I.

OBJECTIVES

General Objective:

At the end of the case study, the level 3 nursing students will be able to expound and
connect all ideas and knowledge gained to the nursing approach in doing valid and outmost care
with the patient diagnosed of CHD D-TGA, PDA, PFO.

Specific Objectives:

As supported by our main objective, the level 3 student nurses will be able to:

1. Familiarize with the background of what Congenital Heart Disease and Patent Ductus
Arteriosus is all about;
2. Recognize the predisposing and precipitating factors that may increase the development of
Patent Ductus Arteriosus;
3. Review and understand the Anatomy and Physiology of the Cardiovascular System and
each functions;
4. Explain and Illustrate the Pathophysiology of Patent Ductus Arteriosus;
5. Determine what specific laboratory results that may lead to Patent Ductus Arteriosus;
6. Describe the potential complications related to Patent Ductus Arteriosus.
7. Develop a comprehensive nursing care plan, with a principle of SMART, that is applicable
to the client diagnosed with Patent Ductus Arteriosus;
8. Provide a well-develop Health Teaching using the METHODS formula to promote positive
continuity of care to the patient after discharge which would be in great help for his
condition; and
9. Elaborate and appreciate the importance of the Cardiovascular System.
 II. PERSONAL DATA

NAME: C.T.E

GENDER: Female

AGE: 1 6/12 y.o

ADDRESS: 129 Anonas Ext. Sikatuna Village Quezon City

BIRTHDATE: January 04, 2008

BIRTHPLACE: Tagbilaran Bohol

RELIGION: Roman Catholic

CIVIL STATUS: Single

NATIONALITY: Filipino

ATTENDING PHYSICIAN: Dr. J.D.

DATE AND TIME OF ADMISSION: July 16, 2009; 8:10 PM

CHIEF COMPLAINT: Cyanosis

ADMITTING DIGNOSIS: CHD D-TGA, PDA, PFO

INITIAL V/S (9:00AM)

T 37.3 ̊C
HR 165
RR 65
III. NURSING ASSESSMENT

A. NURSING HISTORY (Gordon’s 11 FUNCTIONAL HEALTH PATTERNS))

1. Health Perception
According to the mother, being in the hospital makes C.J.E. cry a lot especially
when inserted with IV needle/catheter. Also, during phlebotomy, she sees her
daughter in so much suffering. However, when visited by nurses, C.J.E. doesn’t
cry a lot and seems to understand that they are there just to take care of her. She
doesn’t manifest any avoidance behavior
2. Nutritional-Metabolic Pattern
C.J.E. is on DAT diet. Her mother reveals that she likes to brestfeed very often
but can’t eat nor drink water that much. Because of her illness, she has minimal
appetite for food. She can’t tolerate large amount of them because it will cause
her dyspnea (shortness of breath). C.J.E. eats in very small, frequent feedings and
her favorites are biscuits and fried chicken. On the other hand, C.J.E. drinks water
with the use of a dropper containing just 2ml water.
3. Elimination Pattern
C.J.E’s bowel movement is regular. She defecates semi-solid to solid, brownish to
yellowish stool. She is not constipated at all. However, her voiding pattern is
impaired. C.J.E. experiences extreme oliguria in the absence of Furosemide. She
even cries so much if she can’t pass urine thus, making her diuretic-dependent.
4. Activity and Exercise
C.J.E. learns to crawl at her 1st year of age, as well as grasping of objects, saying
her first word, waving goodbye and rolling over the bed. She is fond of grasping
any object within her reach and loves to play with them. Her mother shares, “Pag
latag ko sa kanya sa kama, nagpapaikot-ikot na siya. Parang gumigiling siya
tuwing naririnig yung kantang Igiling-giling”. However, upon admission to
PCMC, C.J.E. becomes generally lethargic.
5. Sleep-Rest Pattern
C.J.E.manifests sleep disturbances. She wakes up at night every now and then.
Her sleeping pattern is interrupted and not comfortable. Her mother tells, “Hindi
talaga tuloy-tuloy ang pagtulog niya. `Ni hindi nga siya nakakatulog ng matagal
at mahimbing e. Kapag dumedede lang siya nakakatulog ng matiwasay”.
6. Cognitive-Perceptual Pattern
At 1 year of age, C.J.E. utters the words “Ma” and “Pa”. She is very attracted to
anything that’s color red and easily turns her head upon hearing her name.
According to her mother, C.J.E. speaks words on her own, without having to
teach them to her.
7. Self-Perception Pattern
 C.J.E.’s overall response to hospitalization is somewhat negative. Though she
seems okay at times, her cries and grimaces show that she feels very ill and truly
suffering.
8. Role-Relationship Pattern
C.J.E. is the 2nd and youngest child in the family. Her eldest brother is 5 years old.
C.J.E. is closest to her mother. Her mother even shares, “Gustong-gusto niya lagi
magpakarga sa akin. Paborito niya yung palagi ko siyang hinahalikan”.
9. Sexuality-Reproductive Pattern
C.J.E. is a1 ½-year old, baby girl.
10. Values-Belief Pattern
Her family is Roman Catholic. Her mother always brings her to the church when
hearing mass every Sunday. They go to mass in their hometown in Bohol. But
now, that C.J.E. is hospitalized, her mother can only pray, “Panginoon, sana
naman po gumaling na ang anak ko”.
11. Coping-Stress Pattern
C.J.E. can only stop crying upon breastfeeding. Also, she likes playing with her
small toys. Divertional activities can be carrying her, showing her bright-colored
stuff which she can touch and play with. C.J.E. smiles easily and is not hard to
take care of.

