Exam 2: Valvular Heart Disease and Aortic Aneurysms

Question 1

Valvular Heart Disease

Answer 1

Functional alteration of one or more valves of the heart due to stenosis and regurgitation

Question 2

Stenosis

Answer 2

Constriction or narrowing

Question 3

Regurgitation

Answer 3

Valvular insufficiency that permits leakage backward through the valve.

Question 4

Mitral Valve Stenosis

Answer 4

Shortening, thickening of the mitral valve.

Question 5

Causes of Mitral Valve Stenosis

Answer 5

• rheumatic heart disease (infection or a complication of strep infection)
• congenital (mitral) stenosis (short or hardened leaflets)
• rheumatoid arthritis
• systemic lupus erythematosus

Question 6

Clinical Manifestations/Complications of Mitral Valve Stenosis

Answer 6

Due to back up of blood flow in the left side of the heart you would have symptoms of left sided heart failure.
• dyspnea
• hemoptysis
• palpitation / atrial fibrillation (atrium can’t empty efficiently causing enlargement leading to arrhythmias)
• fatigue
• murmur
• chest pain
• seizure (from possibility of thromboembolism)
• stroke (same as seizure)

Question 7

Mitral Valve Regurgitation

Answer 7

Backward flow of blood from left ventricle to left atrium

Question 8

Causes of Mitral Valve Regurgitation

Answer 8

• inflammatory (from damage to valve leaflets)
• degenerative
• infective (especially endocarditis. Strept bacteria favor the valves of the heart. If pt has strept throat-can lead to endocarditis. Since bacteria overrun the tonsils)
• structural / congenital

Question 9

Clinical Manifestations of Mitral Valve Regurgitation

Answer 9

• pulmonary edema
• thready peripheral pulses
• cool clammy extremities
• systolic murmur
• weakness
• fatigue
• dyspnea, orthopnea, paroxysmal nocturnal dyspnea
• peripheral edema (if it on the tricuspid and not mitral)

Question 10

Systolic murmur

Answer 10

audible sound due to turbulence of blood through the incompetent valve. Since it is on the squeeze of the left side. Murmur happens on the S1 heart sound. Since it is the AV valve. S2 is the SL valve. The SL valve wound be heard. Aortic and Pulmonic (APE to Man) should have a louder lub DUB. Where the tricuspid and mitral should have a louder LUB dub.

Question 11

Management of Valvular Heart Disease

Answer 11

• prevent recurrent rheumatic fever or infective endocarditis
• Tx is prevention of heart failure, pulmonary edema, thromboembolism
• Tx of CHF, arrhythmia (atrial)

Question 12

Nursing Therapeutic for Valvular Heart Disease

Answer 12

Teach about completing whole course of antibiotic
Assist for plan of ADL such as conserving energy and set priorities to take rest periods.
• Prevent acquired rheumatic valvular disease
• Hospitalization due to CHF and arrhythmia
• Exercise plan to increase cardiac tolerance
• Smoking cessation
• Assist in planning for ADL
• Prophylactic ABT to prevent endocarditis such as when having dental procedure. This provides and open area for infection.

Question 13

Aneurysm

Answer 13

• out pouching or dilatations of the arterial wall. Can happen anywhere in arteries. Most common in aortic since it is high pressure

Question 14

Causes of Aneurysms

Answer 14

• atherosclerosis
• genetic predisposition
• penetrating or blunt trauma
• infection

Question 15

Classifications of Aneurysms

Answer 15

True aneurysm – a dilation of the wall

False aneurysm – disruption of the layer resulting in bleeding that is contained within the layer of the anterior wall.

Question 16

Clinical Manifestations of Aneurysms

Answer 16

• asymptomatic
• deep diffuse chest pain
• hoarseness – pressure against the larryngal nerve
• dysphagia (pressure against the esophagus)
• distended neck vein , edema head and arm
• pulsatile mass in the periumbilical area (if pulsating do not touch. Normal is just movement but not pulse)
• audible bruit (from turbulence caused by aneurysm)
• pain , abdominal or back
• discomfort with or without alteration of bowel elimination

Question 17

Complications of Aneurysms

Answer 17

• Rupture / Bleeding / Death

   Grey Turner’s Sign back pain due to bleeding that accumulates in the retroperitoneal area.

Question 18

Goal of Care For Aneurysms

Answer 18

Prevent rapture of aneurysm

Question 19

Collaborative Care For Aneurysms

Answer 19

• < 4 cm – conservative treatment don’t bend or strain or lift. To prevent intra-abdominal pressure.
• Surgical repair > 5-6 cm

Question 20

Nursing Implications For Aneurysms

Answer 20

• Decrease risk factors associated with atherosclerosis - diet, smoking, exercise,
• Preop. support and teaching breathing exercise
• ICU care post surgery
• Maintain BP
• Oxygen supply oxygen supply to prevent heart to compensate that could increase output.
• Prevention of infection / ABT
• Prevent paralytic ileus early ambulation that could start with isometric exercise. That increases parastaltic movement
• Monitor peripheral perfusion status
• Monitor renal perfusion urinary output.
• Avoid heavy lifting 4-6 weeks post op.
• Monitor sign and symptoms of infections