Understanding Patent Ductus Arteriosus

This is Sarah with RegisteredNurseRN.com and in this video I'm going to be going over patent ductus arteriosus. And this video is part of an NCLEX review series over pediatric nursing. And as always, after you watch this YouTube video, you can access the free quiz that will test you on this condition. So let's get started. What is patent ductus arteriosus, also known as PDA? It is a congenital heart defect where the ductus arteriosus does not close after birth like it should. And what's going to happen is this is going to lead to increased pulmonary blood flow. So you're going to have a lot more blood going to the lungs than it should. And this is going to lead to some complications. And in a moment, you're going to see why we're seeing these certain complications in this patient. Now to really remember these congenital heart defects for pediatric nursing exams, let the name of the condition help you because it gives you some clues. And you can take those clues and plug it in with the normal blood flow of the heart. Those complications, signs and symptoms, treatments, it really makes sense. So we're talking about patent ductus arteriosus. What does patent mean in the medical field? It means something has failed to close. What's failed to close? This ductus arteriosus structure. Now the next thing is, what is the ductus arteriosus? Well, it is a vessel that connects the aorta to the pulmonary artery in a fetus. So a baby in the womb needs this structure. It's very important for their circulation, but as adults, we don't need it. And what's the purpose of this structure? What it does is it carries blood that's on the right side of that fetus's heart to the rest of the body. So you have blood that comes in through the superior and inferior vena cava, goes through the right atrium, tricuspid valve right ventricle up through the pulmonary artery the pulmonic valve and then it's going to go through this neat little ductus arteriosus and go through the rest of the body and the reason it's doing that instead of just going to go through the lungs is because the lungs are not working in that fetus they're not functional yet but when it's born the lungs will become functional and that's going to change the blood flow for the baby. So instead of having blood being shunted in various areas, you're now going to start to have the normal blood flow after birth, which is why it's so crucial for this ductus arteriosus to clamp off and close itself because if it doesn't, what's going to happen? Okay, what's going to happen is you're going to have the normal blood flow going in through the right side of the heart. Deoxygenated blood it now needs to get to the lungs because the baby doesn't have the placenta anymore to give it oxygen like it did when it was in its mother's womb. So blood's in the right side, it's going to be going to the lungs, getting oxygenated, it's going to enter back through the heart through that pulmonary vein into the left side and it's going to be shot up through the aorta through the rest of the heart. But if we have this ductus arteriosus that's still open, what's going to happen is that this blood that's in this aorta It's going to allow blood to pour down through the pulmonary artery. So you have blood that's been nice and oxygenated through the lungs and it's going down through this ductus arteriosus through that pulmonary artery and you have all this extra blood going to the lungs. And this really stresses the lungs out over time because it's going to create a really high pressure. And that pressure is going to damage the integrity of the lungs. of those arteries that feed the lungs. So over time, those arteries are going to narrow. So you're going to get pulmonary hypertension. Now why is that an issue? Well that's going to cause a bunch of respiratory issues for that patient. Decreased oxygenation, at risk for more lung infections. In addition, it's going to make it harder on this heart because if you have this narrow artery, it's going to cause more lung infections. Artery, where you're trying to get blood to the lungs to get oxygenated, that causes a lot of resistance on the heart. It's going to get tired over time and the patient can enter into heart failure. Because it's like the same concept. If you take a water hose, make a really small opening, that water has to really push to get through that opening. It's like the same concept with the blood. So you're going to see heart failure. In addition, that high pressure in the lungs, because what you're having is this left right shunt and you have blood from the left side of the heart being shunted to the right side of the heart and you have the increased pressure that's going to damage the lining of the structures inside the plumbing of your heart which can Increase the risk of any bacteria that may be present in the blood to stick. inside the heart causing endocarditis. Now let's talk about the signs and symptoms of a patent ductus arteriosus. Okay, the signs and symptoms really vary and they vary depending on the size of this opening. If a patient has a large PDA, it's going to cause signs and symptoms and those complications that we talked about because you have a lot of blood escaping from that aorta into that pulmonary artery and you have increased pulmonary blood