B. PHYSICAL ASSESSMENT

ASSESSMENT RESULT INTERPRETATION & ANALYSIS

pale skin with 0/4 functional level

(cannot move without assistance); There is presence of pale skin due
General Health &
weakness on both extremities; poor to poor peripheral circulation and
Appearance
weight gain; chest circumference of cardiac output
44 cm

Cyanosis There is presence of cyanosis

Skin because of increased concentration
of deomyhemoglobin.

Head is larger than the body; Head

Circumference of 44.5cm; absence of
Head nodules; hair strands are thin and the
scalp is not dry; color of the hair is
black
 Pupils are symmetrical, round, and
Eyes reactive to light and accommodation;
(+) droopy eyelids

Ears Symmetrical and with good hearing

No deviation, nasal mucosa appears

pink and without abnormal discharge,
Nose
and no nasal polyps or other lesions
are noted

Present because of decrease in

hemoglobin concentration;
Mouth & Throat Circumoral cyanosis
associated with nipple or breast
feeding

Symmetrical and palpations reveal no

Accumulation of blood in veins that
Neck nodules and masses; (+) distended
are returning blood to the heart
neck vein

Inadequate systemic perfusion;

Nails Poor capillary refill poor capillary perfusion and cardiac

output

Flat, NABS, soft;

Abdomen
abdomen circumference of 39 cm

There is presence of murmur

because of valves does not close
No chest pain, no dyspnea and cough
Respiratory tightly and blood leaks backward;
noted; (+) murmur
turbulent blood flow through the
heart valves

No chest pain, palpitations and

Cardiovascular There is open valves resulting to
tightness; (+) anterior chest bulge;
System presence of murmur
abnormal heart sounds

Gastrointestinal With good bowel elimination

 Urine: amber, aromatic smell; regular
Genitourinary
frequency.

There is severe muscle weakness in

both upper and lower extremities. No
Musculoskeletal Poor cardiac output
deformities or swelling on the joints
and bones

Neurologic Awake and alert

C. MEDICAL HISTORY

A. History of present illness

The mother of the patient was said to be working in the stock room in a mall in
Bohol and for the whole 9 months of her pregnancy to the patient, she was exposed to
insecticides esp. Baygon. The patient was healthy when she was born until she was 2
month old when her mother noticed a bluish-black discoloration of her nails and her heart
beat was faster than usual. Her breast feeding was not regular too plus she doesn’t like
bottlefeeding. The mother then brought her to Romero Hospital in Bohol and the patient
was suspected to have CHD. Lanoxin, Furosemide and Aldactone were given for
maintenance. Laboratory exams were done such as 2D echo, chest X-ray and ECG in
Borja Hospital also in Bohol.

