonstrate improved peripheral perfusion with capillary refill <3 seconds.
• The patient will show no signs of worsening heart failure.

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Care Plan 2: Ineffective Breathing Pattern

Nursing Diagnosis: Ineffective Breathing Pattern related to increased pulmonary blood flow secondary to patent ductus arteriosus as evidenced by tachypnea and increased work of breathing.

Related factors/causes:

• Pulmonary over circulation due to left-to-right shunting
• Decreased lung compliance
• Fatigue from increased respiratory effort

Nursing Interventions and Rationales:

1. Assess respiratory rate, depth, and work of breathing every 2-4 hours.
   Rationale: Helps evaluate the severity of respiratory distress and the effectiveness of interventions.
2. Position the patient to optimize lung expansion (e.g., semi-Fowler’s position).
   Rationale: Improves ventilation and reduces the work of breathing.
3. Administer oxygen as prescribed and monitor oxygen saturation continuously.
   Rationale: Ensures adequate oxygenation and helps prevent hypoxemia.
4. Suction airways as needed, using the appropriate technique for age.
   Rationale: Maintains airway patency and improves gas exchange.
5. Collaborate with respiratory therapists for chest physiotherapy as ordered.
   Rationale: Helps mobilize secretions and improve ventilation.
6. Teach and encourage age-appropriate breathing exercises.
   Rationale: Promotes optimal lung expansion and improves respiratory efficiency.

Desired Outcomes:

• The patient will maintain a respiratory rate within normal limits for their age.
• The patient will demonstrate decreased work of breathing.
• The patient will maintain oxygen saturation >95% or as prescribed.

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Care Plan 3: Imbalanced Nutrition: Less Than Body Requirements

Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to increased metabolic demands and feeding difficulties secondary to patent ductus arteriosus as evidenced by poor weight gain and fatigue during feedings.

Related factors/causes:

• Increased energy expenditure due to cardiac and respiratory workload
• Fatigue during feedings
• Possible fluid restrictions

Nursing Interventions and Rationales:

1. Assess weight daily and track growth patterns.
   Rationale: Helps evaluate nutritional status and effectiveness of feeding interventions.
2. Provide small, frequent feedings as tolerated.
   Rationale: Reduces energy expenditure during feeding and improves nutrient intake.
3. Monitor caloric intake and consider high-calorie supplements as prescribed.
   Rationale: Ensures adequate nutrition to support growth and healing.
4. Assess for signs of feeding intolerance (e.g., vomiting, abdominal distension).
   Rationale: Early detection allows prompt intervention to prevent complications.
5. Collaborate with a dietitian to develop an optimal feeding plan.
   Rationale: Ensures individualized nutritional support based on the patient’s specific needs.
6. Teach parents/caregivers proper feeding techniques and signs of feeding intolerance.
   Rationale: Assists the caregivers to provide optimal nutritional support at home.

Desired Outcomes:

• The patient will demonstrate steady weight gain appropriate for their age.
• The patient will tolerate feedings without signs of distress.
• The patient/caregiver will verbalize understanding of optimal feeding strategies.

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Care Plan 4: Risk for Infection

Nursing Diagnosis: Risk for Infection related to increased susceptibility to endocarditis secondary to turbulent blood flow through patent ductus arteriosus.

Related factors/causes:

• Abnormal blood flow through the PDA creates a risk for bacterial colonization
• Possible invasive procedures (e.g., cardiac catheterization, surgery)
• Compromised immune function in premature infants

Nursing Interventions and Rationales:

1. Implement strict hand hygiene protocols for all care providers and visitors.
   Rationale: Reduces the risk of pathogen transmission.
2. Monitor for signs of infection (e.g., fever, tachycardia, elevated white blood cell count).
   Rationale: Allows for early detection and prompt treatment of infections.
3. Maintain an aseptic technique for all invasive procedures.
   Rationale: Minimizes the risk of introducing pathogens during necessary interventions.
4. Administer prophylactic antibiotics as prescribed before procedures.
   Rationale: Helps prevent endocarditis in high-risk patients.
5. Educate patient/family about signs of infection and when to seek medical attention.
   Rationale: Promotes early recognition and treatment of potential infections.
6. Ensure all vaccinations are up to date and appropriate for each age.
   Rationale: It provides additional protection against preventable infections.

Desired Outcomes:

• The patient will remain free from signs and symptoms of infection.
• The patient/caregiver will demonstrate proper hand hygiene techniques.
• The patient will receive all recommended vaccinations on schedule.

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Care Plan 5: Anxiety (Patient/Family)

Nursing Diagnosis: Anxiety related to uncertainty about prognosis and potential complications of patent ductus arteriosus as evidenced by verbalized concerns and increased questioning.

Related factors/causes:

• Limited understanding of the condition and its management
• Fear of potential complications or surgical interventions
• Stress-related to hospitalization and disruption of family routines

Nursing Interventions and Rationales:

1. Assess the level of anxiety and understanding of PDA in the patient/family.
   Rationale: Provides a baseline for education and support needs.
2. Provide clear, age-appropriate information about PDA, its management, and prognosis.
   Rationale: Increases understanding and helps reduce fear of the unknown.
3. Encourage verbalization of concerns and questions.
   Rationale: Allows for addressing specific worries and misconceptions.
4. Teach age-appropriate relaxation techniques (e.g., deep breathing, guided imagery).
   Rationale: Provides coping strategies to manage anxiety.
5. Facilitate communication with healthcare team members.
   Rationale: Ensures consistent information and allows for addressing complex questions.
6. Provide information about support groups or counseling services if needed.
   Rationale: Offers additional resources for ongoing emotional support.

Desired Outcomes:

• The patient/family will verbalize decreased anxiety levels.
• The patient/family will demonstrate the use of effective coping strategies.
• Patient/family will express an accurate understanding of PDA and its management.

References

1. Allen, H. D., Driscoll, D. J., Shaddy, R. E., & Feltes, T. F. (2013). Moss & Adams’ Heart Disease in Infants, Children, and Adolescents: Including the Fetus and Young Adult (8th ed.). Lippincott Williams & Wilkins.
2. Fulton, D. R., & Saleeb, S. F. (2022). Management of patent ductus arteriosus in term infants, children, and adults. UpToDate. Retrieved November 2023, from https://www.uptodate.com/contents/management-of-patent-ductus-arteriosus-in-term-infants-children-and-adults
3. Herdman, T. H., & Kamitsuru, S. (Eds.). (2018). NANDA International Nursing Diagnoses: Definitions & Classification 2018-2020. Thieme.
4. Kliegman, R. M., St Geme, J. W., Blum, N. J., Shah, S. S., Tasker, R. C., & Wilson, K. M. (2019). Nelson Textbook of Pediatrics (21st ed.). Elsevier.
5. Lewis, S. L., Bucher, L., Heitkemper, M. M., & Harding, M. M. (2016). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (10th ed.). Elsevier.
6. Marino, B. S., & Lipkin, P. H. (2020). Neurodevelopmental Outcomes in Children With Congenital Heart Disease: Evaluation and Management. Circulation, 142(13), 1193-1213. https://doi.org/10.1161/CIRCULATIONAHA.119.040337
7. Slaughter, J. L., & Reagan, P. B. (2021). Patent Ductus Arteriosus Treatment Decisions in Preterm Infants: Where Are We Now? Neonatology, 118(2), 127-137. https://doi.org/10.1159/000514021
8. Wechsler, S. B., & Wernovsky, G. (2021). Cardiac Intensive Care in Infants and Children (3rd ed.). Elsevier.