Ductous Arterious

Subject: Child Health Nursing

Overview

By the eighth week of gestation, the DA, which derives from the distal dorsal sixth aortic arch, has fully developed. Its job is to divert blood away from the fetal lung that isn't working by connecting to the proximal descending aorta and the main pulmonary artery. Through the descending aorta and subsequently the placenta, where gas exchange will take place, the blood with a relatively low oxygen concentration from the right ventricle can be transported. 90% of the right ventricular output before birth passes through the DA. The fetus's premature closure is linked to serious morbidities, such as right-sided heart failure, which can lead to fetal hydrops. Infants who are premature may require more oxygen or ventilator support to breathe. A medication called indomethacin (in-doh-METH-ah-sin) aids in the closure of PDAs in premature newborns. The PDA tightens or constricts as a result of this medication, closing the opening. In most cases, indomethacin doesn't function on fully developed infants. Ibuprofen is also used to help premature newborns with PDA closure. This drug is comparable to indomethacin. Surgery is an option, but it has risks as well, including atelectasis, pneumonia, seizures, and pneumothorax. Assessing the child's current sickness, general health, prescribed medications, and other health issues is part of nursing management. Prior to surgery, get any necessary lab and diagnostic tests, and keep a regular eye on vital signs, a person's skin or mucous membrane color, capillary refill, peripheral pulses, oxygen saturation, and an ECG.

Ductous Arterious

One of the most prevalent congenital heart abnormalities is patent ductus arteriosus (PDA). When the ductus arteriosus (DA) fails to close within 72 hours of delivery, this condition is known as a PDA. It can cause considerable infant morbidity and mortality rates that are close to 30%. Heart failure, renal impairment, necrotizing enterocolitis (NEC), intraventricular hemorrhage, and altered postnatal nutrition and growth are among the potential side effects of a continuously patent DA after delivery. PDA also increases the likelihood of developing chronic lung disease (CLD).

Pathophysiology

By the eighth week of gestation, the DA, which derives from the distal dorsal sixth aortic arch, has fully developed. Its job is to divert blood away from the fetal lung that isn't working by connecting to the proximal descending aorta and the main pulmonary artery. Through the descending aorta and subsequently the placenta, where gas exchange will take place, the blood with a relatively low oxygen concentration from the right ventricle can be transported. 90% of the right ventricular output before birth passes through the DA. The fetus's premature closure is linked to serious morbidities, such as right-sided heart failure, which can lead to fetal hydrops.

Causes

  • Unknown
  • Genetics may play a role in causing the condition. A defect in one or more genes might prevent the ductus arteriosus from closing after birth.

Sign and symptoms

  • Fast breathing, working hard to breathe, or shortness of breath. Premature infants may need to be increased oxygen or help to breathe from a ventilator.
  • Poor feeding and poor weight gain.
  • Tiring easily.
  • Sweating with exertion, such as while feeding.

Diagnosis

  • History taking
  • Physical examination
  • Echocardiology
  • Echocardiogram
  • Chest x-ray
  • CBC and ABG

Treatment

  • Medicine
    • Indomethacin (in-doh-METH-ah-sin) is a medicine that helps close PDAs in premature infants. This medicine triggers the PDA to constrict or tighten, which closes the opening. Indomethacin usually doesn't work in full-term infants.
    • Ibuprofen also is used to close PDAs in premature infants. This medicine is similar to indomethacin.
  • Catheter-Based Procedures
    • Catheters are thin, flexible tubes used in a procedure called cardiac catheterization. Catheter-based procedures often are used to close PDAs in infants or children who are large enough to have the procedure.
  • Surgical
    Surgical procedures include the closure of VSD, resection of the pulmonary stenosis, and removal of hypertrophied muscle. Surgical repair preferred in the first year of life. Other indications for surgeries are cyanosis and development of hyper cyanotic spells. Surgery is the mainstay of treatment for PDA. Two forms of surgical therapy are performed: the traditional surgical approach, which entails a thoracotomy (or alternatively, thoracoscopy), and catheter closure.
    • Complication of surgery
    • Atelectasis
    • Bacterial endocarditis
    • Cardiac arrhythmias
    • Hemorrhage
    • Pleural effusion
    • Pneumonia
    • Seizure
    • Pneumothorax

Nursing management

  • Pre-operative care
    • Assess the child's present illness, general condition, current medication, additional health problems.
    • Obtain any necessary lab and diagnostic test preoperatively.
    • Give preoperative teaching
    • Surgery and its outcomes
    • Post- operative activity
    • Risk and complications
    • Deep breathing exercise
    • Early ambulation
    • Leg exercise
    • Proper gowning.
    • Pre- operative medications and NPO.
  • Post-operative care
    • Immediate post-operative care is provided in surgical ICU with, specially trained nurses.
    • General post-operative care includes
      • Observation/monitor of patient's condition
        • Monitor vital signs frequently, a color of skin/mucous membrane, capillary refill, peripheral pulses, oxygen saturation.
        • Maintain continue/regular ECG monitoring of child.
      • Maintaining respiratory status
        • Care of the child with endotracheal intubation and mechanical ventilation.
        • Administer humidified oxygen
        • Monitor function of the closed chest drainage and mechanical ventilation function.
      • Provide maximum rest and comfort
        • Provide adequate rest after surgery.
        • Provide adequate rest and sleep by scheduling visiting time.
        • Apply analgesics for pain management.
        • Provide non-pharmacological strategies too.
      • Plan for progressive activity
        • Coughing and breathing exercise
        • Passive range of motion exercise of lower extremities.
        • Progressive ambulation.
      • Maintain fluid and electrolytes
        • Maintain strict I/O chart of a chest tube, a drainage tube, CVP line, foleys catheter.
      • Family support and health education
        • Explain clearly about disease condition and operative procedure.
        • Instruct and involve parents in child care.
        • Encourage to provide play and stimulation to the child.
      • Monitor for complication like:
        • Abnormal heart beats
        • Signs of infection
        • Difficulty in breathing
        • Hemorrhage

