Chapter024

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Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Chapter 24: Caring for Clients with Valvular Disorders of the Heart


Disorders of the Aortic Valve Disorders of the Aortic Valve


Disorders of the Aortic Valve Disorders of the Aortic Valve • Aortic Valve

– Three cusps

– Left ventricle: Functions

– Facilitates unrestricted passage of oxygenated blood

– Coronary arteries: First blood vessels perfused

– Two valvular conditions

• Aortic stenosis and aortic regurgitation


QuestionQuestionIs the following statement true or false?

The aortic valve is the only cardiac valve to have three cusps.


AnswerAnswerFalse.

ALL cardiac valves have three cusps, except the mitral valve.


Disorders of the Aortic ValveDisorders of the Aortic Valve• Aortic Stenosis

– Narrowing of the opening in the aortic valve

– Pathophysiology and Etiology

• Age-related degenerative change

• Congenital defect

• Rheumatic carditis and infective endocarditis

• Myocardial ischemia; Left-sided heart failure; Risk of mortality


Disorders of the Aortic ValveDisorders of the Aortic Valve

• Aortic Stenosis

– Assessment Findings: Signs and Symptoms

• Insufficient cardiac output: Dizziness, fainting, and angina

• Dyspnea and fatigue during activity

• Ventricular enlargement; Carotid pulse feels weak

• Lateral or distal displacement of heart pulsations

• PMI; split S2 heart sound


Disorders of the Aortic ValveDisorders of the Aortic Valve• Aortic Stenosis

– Assessment Findings: Diagnostic Findings

• Chest radiograph: Reveals ventricular enlargement

• Echocardiogram: Validates ventricular thickening and diminished transvalvular size

• Electrocardiogram (ECG): Reflects force of contracting muscle

• Left-sided cardiac catheterization: High pressure of blood


Disorders of the Aortic ValveDisorders of the Aortic Valve• Medical and Surgical Management

– Support heart’s pumping activity

– Drug therapy: Digitalis and diuretic

– Restricted sodium

– Antibiotics; Nitrates; Beta-adrenergic blockers

– Balloon valvuloplasty

– Surgical aortic valve replacement

– Coronary arteriogram



In aortic stenosis, the drug of choice is an ACE inhibitor.


AnswerAnswerFalse.

In aortic stenosis, the drug of choice is not an ACE inhibitor but diuretics and cardiac glycosides.


Disorders of the Aortic ValveDisorders of the Aortic Valve• Nursing Management

– Monitors subjective and objective symptoms; Therapeutic or adverse responses

– Explains purposes and techniques of diagnostic tests

– Administers prescribed medications

– Implements measures to ensure adequate cardiac output and tissue oxygenation

– Assists clients with dietary modifications


Disorders of the Aortic ValveDisorders of the Aortic Valve• Aortic Regurgitation

– Valvular Incompetence: Aortic valve does not close tightly


• Cause: Damage to the valve cusps or papillary muscles

• Consequence of various disorders

• Increase aortic and mitral regurgitation

• Reduces cardiac output; Fluid overload

• Factors hindering supply to heart muscle




• Tachycardia; palpitations; dyspnea and chest pain

• Physical examination

• Moist and flushed skin; Water-hammer pulse; Wide pulse pressure

• Forceful contractions of the enlarged left ventricle; Heart murmur




• Cardiac catheterization: High left ventricular pressure

• Chest radiograph: Heart enlargement and dilated aortic valve

• ECG: Myocardial ischemia

• Radionuclide scan: Severity of the disease

• Echocardiography: Images of atypical valvular and myocardial function



As a result of aortic regurgitation, a chest radiograph will show cardiomegaly and a dilated aorta.


AnswerAnswerTrue.

As a result of aortic regurgitation, a chest radiograph will show an enlargement of the heart.



– Medical and Surgical Management

• Aortic regurgitation: Cardiac glycosides and diuretics

• Prophylactic antibiotics

• Modify lifestyle: Avoid demands on heart

• Replacement of the diseased aortic valve

• Vascular graft


Disorders of the Aortic ValveDisorders of the Aortic Valve• Nursing Management

– Prepares the client for diagnostic procedures and monitors responses

– Reports change in vital signs, dyspnea, chest pain, and LOC

– Administers prescribed medications and evaluates the client’s response

– Ensures balanced physical activity

– Client teaching

• Advise client about drug therapy; Assess BP; Methods to control hypertension


Disorders of the Mitral ValveDisorders of the Mitral Valve

• Mitral Valve

– Location and function of mitral valve

– Stroke volume

• Bolus of oxygenated blood aorta receives

– Valvular disorder

• Rigid, incompetent, or prolapsed


Disorders of the Mitral ValveDisorders of the Mitral Valve• Mitral Stenosis

– Valve not open properly to facilitate filling of left ventricle


• Sequela of rheumatic carditis; Recurrence of endocarditis; Effects of inflammation

