Tricuspid valve stenosis

tricuspid valve stenosis

1. TRICUSPID VALVE STENOSIS AND INSUFFICIENCY

2. INTRODUCTION TRICUSPID VALVE Known as RIGHT ATRIOVENTRICULAR VALVE Consists of the three flaps or cups Situated between the right atrium and right ventricle. Acts as valve to prevent backflow of the blood.

3. DEFINITION Narrowing or stiffening of the opening in the valve stenosis. TRICUSPID VALVE STENOSIS

4. TRICUSPID VALVE STENOSIS

5. DEFINITION TRICUSPID VALVE INSUSFFICIENCY The valve does not close tightly enough to prevent leakage TRICUSPID REGURGITATION TRICUSPID VALVE INCOMPETENCE

6. TRICUSPID INSUFFICIENCY

7. CAUSES RHEUMATIC FEVER ACCOMPANIED BY VALVULAR DISEASES CONGENITAL HEART DISEASES INFECTION TUMOUR CONGESTION HEART FAILURE

8. RISK FACTOR Rheumatic fever Infection ( endocarditis) Congenital malformation Tumor (rare) Diet medication called “Fen- Phen (phentermine and fenfluramine) or dexfenfluramine

9. PATHOPHYSIOLOGY BLOOD FLOW TO THE RIGHT ATRIUM TRICUSPID VALVE RIGHT VENTRICLES

10. PATHOPHYSIOLOGY BACKFLOW TO THE RIGHT ATRIUM HIGHER PRESSURE RIGHT ATRIUM, ENLARGEMENT, AND HYPERTROPHY SYSTEMIC VENOUS RETURN CONGESTION HEPATOMEGALY ASCITES

11. CLINICAL MANIFESTATION

12. INVESTIGATION LABORATORY TEST RADIOLOGY INVESTIGATION

13. INVESTIGATION LABORATORY TEST RESULT FULL BLOOD COUNT (FBC) Polycythemia result Leukocytosis indicate ineffective endocarditis LIVER FUNCTION TEST (LFT) Mild elevation of aminotransferases may present secondary to chronic hepatic venous congestion. BLOOD CULTURES Positive infective endocarditis.

14. INVESTIGATION Physical examination Pulse Abnormal pulse elevated in the jugular vein of the neck. Auscultation with a stethoscope. The result is abnormal heart sounds and heart murmur.

15. INVESTIGATION

16. INVESTIGATION Transesophageal echocardiogram CT - Scan MRI Stress test

17. CHEST X-RAY RIGHT ATRIUM ENLARGEMENT

18. 12 LEAD ECG

19. ECHOCARDIOGRAM

20. CARDIAC CATHETERIZATION

21. ULTRASOUND

22. CT SCAN

23. MRI SCAN

24. TRANSESOPHAGEAL ECHOCARDIOGRAM

25. STRESS TEST

26. TREATMENT MEDICAL TREATMENT SURGICAL TREATMENT

27. MEDICAL TREATMENT Mild- no symptoms no require treatment. Medication as prescribed to relief the symptoms only . Types of medication prescribed depends on the condition of patient. Antibiotics Diuretics Anticoagulants Antiplatelets Vasodilators Cardiac glycosides

28. MEDICATION GROUP EXAMPLE ACTION ANTIBIOTICS PENICILLIN G POTASSIUM ( PFIZERPEN ) Inhibit cell wall synthesis in susceptible organism cell death. ANTICOAGULANTS WARFARIN SODIUM (COUDIUM ) Prevent thrombosis and prolong clotting time CARDIAC GLYCOSIDES DIGOXIN ( LANOXIN ) Increasing cardiac output by slowing heart rate and increase the force contraction.

29. MEDICATION GROUP EXAMPLE ACTION ANTIPLATELETS TICLOPIDINE HYDROCHLORIDE (TICLID) Reduces the clot production by interfering with platelets aggregation. VASODILATORS GTN ISORDIL To vasodilators the blood vessels. DIURETICS FRUSEMIDE (LASIX) To reduce the edema.

30. SURGICAL TREATMENT

31. ANNULOPLASTY Procedure to reduce the an enlarged annulus (fibrous ring) surrounding the valve. Prosthetic ring sutured into the circumference of tricuspid annulus and the stitches are pulled towards to prosthesis .

32. ANNULOPLASTY

33. VALVULOPLASTY Involves direct repair to torn leaflets by open surgery.

34. COMMISSUROTOMY Incision of stenos valve leaflets at their borders. OPEN COMMISSUROTOMY Performed median sternotomy CLOSED COMMISSUROTOMY Insert finger through a small incision

35. OPEN COMMISSUROTOMY CLOSED COMMISSUROTOMY

36. REPLACEMENT HEART VALVE Replacement valve can replace to overcome the congenital or obstructive of valvular disorders. Types of replacement valve Natural valve Modified natural valves (animal donors) Artificial or mechanical valve

37. MODIFIED NATURAL VALVE PIG TISSUE VALVE PORCINE VALVE COW VALVE

38. MECHANICAL VALVE

39. COMPLICATION OF TRICUSPID VALVE STENOSIS AND INSUFFICIENCY

40. COMPLICATION CHRONIC HEART FAILURE ENDOCARDITIS LIVER CIRHOSIS

41. COMPLICATION HEPATOMEGALY ASCITES

42. HEALTH TEACHING

43. HEALTH TEACHING

44. NURSING CARE PLAN

45. NCP 1 NURSING DIAGNOSIS : DECREASED OF CARDIAC OUTPUT RELATED TO THE TRICUSPID VALVE STENOSIS AND INSUFFICIENCY. EXPECTED OUTCOME: CARDIAC OUTPUT WILL ELEVATED AND MAINTAIN.