On March 18, 2008, the patient was 2 month old and was diagnosed with CHD,
PDA, TGA and PFO. She was advised for operation but due to financial constraints, the
operation was not done. On October 2008, they were referred to Philippine Heart Center.

One day prior to admission, the patient was screened, had checked-up, CBC was
done and showed an elevated Hematocrit and a decrease in her Platelet count. Her
operation was scheduled then but her HCT and Platelet count should be fixed first. They
were then referred to Philippine Children’s Medical Center to fix the abnormality in her
blood. And at 8:10 pm of July 16, 2009 the patient was admitted at 1B ward of PCMC.
She was scheduled for platelet transfusion and phlebotomy. CBC was done and Fresh
Frozen Platelet transfusion and phlebotomy followed. On the night of July 27, 2009,
CBC was done again, additional platelets were given. After all the treatment done at
PCMC, the patient went to PHC to have her operation done.

B. History of Past illness

The patient was the second child of her mother. The first child was healthy
because she was not yet exposed to any chemicals during that time. When the patient was
 born, she took injectables because of her mother UTI during the pregnancy. The mother
is said to be G2P2 and was on her 36 th week of gestation. And on January 4, 2008 a
healthy 7.5 lbs baby girl was born. The patient had regular pre-natal and after birth check
ups and after being diagnosed with her disease, she had her check-ups every 2 months.

The patient also experienced cough, colds and fever. She cannot able to stand or
even sit alone. When she was 3 month old, she took her 3 medications namely, lanoxin,
aldactone and furosemide.

C. Family history

Mother: (+) UTI. She took amoxicillin on the first diagnosis and on the recurrence of the
said disease during her pregnancy to the patient.

Father: none.

GROWTH and DEVELOPMENT

GROSS MOTOR AGE

Head control Cannot do it
Rolls over When she was 1 year old
Sits alone Cannot do it
Crawls When she was 1 year old
Cruises Cannot do it
Stands alone Cannot do it
Walks alone Cannot do it
Climbs up/down the stairs Cannot do it
Catches ball She can things only, 9 months

ADAPTIVE AGE
Grasps objects When she was 1 year old
Reach for objects When she was 1 year old
Transfers objects When she was 1 year old can
throw it too.
Gives object/request Points to what she wants, 9
month old
Drinks from cup Cannot do it
Writes alphabet Cannot do it

LANGUAGE AGE
socialize When she was 1 year old
Imitates sounds When she was 7 month old
Understand gestures When she was 8 month old
First word When she was 1 year old
(mama)
Indicates needs Points out on what she wants.
9 month old
Follow directions Cannot do it
Tell little stories Cannot do it
Gives full name Cannot do it

PERSONAL-SOCIAL AGE
Smiles When she was 4 month old
Turns to sound When she was 6 month old
Peek- a- boo When she was 10 month old
Close-open hands When she was 9 month old
Wave bye-bye When she was 1 year old.

IV. ANATOMY AND PHYSIOLOGY

Patent ductus arteriosus (PDA) is a heart problem that occurs soon after birth in some
babies. In PDA, abnormal blood flow occurs between two of the major arteries
connected to the heart.
Before birth, the two major arteries—the aorta and the pulmonary artery—are
connected by a blood vessel called the ductus arteriosus. This vessel is an essential
part of fetal blood circulation.
Within minutes or up to a few days after birth, the vessel is supposed to close as part
of the normal changes occurring in the baby's circulation.
In some babies, however, the ductus arteriosus remains open (patent). This opening
allows oxygen-rich blood from the aorta to mix with oxygen-poor blood from the
 pulmonary artery. This can put strain on the heart and increase blood pressure in the
lung arteries.
Normal Heart and Heart with Patent Ductus Arteriosus

Figure A shows the interior of a normal heart and normal blood flow. Figure B shows
a heart with patent ductus arteriosus. The defect connects the aorta with the
pulmonary artery. This allows oxygen-rich blood from the aorta to mix with oxygen-
poor blood in the pulmonary artery.

