Adult health: CARING FOR CLIENTS WITH VALVULAR DISORDERS OF THE HEART

MED SURG

CARING FOR CLIENTS WITH VALVULAR DISORDERS
OF THE HEART

AORTIC VALVE

LOCATED BETWEEN THE LEFT VENTRICLE AND THE AORTA.

THE HEART PUMPS OXYGENATED BLOOD THROUGH IT TO THE AORTA & THEN
THE REST OF THE BODY.

AORTIC STENOSIS

Narrowing of the opening in the aortic valve when the cusps
become stiff & rigid leading to pooling of blood in the left ventricle &
decreased cardiac output; fig 30-3

S/S – asymptomatic for years then dizziness, fainting & anginal
pain, dyspnea

Treatment – meds to support heart, digitalis, antiarrhythmics,
diuretics, antibiotics, NTG, restricted Na+ diet

May have balloon valvuloplasty to stretch the opening, usually
reoccurs within 6-12 months

May need aortic valve replacement eventually

Nursing management- monitor s/s, vs, bedrest, focus assesments
of the pulse rate & rhythm

See nursing care plan 30-1

AORTIC INSUFFICIENCY or
REGURGITATION

Incomplete closing of the aortic valve causing
backflow or reguritation of blood into the left ventricle

Caused by rheumatic fever, endocarditis,
syphilis or age related

Asymptomatic unless the ventricle cannot
maintain adequate circulation then may have palpitations, dyspnea and cxp,
widened pulse pressure

Treatment – drug therapy, replacement of valve if becomes
symptomatic

Nursing – prepare for procedures, adm meds, focused assessments

See drug therapy table 30-1

MITRAL VALVE

LOCATED BETWEEN THE LEFT ATRIUM AND LEFT VENTRICLE

SHOULD OPEN WIDELY TO ALLOW OXYGENATED BLOOD TO ENTER THE LEFT
VENTRICLE & THEN CLOSE TIGHTLY TO KEEP BLOOD FROM REENTERING THE LEFT ATRIUM

MITRAL STENOSIS

Narrowing of the mitral valve, see fig 30-5

Secondary to rheumatic fever, lf atrium cannot
empty completely it becomes enlarged, leads to pulmonary HTN

May take 20-40 yrs to develop after infection

S/S – fatigue & dyspnea with slight exertion,
then at later stages dyspnea at night, productive cough with pink, frothy
sputum

Treatment – antx, asa, oral anticoagulants,
surgery if candidate

Percutaneous balloon valvuloplasty, fig 30-6

Nsy care: assessments, teaching re: drug therapy
& diagnostic procedures

MITRAL REGURGITATION OR
INSUFFICIENCY

Mitral valve does not close completely, also causes enlargement
of the left atrium.

Associated with rheumatic fever & mitral valve prolapse

S/S same as stenosis

Treatment – meds, digitalis & anticoagulants, antx,
vasodilators

Surgery to repair the valve called annuloplasty

Nursing care – vs, focused cardiac assessment, daily wts

MITRAL VALVE PROLAPSE

The valve cusps enlarge, become floppy & bulge
backward into the left atrium, fig 30-8

Most common valvular disorder

Associated with inherited connective tissue
disorders, CAD; more common in women

Mitral valve prolapse syndrome- symptoms mimic a
severe anxiety attack

S/S – atypical chest pain, fatigue, anxiety or
panic attacks, sob, difficulty concentrating, impending doom feelings

Treatment – periodic antx therapy, drugs for
tachyarrhythmias, antianxiety meds, ASA, if symptoms severe may need valve
replacement

Nursing care – relief of cxp , avoid caffeine,
ETOH & med teaching

General Nutritional
Considerations

For those on low Na+ diets encourage them to substitute
homemade foods for mixes or prepared items which contain major amounts of
Na+

Foods that liquefy at room temperature (ice cream, sherbet,
etc) count as liquids for those on fluid restrictions

General Pharmacologic Considerations

Closely monitor those receiving oral anticoagulants for
episodes of bleeding

Therapeutic PT levels are 1.5 to 2.5 times the control value.
INR range is 2.0 to 3.0. Those with mechanical valves should have INR of 2.5
to 3.5

Before administering beta-blockers take the apical pulse. If <
60 hold med & notify MD

General Gerontologic Considerations

Older adults may require lower doses of cardiac glycosides than
younger adults

Monitor the HR & BP of older adults on beta blockers; the
adverse effects of bradycardia & hypotension can cause confusion & falls

Syncope & falls due to decreased cardiac output occur more
often in older adults