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Polish up on client care

DIAGNOSTIC TEST RESULTS

TREATMENT

Aortic insufficiency

Diet: sodium restrictions (in cases of heart


failure)
Surgery: open-heart surgery using
cardiopulmonary bypass for valve
replacement (in severe cases)

Cardiac catheterization shows reduction in


arterial diastolic pressures.
Echocardiography shows left ventricular
enlargement.
ECG shows sinus tachycardia and left ventricular hypertrophy.
X-ray shows left ventricular enlargement
and pulmonary vein congestion.

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Drug therapy
Anticoagulant: warfarin (Coumadin) to
prevent thrombus formation around diseased
or replaced valves

Mitral insufficiency
Cardiac catheterization shows mitral
insufficiency and elevated atrial pressure and
PAWP.
Echocardiography shows abnormal valve
leaflet motion.
ECG may show left atrial and ventricular
hypertrophy.
X-ray shows left atrial and ventricular
enlargement.

Mitral stenosis
Cardiac catheterization shows diastolic
pressure gradient across the valve and elevated left atrial and pulmonary artery wedge
pressures.
Echocardiography shows thickened mitral
valve leaflets.
ECG shows left atrial hypertrophy.
X-ray shows left atrial and ventricular
enlargement.

INTERVENTIONS AND RATIONALES


Watch closely for signs of heart failure
or pulmonary edema and for adverse
effects of drug therapy to prevent cardiac
decompensation.
Place the client in an upright position to
relieve dyspnea.
Maintain bed rest and provide assistance
with bathing, if necessary, to decrease oxygen
demands on the heart.
If the client undergoes surgery, watch
for hypotension, arrhythmias, and thrombus
formation. Monitor vital signs, ABG levels,
intake, output, daily weight, blood chemistries, chest X-rays, and pulmonary artery
catheter readings to detect early signs of
postoperative complications and ensure early
intervention and treatment.
Allow the client to verbalize concerns over
being unable to meet life demands because of
activity restrictions to reduce anxiety.

Mitral valve prolapse


Color-flow Doppler studies show mitral
insufficiency.
ECG shows prolapse of the mitral valve
into the left atrium.

Tricuspid insufficiency
Echocardiography shows systolic prolapse
of the tricuspid valve.
ECG shows right atrial or right ventricular
hypertrophy.
X-ray shows right atrial dilation and right
ventricular enlargement.

Teaching topics

The heart of the


matter is youre
almost through
with this chapter.
Just quiz yourself
with the practice
questions on the
next few pages
before moving on.

Explanation of the disorder and treatment


plan
Medications and possible adverse effects
Following diet restrictions and medication
schedule
Need for consistent follow-up care
Incorporating rest into the daily routine

NURSING DIAGNOSES
Activity intolerance
Anxiety
Decreased cardiac output

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4/8/2010 7:01:53 PM