flow. Now if it's really small and it's not really allowing a lot of blood to escape in there. You're not going to have a lot of pulmonary blood flow. So the patient could be asymptomatic. A lot of times they close on their own, but with the large PDAs, they will need repair of some type. And we'll talk a little bit about that in our treatments later on. Now, PDAs are most common in premature infants. And to help us remember all those signs and symptoms, let's remember the mnemonic call. And this will have signs and symptoms thrown in there. there with that pathophysiology that we were talking about earlier. So the first C is cardiac. This is definitely going to cause some cardiac issues and when you're assessing this patient listening to heart sounds you may hear something unique and remember this this is like a hallmark thing of this condition. It's called a continuous machinery like heart murmur. Continuous in meaning that you're going to hear it during diastole and systole. It's going to be continuous and you can hear it at the left upper sternal border and why Why is that? Well, if you have a large PDA, what's happening is a lot of blood is escaping and it's causing this turbulent blood flow pressure going on. When you listen here, you can hear that turbulence at that left upper sternal border. It's machinery sounding like. In addition, they can have endocarditis and we talked about that. So they're at risk for that. Plus they can have an increased heart rate. Number one, because of the pulmonary issues going on. low oxygen levels, the heart has to work harder, plus it has to work harder to pump the blood through those narrow arteries going to the heart. In addition, they can have what's called a wide pulse pressure. Now, what is a pulse pressure? Well, this is where you take the systolic blood pressure and you subtract it from the diastolic blood pressure and you get a number. And that number represents the force that is needed for the heart to contract. So in these patients, these babies, it's going to be... high. According to Open Journal of Pediatrics, this is defined as a difference between systolic and diastolic blood pressure of greater than 15-25 mmHg in premature infants and greater than 25 mmHg in term infants. So why is there a wide pulse pressure? Well, it ties back to diastolic pressure. It's the one causing us the problem. It's going to drop. Because remember, diastolic pressure is the pressure of blood pressure. blood in the arteries when the heart is feeling when it's resting in between its beats so if you have blood that's escaping into this pulmonary artery during that time that's going to lower the pressure the diastolic pressure so whenever you have a lower diastolic pressure you subtract it from the systolic pressure you're going to get a higher number in addition you can have heart failure which we talked about that so it's not normal for a newborn baby to have heart failure and this can with lung congestion where the fluids backing up into the lungs so they can have crackles they can have difficulty breathing next a for activity and tolerance These infants are going to fatigue very easily and it's tied back to what's going on with the lungs with the heart and any type of activity like eating crying Feeding can cause them to fatigue and they can actually have sweating Diaphoresis with it as well next is L for lung We're going to have a lot of lung issues because that pulmonary hypertension in the lungs from that increased blood flow It's narrowing those arteries that are feeding the lungs Increasing the pressure there. So our lung Function is really going to decrease they're going to have issues with that so they can be at risk for more infections And they're going to have problems feeding So a baby who's trying to nurse or suck on a bottle if they're having respiratory issues It's really going to be difficult for them which ties to the neck Next L, these infants a lot of times have loss of weight because number one, they're burning a lot of calories to breathe and they're not able to get enough caloric intake because they're having trouble feeding. So a lot of these patients are at risk for failure to thrive. Now let's talk about the treatment for PDAs. What can be done to close this extra vessel that is allowing extra blood to escape into the pulmonary artery and is increasing lung blood flow? Well, a medication can be given and the med what it can do it can cause this vessel to clamp off and it'll close a type of medication used is called endomethacin I would remember that PDA endomethacin put those two together and it is a prostaglandin inhibitor however what to remember about this is that it's usually only used in premature infants that's where it's really going to be successful sometimes it can be used in the really young infants who are like a few days old but it's not going to work for older infants, children, or adults. Another treatment is invasive where they can do a heart catheterization where they go up with a catheter through a blood vessel, they insert a device that will actually close the structure off, or they can perform surgery where they go in and actually tie the vessel off. Okay, so that wraps up this review over PDA. Thank you so much for watching. Don't forget to take the free quiz and to subscribe to our channel for more videos.

