Unit 3 part 2 valvular heart disease

Post RN SEMESTER ONE Adult health nursing according to new curriculum of Pakistan nursing council 2019-2020

1. Unit III- VALVULAR HEART DISEASE ADVANCE NURSING MANAGEMENT OF CARDIOVASCULAR DISEASES BY SEHRISH NAZ RN, Post RN, MSN Lecturer, Institute of Nursing Sciences, Khyber Medical University Subject: Adult Health Nursing 11/15/2019 1 Post RN semester one

2. At the end of this unit, students will be able to: Utilize Functional health pattern to identify patients problems related to Valvular heart disease Integrate patho -physiology and pharmacology concepts of Valvular heart disease Apply nursing process with support on Evidence-Based Nursing (EBN) to provide to the clients with Valvular heart disease Discuss the holistic approach for nursing management of the patient with Valvular heart disease Develop a teaching plan for a client experiencing disorders of the Valvular heart disease Objectives

3. Valvular Heart Disease Valvular   heart   disease  is defined by damage or defect in one of the four heart valves: the mitral, aortic, tricuspid or pulmonary. The mitral and aortic valves  are the ones most frequently affected by valvular heart disease. The   mitral and tricuspid valves  control the flow of blood between the atria and the ventricles The  pulmonary valve  controls the flow of blood from the heart to the lungs. The  aortic valve  governs blood flow between the heart and the aorta.

4. Epidemiology of VHD

5. Types of Valvular Heart Disease Tricuspid stenosis : Narrowing of the tricuspid orifice that obstructs blood flow from the right atrium to the right ventricle Tricuspid regurgitation : Insufficiency of the tricuspid valve causing blood flow from the right ventricle to the right atrium during systole Pulmonic stenosis : Narrowing of the pulmonary outflow tract causing obstruction of blood flow from the right ventricle to the pulmonary artery during systole Pulmonic regurgitation : Insufficiency of the pulmonic valve causing blood flow from the pulmonary artery into the right ventricle during diastole

6. Types of Valvular Heart Disease Mitral stenosis : Narrowing of the mitral orifice that impedes blood flow from the left atrium to the left ventricle Mitral regurgitation : Insufficiency of the mitral valve causing flow of blood from the left ventricle (LV) into the left atrium during ventricular systole . Aortic stenosis : Narrowing of the aortic valve , obstructing blood flow from the left ventricle to the ascending aorta during systole Aortic regurgitation : Insufficiency of the aortic valve causing backflow of blood from the aorta into the left ventricle during diastole

7. VALVULAR STENOSIS Valve opening narrows Obstruction in blood flow Stress increase in chamber behind stenotic valve Pressure increase to force blood Compensation for additional workload Hypertrophy Heart failure

8. Valvular Regurgitation incomplete closure of the valve Leakage or blockage of blood H eart pumps the same blood twice (as the blood comes back into the chamber) The heart dilates to accommodate more blood Hypertrophy Heart failure

9. Risk factors Defects in these valves can be congenital or acquired . Age Gender Tobacco use Hypercholesterolemia Hypertension T ype II diabetes

10. Causes Advanced age .(Degeneration/calcification) Congenital heart disorders Rheumatic fever. Bacterial endocarditis. High blood pressure and atherosclerosis Myocardial infarction (damage of the muscles that control the heart valves)

11. Signs and symptoms Many of the symptoms are similar to those associated with congestive heart failure Shortness of breath Wheezing after limited physical exertion Swelling of the feet, ankles, hands or abdomen (edema). Palpitations, chest pain (may be mild). Fatigue. Dizziness or fainting (with aortic stenosis). Fever (with bacterial endocarditis). Rapid weight gain.

12. Diagnostic procedures Heart murmurs on auscultation X-ray chest ECG/ ECHO ETT CT scan /MRI Cardiac Catheterization

13. Management Life style changes Medical management Surgical management Nursing management

14. Lifestyle Modifications Healthy life choices will improve your overall health and your heart health and can help you slow the progression of your heart disease. Some healthy choices include: Healthy Diet Quit Smoking and Alcohal Exercise to reduce stress Weight maintenance

15. Medical Management Along with life style modification for heart health, medications are needed to control symptoms of Valvular Heart Disease Anticoagulants or Thrombolytic agents  Digitalis ( digoxicin ) ACE Inhibitors   Beta-blockers Calcium Channel Blockers Diuretics Antibiotics

16. Surgical Management Two main types of procedure are Heart valve surgery Minimally invasive valve surgery Complex valve repair and replacement

17. Transcatheter Procedures Transcatheter aortic valve replacement ( TAVR) Transcatheter mitral valve repair with Mitral Clip Transcatheter aortic valve fusion Transcatheter repair of congenital defects

18. Pre-operative Nursing diagnosis Activity intolerance related to insufficient oxygenation secondary to decreased cardiac output and pulmonary congestion..   Ineffective cardiopulmonary tissue perfusion related to reduced coronary blood flow. Ineffective air exchange related to fluid overload.   Anxiety related to fear of death, change in health status & impending surgery.

19. Post-operative nursing diagnosis Acute pain related to surgical trauma and pleural irritation caused by chest tubes  Ineffective renal tissue perfusion related to decreased cardiac output, hemolysis, or vasopressor drug therapy Decreased cardiac output related to blood loss and compromised myocardial function Impaired gas exchange related to trauma of extensive chest surgery Risk for deficient fluid volume and electrolyte imbalance related to alterations in blood volume

20. Nursing Interventions Assess mental status (Restlessness, severe anxiety and confusion ). Check vital signs (temperature, heart rate and blood pressure ). Maintain intake output and daily weight. Maintain physical and emotional rest (restrict activity and provide quiet and relax environment). Monitor sleep patterns; administer sedative. Explain diet restrictions (fluid, sodium).

21. Nursing Intervention Administer medication as prescribed, noting response and watching for side effects and toxicity. Explain drug regimen, purpose, dose, and side effects. Maintain adequate ventilation and perfusion (Place patient in semi- to high-Fowler’s position or supine position). Administer O2 as advised. Assess response to increased activity and help patient in daily activities

22. Group weekly Assignments Topic: Myocardial infarction (MI) Coronary heart disease (CHD) and Coronary artery disease (CAD ) Objectives: Utilize Functional health pattern to identify patients problems related to cardiovascular disorders Integrate patho -physiology and pharmacology concepts of cardiovascular disease Apply nursing process with support on Evidence-Based Nursing (EBN) to provide to the clients with CV disorders Discuss the holistic approach for nursing management of the patient with cardiovascular diseases

23. References Porter, P. A & Perry, A. G. (2016). Basic Nursing: Essentials for practice (5th ed.) St. Louis: Mosby. Kozier & Erb , G. K., (2015). Fundamentals of Nursing: Concept, process and practice (10th ed.). Addison: Wesley.Bruner , L.S., & Suddarth , D.S. (2015). Text book of Medical-Surgical Nursing (14 Ed.). Philadelphia: Lippincott.

24. Thank you so much for attention