Cues & Clues Subjective: N/A Objectives: RR = 65 Nasal flaring Tachycardia (HR = 165) difficulty feeding; poor growth

growth lung infections (pneumonia) Recurrent apnea

Nursing Diagnosis Impaired gas exchange

Rationale While still on the mother's womb a baby's lungs are not needed to supply oxygen because the baby receives its oxygen via the mother's lungs and placenta. Since a baby's lungs do not provide any oxygen, there is no need for energy to be expended pumping blood to the lungs. The ductus arteriosus is a blood vessel that is present in all babies while still in the womb that allows blood to bypass the pathway to the lungs; it allows blood to flow from the pulmonary artery to the aorta.

Objectives Short term goal: Nursing:

Intervention

Rationale

Evaluation Short term goal:

After 8 hours of nursing interventions, the patient will be able to: Breath properly with a respiration rate of 50 breaths per minute. Decrease episodes of nasal flaring and apnea. Long term goal: After one month of nursing interventions, the patient will be able

Assess the condition of the patient Monitor vital signs and cardiac rhythms and evaluate pulse oximetry Evaluate lung volumes and forced vital capacity. Elevate head of bed/position the patient appropriately. Review risk factors particularly environment to client and relatives. Emphasize the importance of nutrition to the mother. Maintain adequate I & O. Minimize blood loss from procedures. Keep environment allergen and pollutant free

To obtain baseline data. To determine oxygenation and levels of carbon dioxide retention To assess for respiratory insufficiency. To maintain airway. To promote prevention or management of risk. It helps in improving stamina and reducing the work of breathing. For mobilization of secretions. To limit adverse effects of anemia. To reduce irritant effect of dust and chemicals on airways. To treat underlying conditions. Monitor the infant for bleeding and renal function

After 8 hours of nursing interventions, the patient was able to: Breath properly with a respiration rate of 55 breaths per minute. Decrease episodes of nasal flaring and apnea. Long term goal: After one month of nursing interventions, the patient was able: To have improved ventilation and adequate oxygenation of tissues and absence of symptoms of respiratory distress.

To have improved When the baby is born ventilation and and the umbilical cord is adequate Medical: cut, the lungs are now oxygenation of needed to supply oxygen. tissues and absence Administer medications, as The lungs expand, their of symptoms of indicated (prostaglandin blood vessels relax to respiratory distress. inhibitors such as accept more flow and the indomethacin) ductus arteriosus usually Recent days PDA can be closes within the first closed by percutaneous hours of life. On interventional method, occasion, however, the through femoral vein or

ductus arteriosus ductus arteriosus does not close on its own and this results in an irregular transmission of blood between two of the most important arteries in close proximity to the heart because of the said patency leading to impaired gas exchange.

femoral artery, a coil can be placed with the help of myocardial forceps to make an embolus, which closes the PDA without open heart surgery. Surgical: DA may be closed by ligation DA is manually tied shut, or with intravascular coils or plugs that leads to formation of a thrombus in the DA.