Which nursing diagnoses are appropriate for an infant with a large patent ductus arteriosus (PDA)?

Choice A rationale Risk for infection is a generalized diagnosis and is not specific to the hemodynamic consequences of a large patent ductus arteriosus (PDA). The primary pathophysiology involves a left-to-right shunting of oxygenated blood leading to pulmonary overcirculation and systemic underperfusion, which are more critical issues. Choice B rationale A large PDA allows a significant volume of blood to shunt from the aorta (higher pressure) to the pulmonary artery (lower pressure). This diversion of systemic blood volume results in decreased systemic cardiac output and perfusion, leading to compensatory tachycardia and eventual heart failure. Choice C rationale Fluid volume deficit is incorrect. The left-to-right shunting in a large PDA causes increased pulmonary blood flow and pressure, leading to pulmonary congestion, which can manifest as fluid volume excess in the lungs and sometimes systemically, not a deficit. Choice D rationale The excessive blood flow shunting to the lungs due to a large PDA causes pulmonary overcirculation and pressure increase. This over-perfusion impairs alveolar-capillary gas exchange dynamics, leading to pulmonary edema and ventilation-perfusion mismatch, increasing the risk for impaired gas exchange. Choice E rationale The chronic strain on the heart from the increased volume and pressure load due to the large left-to-right shunt requires increased myocardial work. This leads to cardiac muscle fatigue and an inability to meet the body's metabolic demands during exertion, resulting in activity intolerance and poor weight gain.