Reference: http://www.nhlbi.nih.gov/health/dci/Diseases/pda/pda_what.html

VI. COURSE IN THE WARD

DATE ORDERED DOCTOR’S ORDER RATIONALE

7/16/09 7:00PM Labs: CBC  as a preoperative test to
ensure both adequate oxygen
carrying capacity and
hemostasis
 to diagnose anemia
 to identify acute and chronic
illness, bleeding tendencies,
 and white blood cell disorders
such as leukemia
Urinalysis  general health screening to
detect renal and metabolic
diseases
 diagnosis of diseases or
disorders of the kidneys or
urinary tract
Chest XRAY  While less sensitive than
echocardiography, chest x ray
can be used to check for
disorders such as congestive
heart failure or pulmonary
edema.
WOF DOB, arrhythmia, decrease  Manifestations after
sensorium phlebotomy
For phlebotomy  is performed to treat
polycythemia vera, a
condition that causes an
elevated red blood cell
volume (hematocrit).

 also prescribed for patients

with disorders that increase
the amount of iron in their
blood to dangerous levels,
such as hemochromatosis,
hepatitis B, and hepatitis C.

 Patients with pulmonary

edema may undergo
phlebotomy procedures to
decrease their total blood
volume.

 is also used to remove blood

from the body during blood
donation and for analysis of
the substances contained
within it.

Secure FFP, type specific  To check the labile as well as

the stable components of the
coagulation, fibrinolytic and
complement systems; the
proteins that maintain oncotic

Hydrate prior to phlebotomy with
PNSS
If HCT >65, repeat phlebotomy
pressure and modulate
immunity; and other proteins
that have diverse activities.
 Also fats, carbohydrates and
minerals that are present in
concentrations similar to those
in circulation.
 is used to give intravenous
fluids to the patients suffering
from salt and water
deprivation.
 is performed to treat
polycythemia vera, a
condition that causes an
elevated red blood cell
volume (hematocrit).

 is also used to remove blood

from the body during blood
donation and for analysis of
the substances contained
within it.

Platelet transfusion after  used to prevent bleeding in

phlebotomy patients with very low platelet
counts, usually less than
20,000 cells per microlitre, and
in those undergoing surgery or
other invasive procedures
whose counts are less than
50,000 cells per microlitre
7/17/09 11:45AM Continue furosemide, lanoxin  Furosemide - is a potent
and aldactone diuretic (water pill) that is used
to eliminate water and salt
from the body. In the kidneys,
salt (composed of sodium and
chloride), water, and other
small molecules normally are
filtered out of the blood and
into the tubules of the kidney.
The filtered fluid ultimately
becomes urine. Most of the
sodium, chloride and water
that is filtered out of the blood
is reabsorbed into the blood
before the filtered fluid
becomes urine and is
 eliminated from the body.
Furosemide works by blocking
the absorption of sodium,
chloride, and water from the
filtered fluid in the kidney
tubules, causing a profound
increase in the output of urine
(diuresis).
 Lanoxin - increases the
strength and vigor of heart
contractions, and is useful in
the treatment of heart failure.
It is extracted from the leaves
of a plant called digitalis
lanata. Digoxin increases the
force of contraction of the
muscle of the heart by
inhibiting the activity of an
enzyme (ATPase) that controls
movement of calcium, sodium
and potassium into heart
muscle. Calcium controls the
force of contraction. Inhibiting
ATPase increases calcium in
heart muscle and therefore
increases the force of heart
contractions. Digoxin also
slows electrical conduction
between the atria and the
ventricles of the heart and is
useful in treating abnormally
rapid atrial rhythms such as
atrial fibrillation, atrial flutter,
and atrial tachycardia.
 Aldactone - In patients with
heart failure and cirrhosis,
increased levels of a hormone
produced by the adrenal
glands, called aldosterone,
causes salt and fluid to be
retained by the kidneys. (At
the same time, it also causes
the kidneys to eliminate
potassium.) The body becomes
overloaded with salt and
water, and this worsens the
heart failure. Spironolactone
inhibits the action of
 aldosterone thereby causing
the kidneys to excrete salt and
fluid in the urine while
retaining potassium.
Therefore, spironolactone is
classified as a potassium-
sparing diuretic, a drug that
promotes the output of urine
(diuretic) while allowing the
kidneys to hold onto
potassium.