 

 
Things to remember
  • Patent ductus arteriosus (PDA) is one of the most common congenital heart defects.
  • The DA is derived from the distal dorsal sixth aortic arch and is completely formed by the eighth week of gestation.
  • Genetics may play a role in causing the condition. A defect in one or more genes might prevent the ductus arteriosus from closing after birth.
  • Fast breathing, working hard to breathe, or shortness of breath. Premature infants may need to be increased oxygen or help to breathe from a ventilator.
  • Surgical procedures include the closure of VSD, resection of the pulmonary stenosis, and removal of hypertrophied muscle.
  • Assess the child's present illness, general condition, current medication, additional health problems.
  • Monitor vital signs frequently, a color of skin/mucous membrane, capillary refill, peripheral pulses, oxygen saturation.
Videos for Ductous Arterious
Ductous Arterious
Ductous Arterious
Questions and Answers

One of the most prevalent congenital heart abnormalities is patent ductus arteriosus (PDA). When the ductus arteriosus (DA) fails to close within 72 hours of birth, this condition is known as a PDA, and it can cause significant infant morbidity and mortality rates that are close to 30%. 2 Heart failure, renal impairment, necrotizing enterocolitis (NEC), intraventricular hemorrhage, and altered postnatal nutrition and growth are possible side effects of a persistently patent DA after birth. 3,4 PDA also increases the risk of developing chronic lung disease.

 

  • Breathing too quickly, laboriously, or experiencing breathlessness. 
  • Premature infants could require more oxygen or ventilator support to help them breathe.
  • Bad nutrition, bad weight growth.
  • Easily worn out.
  • Sweating when working hard, such as during eating.

 

Treatment:

  • Medicine:
    • A medication called indomethacin (in-doh-METH-ah-sin) aids in the closure of PDAs in premature newborns. The PDA tightens or constricts as a result of this medication, closing the opening. In most cases, indomethacin doesn't function on fully developed infants.
    • Ibuprofen is also used to help premature newborns with PDA closure. This drug is comparable to indomethacin.
  • Surgical:
    • Closing a VSD, resecting a pulmonary stenosis, and removing a hypertrophied muscle are all surgical procedures. The first year of life is ideal for surgical repair. The occurrence of hypercyanotic spells and cyanosis are additional indications for surgery.

Complication of surgery:

  • Atelectasis
  • Bacterial endocarditis
  • Cardiac arrhythmia
  • Hemorrhage
  • Pleural effusion
  • Pneumonia
  • Seizure
  • Pneumothorax

Nursing management:

  • Preoperative treatment
  • Examine the child's current health issues, overall status, medications, and other medical issues.
  • Prior to surgery, get any necessary lab and diagnostic tests.
  • Impart preoperative instruction
  • The results of surgery
  • Post-surgical activities
  • Risk and difficulties
  • Exercises for deep breathing
  • First ambulation
  • Leg workout
  • Correctly gowned.
  • NPO and preoperative medicines.
  • After-surgery care
  • The surgical ICU offers immediate post-operative treatment with fully trained nurses.

Included in general post-operative treatment are:

  • Observation/monitor of patient's condition:

    • Regularly check your vital signs, including your skin's or mucous membrane's color, capillary refill, peripheral pulses, and oxygen saturation.
    • Continue to monitor the child's ECG on a regular basis.

  • Maintaining respiratory status:

    • Endotracheal intubation and mechanical ventilation are used to care for the infant.
    • Give out humidified oxygen.
    • Keep an eye on the mechanical ventilation and closed chest drainage functions.

  • Provide maximum rest and comfort:

    • Rest as much as you need following surgery.
    • By planning visitation times, you can give yourself enough rest and sleep.
    • To manage pain, use analgesics.
    • Likewise offer non-pharmacological methods.

  • Plan for progressive activity:

    • Exercises for breathing and coughing
    • Lower-extremity passive range of motion exercises.
    • Advancing ambulation.

  • Maintain fluid and electrolytes:

    • Keep a strict I/O chart with a CVP line, a foleys catheter, a drainage tube, and a chest tube.

  • Family support and health education:

    • Clearly describe the disease's symptoms and the surgical process.
    • Parent education and involvement in child care.
    • Encourage others to play with and stimulate the child.

  • Monitor for complication like:

    • Irregular heartbeats
    • Indicators of infection
    • Breathing difficulties
    • Hemorrhage.

 

  • History taking
  • Physical examination
  • Echocardiology
  • Echocardiogram
  • Chest x-ray
  • CBC and ABG

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