• Mitral valve not open completely: Incomplete emptying of left atrium

• Risk for arterial emboli; Pulmonary hypertension; Affects right ventricle


Disorders of the Mitral ValveDisorders of the Mitral Valve• Mitral Stenosis


Disorders of the Mitral ValveDisorders of the Mitral Valve• Assessment Findings: Signs and Symptoms

– Valve area is less than 2.5 cm2

• Fatigue and dyspnea; heart palpitations

• Pulmonary hypertension: More dyspneic at night

• Cough: Pink, frothy sputum

• Pulmonary congestion

• Changes in heart sounds: Earliest indication

• Low systolic BP

• Effects on right ventricle


Disorders of the Mitral ValveDisorders of the Mitral Valve• Assessment Findings: Diagnostic Findings

– Chest radiograph

• Enlarged left atrium; Mitral valve calcification

– Fluid congestion in the lungs

– Echocardiogram

• Decreased movement of the mitral valve cusps

• Changes in the size of the atrial chamber

– ECG—P wave notched


Disorders of the Mitral ValveDisorders of the Mitral Valve• Medical and Surgical Management

– Antibiotic therapy: Prevent infective endocarditis

– Preventing symptoms of heart failure: Drug therapy

– Cardioversion: Allows SA node to reestablish itself as pacemaker

– Surgical: Commissurotomy

– Nonsurgical: Valvotomy

• Closes in 6 months; complications

• Nursing interventions after valvotomy


Disorders of the Mitral ValveDisorders of the Mitral Valve• Medical and Surgical

Management


Disorders of the Mitral ValveDisorders of the Mitral Valve• Nursing Management

– Monitor client’s physical condition

– Prepare client for diagnostic tests

– Provide post-treatment care

– Client teaching on discharge

• Drug therapy

• Activity modification

• Signs and symptoms of complications

• Contact physician


Disorders of the Mitral ValveDisorders of the Mitral Valve• Mitral Regurgitation (Insufficiency)


• Causes: Rheumatic carditis and mitral valve prolapse

• Damage to the papillary muscles; Impaired myocardial function; Connective tissue disorders; Stretching of the valve opening; Malfunction of a replaced valve

• Balloon valvuloplasty; Anorectic drugs

• Complications: Cardiogenic shock; Pulmonary congestion






• Chronic fatigue and dyspnea on exertion

• Heart palpitations

• Diminished S1 heart sound

• S3 heart sound: Impending heart failure

• Hypertension; Tachycardia

• Heart murmur

• Pulmonary congestion




• Transesophageal echocardiography: Structural changes in the mitral valve

• Chest radiography: Enlarged chambers of the heart

• Radionuclide angiography: Volume of regurgitated blood

• ECG: Cardiac enlargement, papillary muscle dysfunction, and various associated dysrhythmias




• Asymptomatic clients: Physical examination and annual echocardiograms

• Exercise; Angiotensin-converting enzyme (ACE) inhibitor

• Tachycardia: Drug therapy

• Prophylactic antibiotics

• Intra-aortic balloon pump

• Surgery: Annuloplasty; Implantation of a biologic or prosthetic valve



– Nursing Management

• Monitors BP, heart rate, heart sounds, lung sounds, and weight

• Restricted sodium: Alternative diet

• Administers medications and reports signs of left- or right-sided heart failure immediately

• Emphasizes need for prophylactic antibiotics and periodic health assessments



• Mitral Valve Prolapse

– Valve cusps enlarge, become floppy, and bulge backward into the left atrium

– Most common valvular disorder

– Common in young women

– Benign disease





Mitral valve prolapse is the rarest of cardiac valvular disorders.


AnswerAnswerFalse.

Mitral valve prolapse is the most common of cardiac valvular disorders.


Disorders of the Mitral ValveDisorders of the Mitral Valve• Mitral Valve Prolapse


• Idiopathic; Tissue changes—connective tissue disorder; Association with CAD

• Valvular changes of rheumatic carditis

• Mitral valve prolapse syndrome; Decreased circulatory volume

• Changes in the mitral valve tissue layers

• Stretching of the papillary muscles

• Congestive heart failure




• Chest pain, palpitations, fatigue, rapid heart rate, lightheadedness, and difficulty concentrating

• Chest pain: Prolonged and not easily relieved; auscultation of heart sound

• Significance of systolic murmur

• Echocardiography: Abnormal movement of mitral valve leaflets during systole

• ECG




• Periodic antibiotic therapy before invasive procedures

• Drug therapy: Reduce platelet aggregation —prevent thrombus formation

• Valve replacement

• Antianxiety medication: Valve prolapse syndrome; avoid caffeine; liberal fluid; adequate sodium intake

• Restrict alcohol



• Mitral Valve Prolapse

– Nursing Management

• Methods to relieve chest pain; Position of client; Increasing activity

• Instructs the client to breathe deeply and slowly

• Client teaching regarding

• Caffeine, over-the-counter medications, alcohol, fluid intake, use of salt, and tranquilizers


End of Presentation

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