VII. MEDICAL ASSESSMENT

A. LABORATORY EXAMS

NAME: Elicano, Chrishel Joy,

Age: 1 year old Hospital No: 361936 Lab Accession no:
Sex: Female Specimen: Urine Test required: 7/17/09
Ward # 1B Sample submitted: 7/17/09
Requested by: Jarillas, MD Result Validated: 5:10 AM

Microscopic/ Chemical examination

Routine Physical Examination

Color light yellow
Turbidity (clarity) Clear

Chemical Analysis:

Glucose: negative ph: 7.0

Bilirubin: negative protein: negative
Ketone: negative Urobilinogen: Normal
Specific gravity: 1.010 Nitrite: negative
Blood: moderate leukocytes: negative

 All laboratory results for Microscopic/ Chemical examination are normal.

Urine Sediment Analysis by Flowcytometry

Result Reference Range Interpretation

Red blood cells 3 (M)0-3 (F) 0-4 WITHIN NORMAL RANGE

White Blood cells 1 (M)0-3 (F) 0-4 WITHIN NORMAL RANGE
Epithelial Cells 0 (M)0-1 (F) 0-3 WITHIN NORMAL RANGE
Casts 0 (M)0-1 (F) 0-1 WITHIN NORMAL RANGE
Bacteria 352 (M)0-750 (F) 0-850 WITHIN NORMAL RANGE

OTHERS: Crystals none found

HEMATOLOGY SECTION

PARAMETERS RESULTS NORMAL VALUES INTERPRETATION

Hemoglobin (HGB) 215.1 116-140G/L may be due to increased RBC

and CHD

Hematocrit (HCT) 0.67 0.35-0.4 l may reflect a condition called

polycythemia vera
RBC 7.44 3.6-5.0 M/ul may be due to CHD
White cell count 9.2 5-10 x 10 9/L WITHIN NORMAL RANGE
Differential Count
Basophils 0.01 0-0.05 WITHIN NORMAL RANGE
Eosinophils 0.01 0.02-0.07 can occur as a result of infection
Segmenters 0.32 0.55-0.65 may be due to infections
 Lymphocytes 0.58 0.25-0.35 may be due to infections
Monocytes 0.08 0.02-0.06 may be due to infections
Platelet count 50 150-350 10 9/L may be due to low oxygen-
. carrying blood in the body and
. drug induced causes.
MPV 7.68 5.83-8.46 Fl WITHIN NORMAL RANGE
RDW 13.51 11.0-14.0 WITHIN NORMAL RANGE
MCV 89.57 80-97 fL WITHIN NORMAL RANGE
MCH 28.91 27-31 pg WITHIN NORMAL RANGE
MCHC 32.27 32-36 % WITHIN NORMAL RANGE

BLOOD TYPRE CROSS-MATCH RESULT

Patient’s ABO GROUP: O

RH GROUP: POSITIVE ANTI-BODY SCREENING(PATIENT)
Source Unit Component ABO CROSS-MATCH
of blood serial no. group Rh Anti-body IS(saline) 37.0 AHG Interpretation
0
FCMC NVBSP FFP 0 Group screening(unit) C
2009 Positive negative Same
.002 (LR) ABO
4499

