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valvular disease
| Question | Answer |
|---|---|
| Valvular heart disease (malfunctioning valves) is caused by two primary pathologies | Stenosis Insufficiency(regurgitation |
| Congenital defects are the _____ cause of valvular heart disease in children. | primary |
| primary cause of valvular heart disease in adults | Rheumatic heart disease |
| ______and_____ affected most frequently due to greater workload and blood volume on the left vs right side of the heart. | Mitral and Aortic valves |
| 4 valvular heart disorders: | Mitral stenosis & insufficiency. Aortic stenosis & insufficiency. Tricuspid stenosis & insufficiency. Pulmonary stenosis & insufficiency |
| Test used to confirm diagnosis of valvular heart disease: | Chest radiograph. Echocardiogram. Cardiac catheterization: confirm presence of valvular disease |
| Medical Management of valvular heart disease | Activity limitations. Sodium restricted diet. Medications include: Diuretics. Cardiac glycosides. Antidysrhythmics. Anticoagulants. Antibiotics. |
| What is Indicated when lifestyle is affected and medical therapy no longer alleviates symptoms, or there is diagnostic evidence of progressive myocardial failure. | surgical intervention |
| What is most commonly included in valvular repair surgury | Most common surgery for valve repair includes open commissurotomy: a surgical splitting of the fused mitral valve for treating stenosis. |
| Valve replacement of the stenosed or incompetent valve with prosthetic or mechanical valve. Commonly used valves include: | a) Porcine (pig). (b) Heterograft: tissue taking from one species and grafted to another. c) Homograft: tissue taken from the same species. (d) Ball in cage. |
| QUESTION: Where are the aortic and mitral valves located? | ANSWER: Between the left ventricle and the aorta and between the left atrium and left ventricle |
| QUESTION: Why are antibiotics used in the treatment of VHD? | ANSWER: Prophylaxis in the prevention of infective endocarditis. |
| Heterograft: | issue taking from one species and grafted to another (eg.porcine) |
| Homograft | tissue taken from the same species. |
| Anticoagulant Agents Use: | Prevention and treatment of thromboembolic disorders including deep vein thrombosis (DVT), pulmonary embolism (PE), and atrial fibrillation with embolization. Management of MI sequentially or in combination with thrombolytics and/or antiplatelet agents |
| Anticoagulant Agents Action | To prevent clot extension and formation. Anticoagulants do not dissolve clots. Potentiates the inhibitory effect of antithrombin on factor Xa and thrombin. |
| Anticoagulants Category Therapeutic | Therapeutic: anticoagulant |
| Anticoagulants Category Pharmacological: | antithrombotics Examples: heparin. warfarin (Coumadin |
| Anticoagulants Contraindications: | Hypersensitivity. Underlying coagulation disorders. Ulcer Disease. Malignancy. Recent surgery. Active, major bleeding |
| Precautions for anticoagulation therapy: | Precautions for anticoagulation therapy: History of congenital or acquired bleeding disorder. Pregnancy. Lactation. |
| Anticoagulants Side Effects: | CNS: fever. GI: diarrhea. Derm: rash. Hemat: hemorrhage, agranulocytosis, leukopenia, eosinophilia, thrombocytopenia |
| Anticoagulants Interactions | Risk of bleeding may be by concurrent use of drugs that affect platelet function and coagulation, including: warfarin, aspirin, thrombolytic agents, e, some penicillins, clopidogrel, abciximab, eptifibatide, tirofiban, ticlopidine, and dextran |
| Nursing Implications for Patients receiving anticoagulants Assessment: | bleeding hemorrhage (bleeding gums; nosebleed; unusual bruising; black, tarry stools; hematuria; fall in hematocrit or blood pressure; guaiac-positive stools); bleeding from surgical site. Notify physician or other health care professional if these occur |
| Nursing Implications for Patients receiving anticoagulants Assess patient for evidence of additional or increased _____ | thrombosis;S/S & report it* Monitor for hypersensitivity (chills, fever, urticaria). Monitor pt with epidural catheters frequently for signs and symptoms of neurologic impairment. Observe injection sites for hematomas, ecchymosis, or inflammation. |
| Anticoagulants Labs | Monitor CBC, platelet count, and stools for occult blood periodically during therapy,hematocrit, bleeding,(PT) or (INR) with warfarin therapy, (aPTT) with full-dose heparin therapy and hematocrit and other clotting factors frequently during therapy. |
| PT (in labs) | prothrombin |
| INR (in labs) | International normalized ratio |
| aPTT (in labs) | activiated partial thromboplastin time |
| Anticoagulants Toxicity and Overdose | Protamine sulfate 1 mg for each mg of enoxaparin should be administered by slow IV injection. Vitamin K is the antidote for warfarin |
| Anticoagulants Implementation: | Cannot be used interchangeably (unit for unit) with unfractionated heparin or other low-molecular-weight heparins. |
| Anticoagulants Implementation | Administer deep into SQ tissue. Alternate injection sites daily * Inject entire length of needle at a 45° or 90° angle into a skin fold held between thumb and forefinger; Do not aspirate or massage; Rotate sites frequently;Do not administer IM. |
| To minimize risk of bleeding after vascular instrumentation for unstable angina, recommended intervals between doses should be followed closely | Leave vascular access sheath in place for 6–8 hr after enoxaparin dose. Give next enoxaparin dose >=6–8 hr after sheath removal. Observe site for bleeding or hematoma formation |
| Anticoagulant Patient Teaching | Advise pt to report any symptoms of unusual bleeding or bruising, dizziness, itching, rash, fever, swelling, or difficulty breathing to health care professional immediately* no aspirin or NSAID's while on therapy |
| Anticoagulants Evaluation | Prevention of deep vein thrombosis and pulmonary embolism. Resolution of acute deep vein thrombosis. Prevention of ischemic complications (with aspirin) in patients with unstable angina or non-Q-wave MI. |
| QUESTION: A patient has been prescribed warfarin (Coumadin) in addition to a heparin infusion. The nurse recognizes that the reason for the two anticoagulants is which of the following? | ANSWER: D Heparin is often used to initiate therapy when oral anticoagulants are prescribed until laboratory tests indicate an adequate therapeutic response. |
| Nursing Diagnosis | Activity intolerance r/t weakness fatigue, and dyspnea. |
| Nursing interventions | Balance rest periods with activities. Obtain assistance as needed for activities. Utilize oxygen as prescribed |
| Nursing interventions include: | Administer prescribed medications: Digoxin. Diuretics. Antidysrhythmics. Oxygen. |
| Patient Teaching | importance of prophylaxis antibiotics in prevention of infective endocarditis |
| Patient Teaching after valve replacement | After valve replacement surgery Pt. must be on anticoagulant therapy. Prothrombin time or INR monitored closely |
| Valvular Heart Disease | Etiology/Pathophysiology. Clinical Manifestations. Assessment. Diagnostic Tests. Medical Management. Surgical Management. Anticoagulant agents Nursing Implications. |
Created by:
ninja3lake
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