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Cardiovascular 4
- Tricuspid stenosis
- Definition: narrowing of the tricuspid valve between right atrium and right ventricle
- Epidemiology
- relatively uncommon
- usually associated with lesions of other valves
- caused by rheumatic fever
- Findings
- dyspnea, fatigue, weakness, syncope
- peripheral edema
- jaundice with severe peripheral edema and ascites can mean that tricuspid stenosis has led to right ventricular failure
- may appear malnourished
- distended jugular vein
- Management: surgery - valvulotomy or valve replacement; valvuloplasty
- Nursing interventions
- the cardio-care six
- monitor the cardio seven
- monitor for findings of heart failure, pulmonary edema, and adverse reactions to the drug therapy
- post valve surgery, monitor client for hypotension, arrhythmias and thrombus formation
- when client sits, elevate legs - to prevent dependent edema
- client and family teaching
- teach the cardio five
- client must comply with long-term antibiotic and follow up care
- emphasize the need for prophylactic antibiotics during dental care
- Diagnostic findings
- EKG - for arrythmias
- echocardiogram - right ventricular dilation and paradoxic septal motion
- Tricuspid insufficiency (regurgitation)
- Definition - tricuspid valve lets blood leak from the right ventricle back into the right atrium
- Epidemiology
- results from dilation of the right ventricle and tricuspid valve ring
- most common in late stages of heart failure from rheumatic or congenital heart disease
- Findings
- dyspnea, fatigue, weakness and syncope
- peripheral edema may cause discomfort
- Management: surgical - valve replacement
- Nursing interventions
- the cardio-care six
- monitor for cardio seven
- monitor for findings of heart failure, pulmonary edema, and adverse reactions to the drug therapy
- post-op monitor client for hypotension, arrhythmias and thrombus formation
- when sitting, client should raise legs - to prevent dependent edema
- client and family teaching
- the cardio five
- emphasize the need for prophylactic antibiotics during dental care
- instruct client to raise legs when sitting - to prevent dependent edema
- Pulmonic stenosis
- Definition - obstructed right ventricular outflow resulting in right ventricular hypertrophy
- Epidemiology
- usually congenital, often with other birth defects such as tetralogy of Fallot
- rare among the elderly
- may result from rheumatic fever
- Findings
- dyspnea, fatigue, chest pain and syncope
- peripheral edema may cause discomfort
- Management: surgical - replace the valve via balloon and cardiac catheter
- Nursing interventions
- same as tricuspid stenosis and tricuspid insufficiency
- monitor for findings of heart failure, pulmonary edema, and adverse reactions to to the drug therapy
- post-op: monitor client for hypotension, dysrhythmias and thrombus formation
- monitor the cardio seven
- client and family teaching - same as tricuspid stenosis and tricuspid insufficiency.
- Pulmonic insufficiency (regurgitation)
- Definition - pulmonary valve fails to close, so that blood flows back into the right ventricle
- Epidemiology
- a birth defect, or a result of pulmonary hypertension
- rarely, result of prolonged use of a pressure-monitoring catheter in the pulmonary artery
- Findings
- dyspnea, fatigue, chest pain and syncope
- peripheral edema may cause discomfort
- if advanced: jaundicewith ascitesand peripheral edema
- possible malnourished appearance
- Management
- diuretics - to mobilize edematous fluid to reduce pulmonary venous pressure
- sodium-restricted diet - to control underlying heart disease
- anticoagulants - to prevent blood clots
- digitalis - to increase the force or strength of cardiac contractions (inotropic action)
- surgery for severe cases: valvulotomy or valve replacement
- Nursing interventions
- the cardio-care six
- monitor the cardio seven
- monitor for findings of heart failure, pulmonary edema, and adverse reactions to drug therapy
- post-op: monitor client for hypotension, arrhythmiasand thrombusformation
- provide rest periods
- when client sits, raise legs
- client and family teaching: (same as tricuspid stenosis, tricuspid insufficiency, and pulmonic stenosis)
- the cardio five
- client's dentist must give client prophylactic antibiotics to prevent infection
- instruct client to raise legs when sitting to prevent dependent edema
- Aortic stenosis
- Definition - aortic valve narrows. left ventricle must work harder, so needs more oxygen, and may suffer ischemiaand heart failure.
- Epidemiology
- most significant valvular lesion seen among elderly people. It usually leads to left-sided heart failure
- incidence increases with age
- occurs in 1% of the population
- about 80% of these people are male
- 20% of them die suddenly, around age 60
- Findings
- classic triad: dyspnea, syncope, angina(see Assessing Clients with Cardiovascular Disorders)
- fatigue
- palpitations
- left-sided heart failure may bring on orthopnea, paroxysmal nocturnal dyspnea, and peripheral edema
- Management
- nitroglycerin to relieve chest pain
- low-sodium diet - to prevent fluid retention
- diuretics - to mobilize edematous fluid and to reduce pulmonary venous pressure
- digitalis - to increase the force or strength of cardiac contractions (inotropic action)
- oxygen - to prevent hypoxia
- surgery - percutaneous balloon valvuloplasty, then valve replacement
- Nursing interventions
- the cardio-care six
- monitor the cardio seven
- monitor for findings of heart failure, pulmonary edema, and adverse reactions to the drug therapy
- post-op: monitor client for hypotension, arrhythmias and clots
- when client sits, raise legs to prevent dependent edema
- client and family teaching: (same as tricuspid stenosis, tricuspid insufficiency, pulmonic stenosis and pulmonic insufficiency)
- the cardio five
- client's dentist must administer prophylactic antibiotics
- client should raise legs when sitting
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