VIII. Nursing care plan

A. Impaired gas exchange

Assessment N.Diagnosi Inference Planning Intervention Rationale Evaluation

s
O: Impaired irregular Short term >assess the >to obtain After 8 hours
>Irritability gas transmissio goal: after condition of baseline of nursing
>Cyanosis exchange n of blood 8hours of the patient data interventions,
>Nasal related to between nursing >monitor v/s >indication the goal was
flaring ventilation two of the interventions, and cardiac of proper met as
RR 65 perfusion most the patient rhythms ventilation evidenced by
>Tachycardi imbalance important will verbalize >evaluate or vice versa the relative of
a as in arteries in understandin pulse >to be able the patient
HR 165 altered close g of causative oximetry to to give verbalized
>Diaphoresis blood flow proximity to factors and determine appropriate understandin
the heart appropriate oxygenation intervention g in giving
because of interventions. >elevate s appropriate
patency head of interventions
leading to Long term bed / >to maintain and able to
impaired goal: the position airway identify
gas patient will client causative
exchange participate in appropriatel factors of
treatment y dyspnea for
regimen >encourage >to promote example in
within level of adequate calm / simple body
ability. rest and limit restful positioning.
activities to environment
within client that helps
tolerance limit oxygen
>review risk consumption
factors >to promote
particularly prevention /
environment managemen
to client and t of risk
relative
>emphasize
the >it helps in
importance improving
of nutrition stamina and
to client and reducing the
relative work of
>review breathing
oxygen >to decrease
conserving dyspnea and
techniques improve
like sitting quality of life
instead of
standing to
perform
tasks, etc to
client and
relative
>refer to
physician
 B. Ineffective tissue perfusion

Assessment N.Diagnosi Inference Planning Interventio Rationale Evaluation

s n
O: Ineffective irregular Short term >assess the >to give After 8 hours
>Restlesness tissue transmissio goal: after 8 condition of appropriate of nursing
>Capillary perfusion n of blood hours of the patient managemen interventions,
refill >3sec related to between nursing >note t the goal was
>Altered mismatch of the most interventions, customary >provides met as
respiratory ventilation important the patient baseline data comparison evidenced by
rate outside with blood arteries in will be able to (e.g. usual RR, with current the patient
of acceptable flow: close verbalize HR, weight, findings was able to
parameters exchange proximity to understandin etc) comply with
RR 65 problems the heart g of condition, >Note the
>Skin causing therapy presence of >to assess therapeutic
discoloration ineffective regimen and dyspnea and and give regimen and
s tissue when to cyanosis appropriate understandin
[gums, perfusion contact >Measure managemen g of the
conjunctiva] healthcare capillary refill t appropriate
provider >result less interventions
than 0.9 regarding the
Long term indicates patient’s
goal: the need for condition.
patient will more
demonstrate aggressive
increased >provide preventive
perfusion as psychological intervention
individually support s
appropriate >to lessen
(e.g. v/s >elevate head the burdens
within client’s of bed and and anxiety
normal range, maintain level
free of head / neck in >to promote
discomfort, midline or circulation
etc) neutral
position
>encourage
quiet, restful
atmosphere
>lowers
>administer tissue
medications a oxygen
prescribed by demand
the physician >to help the
>refer to client in his
physician condition
 C. Risk for delayed development

Assessmen N.Diagnosi Inference Planning Intervention Rationale Evaluation

t s
O: Risk for Presence of Short term >assess the >to obtain After 8 hours
>Congenital delayed congenital goal: after 8 condition of the baseline data of nursing
disorder developmen disorder hours of patient interventions,
t related to may cause nursing >collaborate in >to determine the goal was
congenital the person interventions, multidisciplinar area(s) of met as
disorder risk for the patient y evaluation to need / evidenced by
delayed will be able to assess client’s possible the relative
developmen verbalize development in interventions was able to
t because it understandin ff areas: gross identify and
needs g of motor, fine verbalize
further condition, motor, appropriate
screening, therapy cognitive, social developmenta
studies and regimen and / emotional, l expectation
surgical when to adaptive and that the
treatment contact communicative patient must
that may healthcare development have.
affect / provider >ascertain >to be able to
delay the nature of not develop
normal caregiver- too much
activity of a required dependencies
person activities and and promote
abilities to independence
perform
needed
activities >to help
>note determine
chronological developmenta
age and review l expectations
expectations
for “normal”
development
at this stage > to help
>provide determine
information developmenta
regarding l expectations
normal
development,
as appropriate,
including
pertinent
reference
materials
IX. HEALTH TEACHING
 Medication

Doctors use nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or

indomethacin, to help close a patent ductus arteriosus in premature infants. NSAIDs
block the hormone-like chemicals in the body that keep the PDA open.

 Exercise

Parents of children with congenital heart defects often worry about the risks of rough play
and vigorous activity even after successful treatment. Although some children may need
to limit the amount or type of exercise, many can lead normal or near-normal lives. Your
doctor can advise you about which activities are safe for your child.

