081-PP02L021 ELO B_Valvular Heart Disease _V 2.0_.pdf

DISORDERS OF THE HEART NP02L021 ELO B · Version 2.0 Valvular Heart Disease Foundations and Adult Health Nursing, 8th ed., pp. 1555-1557 TERMINAL LEARNING OBJECTIVE Determine nursing care for a patient with a disorder of the heart without error. LEARNING STEP ACTIVITY Explain the etiology of valvu...

DISORDERS OF THE HEART NP02L021 ELO B · Version 2.0 Valvular Heart Disease Foundations and Adult Health Nursing, 8th ed., pp. 1555-1557 TERMINAL LEARNING OBJECTIVE Determine nursing care for a patient with a disorder of the heart without error. LEARNING STEP ACTIVITY Explain the etiology of valvular heart disease. DEFINITIONS Stenosis – thickening of valve tissue Insufficiency- valve is unable to close completely Valve replacement- replacement of valve HEART VALVES Tricuspid Pulmonary semilunar Mitral (bicuspid) Aortic semilunar Normal valves Maintain directional blood flow Open and close passively NORMAL BLOOD FLOW Blood is received from the inferior and superior vena cava from the body  Right atrium, through the tricuspid valve right ventricle From the right ventricle through the pulmonary semilunar valve  the pulmonary artery  lungs Pulmonary veins return blood to the left atrium through the mitral (bicuspid) valve  left ventricle and out the aorta  the body VALVULAR HEART DISEASE Occurs when valves are damaged; they do not open and close properly Stenosis Regurgitation Thickening of Valve does not the valve close properly ETIOLOGY/PATHOPHYSIOLOGY Congenital disorder Children Adolescents Adults Factors associated History of rheumatic fever Clinical symptoms occur 10-40 years after an episode of rheumatic fever The streptococcal infection may lay dormant for years in either mitral or aortic valve VALVULAR HEART DISORDERS Mitral stenosis Mitral insufficiency Mitral prolapse Aortic stenosis Aortic insufficiency Tricuspid stenosis Pulmonary stenosis CLINICAL MANIFESTATIONS Depend on type of disease Related to decreased cardiac output Severity of heart failure Valve disorders Staged Treatment recommendations made according to severity of the disease STAGING OF VALVULAR DISEASE ASSESSMENT SUBJECTIVE OBJECTIVE History of rheumatic fever Auscultation of heart murmur Fatigue or shortness of breath Adventitious breath sounds Chest pain Edema (pitting or non-pitting) Lightheadedness, dizziness, or fainting Exertional and nocturnal dyspnea DIAGNOSTIC TESTS Chest radiograph Echocardiogram Cardiac catheterization MEDICAL MANAGEMENT Activity limitations Sodium restricted diet Medications Diuretics Cardiac glycosides Antidysrhythmics Anticoagulants Antibiotics SURGICAL INTERVENTIONS Indications Lifestyle is affected Medical therapy no longer alleviates symptoms Diagnostic evidence of progressive myocardial failure Valve repair Most common for mitral valve stenosis Valve replacement Valve replaced with a prosthetic or mechanical valve NURSING CARE Balance rest periods with activities Assistance as needed for activities Utilize oxygen as prescribed Administer prescribed medications Digoxin Diuretics Antidysrhythmics Monitor intake and output Weigh patient daily Maintain sodium-restricted diet PATIENT TEACHING Explain the importance of prophylaxis antibiotics Anticoagulant therapy Taking all your medications a prescribed Diet management and teaching Activity limitations Monitoring if on anticoagulant therapy Importance of notifying dentist and all health care providers of valvular heart disease CHECK ON LEARNING 1. The nurse caring for this client receives these orders. Of these orders, which 3 should be performed first? a. Maintain SpO2 at 94% to maintain adequate oxygen supply for the demand. b. EKG. c. Portable CXR to identify pulmonary effusion as a secondary effect of mitral stenosis. d. Lasix 20 mg PO x 1 dose to decrease preload. CHECK ON LEARNING Nursing interventions for a patient with valvular heart disease focus on ___________________? REVIEW OF MAIN POINTS Heart Valves Valvular heart disorders Care for the patient with valvular heart disease QUESTIONS?