46. NURSING INTERVENTION NURSING INTERVENTION RATIONALE Monitor vital signs , hemodynamic parameters, cardiac rhythm. To report any changes /abnormality reading. Monitor intake and output chart. To detect loss of function of the renal perfusion or renal failure. Weight daily. To evaluate the elevation of weight due to fluid retention. Restrict the fluid as ordered. To reduce cardiac workload. Monitor oxygen saturation and ABG results. To allow the assessment of oxygenation. Administer oxygen as ordered. To improve alveolar ventilation and oxygenation. Encourage rest on the bed. To decrease cardiac workload. Administer medication as prescribed. To reduce fluid volume and cardiac work Elevate the head of the bed. To promote breathing mechanism.

47. NCP 1 EVALUATION CARDIAC OUTPUT INCREASING , THE HEART RATE, BLOOD PREESSURE AND URINE OUTPUT WITHIN THE NORMAL RANGE.

48. NCP 2 NURSING DIAGNOSIS: ACTIVITIY INTOLERANCE RELATED TO THE TRICUSPID VALVE STENOSIS AND INSUFFICIENCY EXPECTED OUTCOME : CLIENT WILL TOLERATE ACTIVITY WITHOUT DYSPNEA OR TACHYCARDIA

49. NURSING INTERVENTION NURSING INTERVENTION RATIONALE Monitor vital signs before and during activity. To report any abnormalities reading. Encourage self-care and gradually increasing activities as a lower and tolerated. To improve client self-esteem and sense of power. Provide assistance as needed. To reducing the energy expenditure to help maintain a balance oxygen balance. Consult with cardiac rehabilitation , physical therapy for in-bed exercise and activity plan. To improve the strength and promote good circulation. Discuss ways to conserve the energy. To maintain oxygen level in the body.

50. NCP 2 EVALUATION CLIENT MANAGE SELF-CARE AND MODERATE ACTIVITY WITHOUT BECOMING DYSPNEA AND MAINTAIN HEART RATE.

51. NCP 3 NURSING DIAGNOSIS: RISK FOR INFECTION RELATED TO THE TRICUSPID VALVE STENOSIS AND INSUFFICIENCY EXPECTED OUTCOME : CLIENT WILL FREE OF INFECTION

52. NURSING INTERVENTION NURSING INTERVENTION RATIONALE Use aseptic technique for all invasive procedures. To prevents infection. Assess the wound and catheter sites for redness, swelling, warmth, pain . To reduce the risk of infection. Administer antibiotics as ordered. To treat and prevent the infection. Monitor WBC and TWDC results. To notify the leukocytosis and leucopenia. EVALUATION: CLIENT FREE FROM NOSOCOMIAL INFECTION

53. NCP 4 NURSING DIAGNOSIS: DEFICIT KNOWLEDGE OF SELF-CARE RELATED TO THE TRICUSPID VALVE SYENOSIS AND INSUFFICIENCY EXPECTED OUTCOME : CLIENT WILL ACCURATEKY DESCRIBE DISCHARGE INSTRUCTION

54. NURSING INTERVENTION NURSING INTERVENTION RATIONALE Completely explain all treatment. To improve the understanding disease process. Consult the physician about prophylactic antibiotics therapy before or invasive treatment. To prevent infection. Avoid vigorously activities and competitive sports. To reduces cardiac workload. Avoid caffeine and over-the –counter medications To reduce the high risk of congestion cardiac failure. EVALUATION: CLIENT MORE UNDERSTANDING AND KNOWLEGEABLE.

55. CONCLUSION Tricuspid valve stenosis and insufficiency are the heart valvular disease. Both of them caused by the rheumatic heart diseases. It can be corrected by the repairment of the valve and replacement of the valve for good circulation of blood in the body and improve breathing process.

56. REFERENCES http://www.nlm.nih.gov/medlineplus/ency/article/000169.htm http://emedicine.medscape.com/article/158484-followup#showall http://heart_emedtv.com/tricuspid-stenosis/tricuspid-stenosis.html http://www.tricuspidvalvestenosis.com/ http://www.mayoclinic.org/tricuspid-valve-disease/

57. REFERENCES Luckmann and sorenser’s Medical surgical nursing ( A Psychophysiology approach) fourth edition, JOYCE M.BLACK & ESTHER MATASSARIN (1234&1235) PEARSON INTERNATIONAL EDITION (2008),Medical- surgical nursing critical thinking in client care.(Fourth edition),PRISCILLA LEMONE AND KAREN BURKE,(2008) Lippincott Williams and Wilkins, Introduction medical surgical nursing (ninth edition), BARBARA R.TIMBY & NANCY E.SMITH.