Timby/Smith: Introductory Medical-Surgical Nursing, 11/e

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Presentation transcript:

Timby/Smith: Introductory Medical-Surgical Nursing, 11/e Chapter 24: Caring for Clients With Valvular Disorders of the Heart

Heart Structures Four cardiac valves: aortic, mitral, tricuspid, and pulmonic Structures can be affected by malformations at birth, inflammatory and infectious disorders, age- related degeneration, structural damage after MI, or injury from intracardiac procedure. Left side of heart: aortic and mitral valves Right side of heart: pulmonic and tricuspid valves

Valves of the Heart

Disorders of the Aortic Valve Aortic Stenosis Pathophysiology and Etiology: aortic valve: three cusps or leaflets Narrowing of the opening in the aortic valve, valve cusps become stiff and rigid; muscular wall of left ventricle enlarges and thickens in response to stiff, calcified valve Older adults: narrowing of aortic valve, degenerative change; young adults: congenital defect Other causes: rheumatic carditis and infective endocarditis

Disorders of the Aortic Valve—(cont.) Assessment Findings Asymptomatic; dyspnea and fatigue during activity, dizziness, fainting, angina, carotid pulse feels weak, S2 heart sound is split (“lub-t-tub”) Diagnostic Findings Chest radiograph, echocardiogram, ECG, cardiac catheterization Medical Management: maintaining adequate cardiac output (digitalis), diuretic, sodium restriction, antibiotics, nitrates, beta-adrenergic blockers Surgical Management: balloon valvuloplasty, aortic valve replacement, transcatheter aortic valve implantation

Disorders of the Aortic Valve—(cont.) Nursing Management Monitor symptoms Explain purposes and techniques of diagnostic tests Administer prescribed medications Institute measures for adequate cardiac output and tissue oxygenation Dietary modifications

Question The nurse assesses the client diagnosed with aortic stenosis. On auscultation, the nurse assesses a grade 2 heart murmur. A description of this heart murmur includes: A) A very loud murmur with a palpable thrill B) A heart murmur that is moderately loud C) A very quiet murmur that can be heard when auscultating the heart D) A very faint murmur that may not be heard in all positions

Answer C) A very quiet murmur that can be heard when auscultating the heart Rationale: The S2 heart sound is split; that is, there is a definite separation between the sounds of the aortic valve and pulmonic valve closing.

Disorders of the Aortic Valve—(cont.) Aortic Regurgitation Pathophysiology and Etiology Aortic valve does not close tightly and blood can leak backward; valvular incompetence Causes: damage to valve cusps or papillary muscles, rheumatic carditis, endocarditis, syphilis, age-related stretching or proximal aorta, systemic inflammatory conditions Use of Fen-Phen, Redux Fluid overload in left ventricle; high pressure, interferes with atrial emptying

Disorders of the Aortic Valve—(cont.) Assessment Findings Tachycardia, skin flushed or moist, water-hammer pulse, systolic BP is high, diastolic BP is low or normal, heart murmur First: palpitations when lying flat or on left side Later stages: dyspnea, chest pain Diagnostic Findings Cardiac catheterization, chest radiograph, ECG, radionuclide scan, transesophageal echocardiography, CT, MRI

Disorders of the Aortic Valve—(cont.) Medical Management: cardiac glycosides, beta- blockers, diuretics, prophylactic antibiotics; modify lifestyle Surgical Management: aortic valve replacement, vascular graft Nursing Management Prepares patient for diagnostic procedures, monitors response, reports changes in heart rate and rhythm, dyspnea, chest pain, loss of consciousness Prophylactic antibiotic therapy, BP teaching

Question For which one of the following assessments should the nurse withhold a cardiac glycoside such as digoxin (Lanoxin) when caring for a client with a valvular disorder of the heart? A) The client’s diastolic blood pressure is 80 mm Hg. B) The client’s heart rate is 50 beats/minute. C) The client has an S2 heart sound. D) The client’s heart rhythm is irregular.