What is patent ductus arteriosus, also known as PDA? It is a congenital heart defect where the ductus arteriosus does not close after birth like it should. And what's going to happen is this is going to lead to increased pulmonary blood flow. So you're going to have a lot more blood going to the lungs than it should.

And this is going to lead to some complications. And in a moment, you're going to see why we're seeing these certain complications in this patient. Now to really remember these congenital heart defects for pediatric nursing exams, let the name of the condition help you because it gives you some clues. And you can take those clues and plug it in with the normal blood flow of the heart.

Those complications, signs and symptoms, treatments, it really makes sense. So we're talking about patent ductus arteriosus. What does patent mean in the medical field? It means something has failed to close. What's failed to close?

This ductus arteriosus structure. Now the next thing is, what is the ductus arteriosus? Well, it is a vessel that connects the aorta to the pulmonary artery in a fetus. So a baby in the womb needs this structure. It's very important for their circulation, but as adults, we don't need it.

And what's the purpose of this structure? What it does is it carries blood that's on the right side of that fetus's heart to the rest of the body. So you have blood that comes in through the superior and inferior vena cava, goes through the right atrium, tricuspid valve right ventricle up through the pulmonary artery the pulmonic valve and then it's going to go through this neat little ductus arteriosus and go through the rest of the body and the reason it's doing that instead of just going to go through the lungs is because the lungs are not working in that fetus they're not functional yet but when it's born the lungs will become functional and that's going to change the blood flow for the baby.

So instead of having blood being shunted in various areas, you're now going to start to have the normal blood flow after birth, which is why it's so crucial for this ductus arteriosus to clamp off and close itself because if it doesn't, what's going to happen? Okay, what's going to happen is you're going to have the normal blood flow going in through the right side of the heart. Deoxygenated blood it now needs to get to the lungs because the baby doesn't have the placenta anymore to give it oxygen like it did when it was in its mother's womb.

So blood's in the right side, it's going to be going to the lungs, getting oxygenated, it's going to enter back through the heart through that pulmonary vein into the left side and it's going to be shot up through the aorta through the rest of the heart. But if we have this ductus arteriosus that's still open, what's going to happen is that this blood that's in this aorta It's going to allow blood to pour down through the pulmonary artery. So you have blood that's been nice and oxygenated through the lungs and it's going down through this ductus arteriosus through that pulmonary artery and you have all this extra blood going to the lungs. And this really stresses the lungs out over time because it's going to create a really high pressure. And that pressure is going to damage the integrity of the lungs.

of those arteries that feed the lungs. So over time, those arteries are going to narrow. So you're going to get pulmonary hypertension. Now why is that an issue? Well that's going to cause a bunch of respiratory issues for that patient.

Decreased oxygenation, at risk for more lung infections. In addition, it's going to make it harder on this heart because if you have this narrow artery, it's going to cause more lung infections. Artery, where you're trying to get blood to the lungs to get oxygenated, that causes a lot of resistance on the heart. It's going to get tired over time and the patient can enter into heart failure.

Because it's like the same concept. If you take a water hose, make a really small opening, that water has to really push to get through that opening. It's like the same concept with the blood. So you're going to see heart failure.

In addition, that high pressure in the lungs, because what you're having is this left right shunt and you have blood from the left side of the heart being shunted to the right side of the heart and you have the increased pressure that's going to damage the lining of the structures inside the plumbing of your heart which can Increase the risk of any bacteria that may be present in the blood to stick. inside the heart causing endocarditis. Now let's talk about the signs and symptoms of a patent ductus arteriosus.

Okay, the signs and symptoms really vary and they vary depending on the size of this opening. If a patient has a large PDA, it's going to cause signs and symptoms and those complications that we talked about because you have a lot of blood escaping from that aorta into that pulmonary artery and you have increased pulmonary blood flow. Now if it's really small and it's not really allowing a lot of blood to escape in there.

You're not going to have a lot of pulmonary blood flow. So the patient could be asymptomatic. A lot of times they close on their own, but with the large PDAs, they will need repair of some type. And we'll talk a little bit about that in our treatments later on.