 Treatment

Surgery to repair a patent ductus arteriosus involves patching or sewing shut the
abnormal opening. This can be done through an incision in the side of the chest or by
catheterization. In cardiac catheterization, 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 may
be deployed to close the ductus arteriosus. In surgery, the ductus is closed with a metal
clip.

 Hygiene

A child who has congenital heart disease may need to take preventive antibiotics before
certain dental and surgical procedures. Your doctor will help you learn if this is
necessary. But for most kids with a single heart defect, maintaining good oral hygiene
and getting regular dental checkups is the best way to help prevent infection.

 Out patient

Neonates without adverse symptoms may simply be monitored

 Diet

Eat a well-balanced diet/ diet as tolerated. Include a vitamin supplement that contains
folic acid.

 high-calorie formula or breast milk Special nutritional supplements may be

added to formula or pumped breast milk that increase the number of calories in
each ounce, thereby allowing your baby to drink less and still consume enough
calories to grow properly.
 supplemental tube feedings Feedings given through a small, flexible tube that
passes through the nose, down the esophagus, and into the stomach, can either
supplement or take the place of bottle-feedings. Infants who can drink part of their
 bottle, but not all, may be fed the remainder through the feeding tube. Infants who
are too tired to bottle-feed may receive their formula or breast milk through the
feeding tube alone.
 Spiritual

Parents where able to ask God’s guidance and assistance in times of losing hope.

X. CONCLUSION
 Towards the end of the case study or learning, the level 3 nursing students were able to ,
proposed the over all assessment findings with the patient with a Patent Ductus Arteriosus
and expounded thoroughly and articulately the anatomy and physiology of the systems
involved. They were able to illustration and explanation of the pathophysiology of the Patent
Ductus Arteriosus with regards to the patient, devised a well planned, with the principle of
SMART a comprehensive nursing care plan that is applicable to the patient with Patent
Ductus Arteriosus, inculcated health teachings and elucidated and discuss the rationale of the
different nursing interventions to the patient and to the family as well. After proving the
interventions, they evaluated the effectiveness and accuracy of the outcome.

Patent Ductus Arteriosus is a cardiovascular disorder found in patients of all ages and
sizes, from tiny premature infants to older adults. The clinical implications vary depending on
the anatomy of the ductus arteriosus and the underlying cardiovascular status of the patient.
Concurrently, advances and widespread availability of technological diagnosis have resulted
in improved detection and characterization of Patent Ductus Arteriosus in patients of all ages.

In most cases, you can't do anything to prevent having a baby with a heart defect.
However, it's important to do everything possible to have a healthy pregnancy. Getting early
prenatal care, even before you're pregnant, quitting smoking, reducing stress, stopping birth
control, eating
eating a well-balanced diet including an intake of vitamin supplement that contains
folic acid, limitation of caffeine, exercise
exercise regularly, avoiding risks and infections, and
keeping diabetes under control, if there is, are the basic guide to prevent baby having heart
diseases. Having proper nursing management concerning the said heart disease would be
helpful and essential. Indeed, complications of Patent Ductus Arteriosus can be avoided or
ameliorated by appropriate diagnosis and management.

All in all, While the majority of children do not have symptoms, the risks are nonetheless
real. It is comforting for parents to know that no matter which technique is employed for
treating this problem of their child's heart, after closure of the PDA, the circulation is normal,
and the child will have a normal heart with no further risks for the remainder of a normal life.
Indeed, meticulous attention to every aspect of care is absolutely essential to providing a
positive outcome and quality of life to these infants. The health care team has a vital role in
the recognition and management of infants that are diagnosed with congenital heart disease
specifically Patent Ductus Arteriosus.

ST. PAUL UNIVERSITY, QUEZON CITY

 NURSING DEPARTMENT

PATENT DUCTUS ARTERIOSUS

[CASE STUDY]

PCMC WARD

SUBMITTED TO:

MS. RHEA BIONAT

SUBMITTED BY:

RAVELO, KIMBERLY

RODIL, SHARLENE

ROMULO, PEACHY

SAKAMOTO, KAREN

SANTIAGO, PATRICIA

JULY 28, 2009