Answer B) The client’s heart rate is 50 beats/minute. Rationale: Before administering digoxin (Lanoxin), the nurse must assess the pulse rate before each dose. Withhold administration if the pulse is <60 or >120 beats/minute.

Disorders of the Mitral Valve Mitral Stenosis Pathophysiology and Etiology Mitral valve; between left atrium and left ventricle; bicuspid valve; stroke volume Causes: rheumatic carditis, recurrence of endocarditis Inflammation causes thick, rigid commissures; incomplete emptying—arterial emboli, pulmonary hypertension, right-sided heart failure Assessment Findings: fatigue and dyspnea after slight exertion, tachydysrhythmias, dyspneic at night; must sleep in sitting position; cough productive of pink, frothy sputum; crackles; changes in heart sounds; neck vein distention; peripheral edema

Disorders of the Mitral Valve—(cont.) Diagnostic Findings Chest radiograph, esophageal echocardiogram, ECG Medical Management: antibiotic therapy, preventing/relieving symptoms of HF, daily aspirin, anticoagulants Surgical Management: commissurotomy, cardioversion, percutaneous balloon valvuloplasty Nursing Management Monitor physical condition, diagnostic testing preparation, posttreatment care, discharge teaching—drug therapy, complication reporting

Disorders of the Mitral Valve—(cont.) Mitral Regurgitation Pathophysiology and Etiology Causes: rheumatic carditis and mitral valve prolapse, damage to papillary muscles, impaired myocardial function after MI Blood flows backward into the left atrium during ventricular systole and leaks into left ventricle during atrial diastole; cardiogenic shock Assessment Findings Chronic fatigue, dyspnea on exertion, palpitations, S1 heart sound is diminished, HTN, tachycardia, blowing murmur

Disorders of the Mitral Valve—(cont.) Diagnostic Findings Transthoracic or transesophageal echocardiography, chest radiography, radionuclide angiography, ECG Medical Management: angiotensin-converting enzyme (Accupril), angiotensin receptor blocker (losartan); digitalis, calcium channel blockers, beta-blockers, antidysrhythmic drugs Surgical Management: intra-aortic balloon pump, annuloplasty, valve replacements

Disorders of the Mitral Valve—(cont.) Nursing Management Monitor BP, heart rate, and rhythm Assess heart sounds and lung sounds Report signs of left- or right-sided HF Education: prophylactic antibiotics

Disorders of the Mitral Valve—(cont.) Mitral Valve Prolapse Pathophysiology and Etiology Valve cusps enlarge, become floppy, and bulge backward into the left atrium. More common in young women than men Causes: idiopathic, rheumatic carditis, inherited connective tissue disorder, CAD Mitral valve prolapse syndrome: autonomic nervous system dysfunction

Mitral Valve Prolapse

Disorders of the Mitral Valve—(cont.) Assessment Findings Asymptomatic, chest pain (angina: onset does not correlate with physical exertion, duration is prolonged, not easily relieved), palpitations, fatigue, anxiety, rapid and irregular heart rate, shortness of breath, light-headedness, difficulty concentrating, “click” sound during ventricular systole Diagnostic Findings Echocardiography, ECG

Disorders of the Mitral Valve—(cont.) Medical Management: antibiotic therapy, digitalis, beta-blockers, calcium channel blockers, low-dose aspirin, antianxiety medications Surgical Management: valve replacement Nursing Management To relieve chest pain: lie flat with legs elevated at 90° Restrict alcohol; avoid caffeinated beverages Promote adequate fluids, exercise, monitor BP

Question A client has a possible diagnosis of mitral stenosis. Which of the following symptoms correlate with this diagnosis? A) Heart murmur B) Heart failure C) Palpitations D) Pulmonary edema

Answer A) Heart murmur C) Palpitations D) Pulmonary edema Rationale: All of the following are symptoms caused by the stricture of the mitral valve; heart failure may be a complication of the disease.