PATENT DUCTUS ARTERIOSUS - ENGLISH
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PDA IN CHILDREN-
The ductus arteriosus, is a
blood vessel in the developing fetus connecting the trunk of the pulmonary
artery to the proximal descending aorta. It allows most of the blood from the
right ventricle to bypass the fetus's non-functioning lungs. It blocks and
disappear after birth when lung starts functioning.
Patent ductus arteriosus (PDA) is a congenital defect in which
the ductus arteriosus fails to close after birth. this allows
a portion of oxygenated blood from the left heart to flow back to the
lungs via the aorta to the pulmonary
artery.
A small patent ductus
arteriosus often doesn't cause problems and might never need treatment.
However, a large patent ductus arteriosus left untreated can allow poorly
oxygenated blood to flow in the wrong direction, weakening the heart muscle and
causing heart failure and other complications.
SIGN AND SYMPTOMS OF PDA
-
Ø Patent ductus arteriosus
symptoms vary with the size of the defect and whether the baby is full term or
premature. A small PDA might cause no signs or symptoms and go undetected for
some time — even until adulthood. A large PDA can cause signs of heart failure
soon after birth.
Ø first
of all the defect present with a heart murmur while listening to the baby's
heart through a stethoscope.
Ø
Pulse
pressure is increased
Ø
Sweating
with crying or eating
Ø
Persistent
fast breathing or breathlessness
Ø
Easy
tiring
Ø
Rapid
heart rate
DIGNOSTIC
INVESTIGATIONS-
q
Physical examination-auscultaion of chest.
q
Echocardiography
q
Chest
X-ray.
TREATMENT-
Ø Treatments for patent ductus
arteriosus depend on the age of the person being treated. Options might
include:
Ø Watchful
waiting. - In a premature baby, a PDA often closes
on its own. The doctor will monitor the baby's heart to make sure the open
blood vessel is closing properly. For full-term babies, children and adults who
have small PDAs that aren't causing other health problems, monitoring might be
all that's needed.
Ø Medications.
- In a
premature baby, nonsteroidal anti-inflammatory drugs (NSAIDs) — such as
ibuprofen or indomethacin might be used
to help close a PDA. NSAIDs block the hormone like chemicals in the body that
keep the PDA open. NSAIDs won't close a PDA in full-term babies, children or
adults.
Ø Surgical
closure. - A surgeon makes a small cut between the
child's ribs to reach the child's heart and repair the open duct using stitches
or clips.
Ø After
the surgery, the child will remain in the hospital for several days for
observation. It usually takes a few weeks for a child to fully recover from
heart surgery.
Ø Catheter
procedures. - In a catheter procedure, a thin tube
(catheter) is inserted into a blood vessel in the groin and threaded up to the
heart. Through the catheter, a plug or coil is inserted to close the ductus
arteriosus.
NURSING MANAGEMENT-
Ø - Observation of
respiratory and cardiac status is very important nursing care in PDA.
Ø - If
signs of respiratory distress are noted, the children should be placed in semi
fowler's position.
Ø -
all the medications are given on time, parents are involved in the care.
Ø
-
Intake output chart is maintained so that nutritional status and water balance
is assessed.
Ø
-
If surgery or catheterization procedure is scheduled, inform the parents about
the procedure and prepare them for surgery.
Ø
-
Anxiety level of parents is assessed and psychological support is provided to
alleviate anxiety.
Ø
Intake
output chart is maintained so that nutritional status and water balance is
assessed.
Ø
Surgical site care is provided with aseptic
technique to prevent infection and promote healing.
Ø
Other Nursing interventions – includes all nursing
care of hospitalized child that we have discussed in previous lecture under
heading Nursing care of hospitalized child in the lecture “Child Health
Nursing”.
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