Now, PDAs are most common in premature infants. And to help us remember all those signs and symptoms, let's remember the mnemonic call. And this will have signs and symptoms thrown in there.

there with that pathophysiology that we were talking about earlier. So the first C is cardiac. This is definitely going to cause some cardiac issues and when you're assessing this patient listening to heart sounds you may hear something unique and remember this this is like a hallmark thing of this condition.

It's called a continuous machinery like heart murmur. Continuous in meaning that you're going to hear it during diastole and systole. It's going to be continuous and you can hear it at the left upper sternal border and why Why is that?

Well, if you have a large PDA, what's happening is a lot of blood is escaping and it's causing this turbulent blood flow pressure going on. When you listen here, you can hear that turbulence at that left upper sternal border. It's machinery sounding like. In addition, they can have endocarditis and we talked about that. So they're at risk for that.

Plus they can have an increased heart rate. Number one, because of the pulmonary issues going on. low oxygen levels, the heart has to work harder, plus it has to work harder to pump the blood through those narrow arteries going to the heart. In addition, they can have what's called a wide pulse pressure. Now, what is a pulse pressure?

Well, this is where you take the systolic blood pressure and you subtract it from the diastolic blood pressure and you get a number. And that number represents the force that is needed for the heart to contract. So in these patients, these babies, it's going to be...

high. According to Open Journal of Pediatrics, this is defined as a difference between systolic and diastolic blood pressure of greater than 15-25 mmHg in premature infants and greater than 25 mmHg in term infants. So why is there a wide pulse pressure?

Well, it ties back to diastolic pressure. It's the one causing us the problem. It's going to drop.

Because remember, diastolic pressure is the pressure of blood pressure. blood in the arteries when the heart is feeling when it's resting in between its beats so if you have blood that's escaping into this pulmonary artery during that time that's going to lower the pressure the diastolic pressure so whenever you have a lower diastolic pressure you subtract it from the systolic pressure you're going to get a higher number in addition you can have heart failure which we talked about that so it's not normal for a newborn baby to have heart failure and this can with lung congestion where the fluids backing up into the lungs so they can have crackles they can have difficulty breathing next a for activity and tolerance These infants are going to fatigue very easily and it's tied back to what's going on with the lungs with the heart and any type of activity like eating crying Feeding can cause them to fatigue and they can actually have sweating Diaphoresis with it as well next is L for lung We're going to have a lot of lung issues because that pulmonary hypertension in the lungs from that increased blood flow It's narrowing those arteries that are feeding the lungs Increasing the pressure there. So our lung Function is really going to decrease they're going to have issues with that so they can be at risk for more infections And they're going to have problems feeding So a baby who's trying to nurse or suck on a bottle if they're having respiratory issues It's really going to be difficult for them which ties to the neck Next L, these infants a lot of times have loss of weight because number one, they're burning a lot of calories to breathe and they're not able to get enough caloric intake because they're having trouble feeding. So a lot of these patients are at risk for failure to thrive. Now let's talk about the treatment for PDAs.

What can be done to close this extra vessel that is allowing extra blood to escape into the pulmonary artery and is increasing lung blood flow? Well, a medication can be given and the med what it can do it can cause this vessel to clamp off and it'll close a type of medication used is called endomethacin I would remember that PDA endomethacin put those two together and it is a prostaglandin inhibitor however what to remember about this is that it's usually only used in premature infants that's where it's really going to be successful sometimes it can be used in the really young infants who are like a few days old but it's not going to work for older infants, children, or adults. Another treatment is invasive where they can do a heart catheterization where they go up with a catheter through a blood vessel, they insert a device that will actually close the structure off, or they can perform surgery where they go in and actually tie the vessel off. Okay, so that wraps up this review over PDA.

Thank you so much for watching. Don't forget to take the free quiz and to subscribe to our channel for more videos.

Transcript for:Understanding Patent Ductus Arteriosus

Transcript for:
Understanding Patent Ductus Arteriosus