Nursing Care Plan (NCP) for Heart Valve Disorders

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Outline

Pathophysiology

Mitral Regurgitation – mitral valve cannot close completely, therefore blood back-flows into the LA

Mitral Stenosis – mitral valve cannot open fully or is narrowed, therefore blood can’t go into the LV

Aortic Regurgitation – aortic valve cannot close completely, therefore blood back-flows into the LV

Aortic Stenosis – aortic valve cannot open fully or is narrowed, therefore blood can’t get out of LV

When the blood can’t flow the direction it’s supposed to flow, cardiac output is compromised.

Etiology

The most common cause of valve disorders is rheumatic fever or endocarditis which cause damage, vegetation, or thickening and scarring of the heart valves. An acute, emergent situation could be caused by mitral valve prolapse or papillary muscle rupture.

Desired Outcome

Preserve cardiac output where possible, and proceed to valve repair or replacement if cardiac output is compromised. Prevent post-op complications from valve repair or replacement.

Heart Valve Disorders Nursing Care Plan

Subjective Data:

May be asymptomatic except heart murmur. If cardiac output is compromised, may see these symptoms:

  • Chest pain
  • Shortness of breath
  • Weakness
  • Fatigue

Objective Data:

  • Heart Murmur
    • Systolic Murmur – Aortic Stenosis or Mitral Regurgitation
    • Diastolic Murmur – Aortic Regurgitation or Mitral Stenosis

 

May be asymptomatic except heart murmur. If cardiac output is compromised, may see these signs:

  • ↓ BP
  • ↑ HR
  • Skin – cool, diaphoretic, pale, dusky
  • Weak pulses
  • Slow cap refill

Nursing Interventions and Rationales

  • Assess Heart SoundsTo identify murmur:
    1. Is it an S1 or S2 murmur?
    2. Which valve are you listening to?
    3. What should the valve be doing at that time?

 

The easiest way for a nurse to determine the presence of a valve disorder is to listen for murmurs. A murmur indicates abnormal or turbulent blood flow through the valve.  

  • If the valve should be open, but doesn’t open fully – stenosis
  • If the valve should be closed, but doesn’t close fully – regurgitation

 

  • Assess and Monitor CV status
    • Pulses
    • Capillary refill
    • Skin color, temperature
    • Heart rate
    • Blood Pressure
    • Arrhythmias (ECG)

 

Valve disorders can compromise cardiac output. Assess cardiovascular status to determine if there is decreased perfusion to the tissues. If BP is dropping, HR may increase to compensate.

 

  • Assess respiratory status
    • Lung sounds
    • SpO2
    • Shortness of Breath
    • Sputum

 

If blood is not going forward or backing up, it can cause pulmonary congestion leading to pulmonary edema. This would cause decreased SpO2, crackles in the lungs, and possibly even pink-frothy sputum

 

  • Notify provider of new or sudden onset or murmurs, especially if accompanied by signs of poor perfusion or pulmonary edema

 

Papillary muscle rupture and mitral valve prolapse may occur suddenly. They are most often accompanied by chest pain, shortness of breath, or other signs of heart failure. This is an emergency that requires surgical intervention immediately. Don’t hesitate to call for help.

 

  • Educate patient about post-op requirements after valve replacement surgery
    • Prophylactic antibiotics prior to any invasive procedures
    • Bleeding Precautions (anticoagulant therapy)
    • Use soft bristle toothbrush
    • Maintain good oral hygiene
    • Avoid dental procedures for 6 months post-op

 

Patients who receive artificial valve replacements will require lifelong anticoagulant therapy. They need to be taught precautions for anticoagulant therapy, including using electric razors and soft bristle toothbrushes and how often they will require monitoring, if at all.

Patients with artificial heart valves are at high risk of developing endocarditis. They need to be taught about preventative measures, including receiving prophylactic antibiotics prior to any invasive procedures.

Oral hygiene is imperative to prevention of endocarditis after valve repair.  This may seem silly but it is a HUGE deal. The evidence has shown that bacteria from the oral cavity are highly likely to translocate (move) to the heart and become lodged in/on the valves. This is also why patients should avoid dental procedures for 6 months after valve surgery. It is so important that you, as the nurse, educate them on why this is so important.

 

Writing a Nursing Care Plan (NCP) for Heart Valve Disorders

A Nursing Care Plan (NCP) for Heart Valve Disorders starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Hey guys, in this lesson, we’re going to take a look at the care plan for heart valve disorders. We’ll briefly take a look at the pathophysiology and the etiology of heart valve disorders. We’re also going to look at additional things like subjective and objective data that your patient may present with as well as nursing interventions and rationales. 

 

Heart valve disorders occur when blood flow direction is compromised through the valves, which then causes cardiac output to be compromised. Heart valve disorders include mitral regurgitation, mitral stenosis, aortic regurgitation, and aortic stenosis. Please see the next slide for a description of these issues. The most common causes of heart valve disorders are rheumatic fever or endocarditis, which causes damage, vegetations or even thickening and scarring of the heart valves. An acute emergency situation could be caused by mitral valve prolapse or papillary muscle rupture, so the desired outcome in these patients is to preserve cardiac output when possible and proceed to valve repair or replacement, and also prevent any complications. Mitral regurgitation occurs when the mitral valve cannot close completely and blood then flows into the left atrium. Mitral stenosis is when the mitral valve cannot open fully or is narrowed, and blood cannot get into the left ventricle. An aortic regurgitation is when the aortic valve cannot close completely and therefore blood backflows into the left ventricle. Finally, aortic stenosis is when the aortic valve cannot open fully or is narrowed and blood can’t get out of that left ventricle. 

 

Alright guys, let’s take a look at some of the subjective and objective data that your patient with heart valve disorders may present with. Now remember, subjective data are going to be things that are based on your patient’s opinions or feelings, but your patient with a heart valve issue may actually be asymptomatic with the exception of a heart murmur. However, if cardiac output is compromised, they may explain symptoms of chest pain, shortness of breath, weakness, fatigue and things like that. 

 

Objective data includes a systolic murmur, which is indicative of aortic stenosis or mitral regurge, and a diastolic murmur is actually indicative of aortic regurge or mitral stenosis. If cardiac output is compromised, we may see a decreased blood pressure, increased heart rate, weak pulses, slow capillary refill, and cool, diaphoretic, pale, even dusky skin. 

 

Okay, guys, let’s begin to review the nursing interventions for heart valve disorders. Assessing heart sounds is critical in these patients and is the easiest way for a nurse to identify a valve disorder. A murmur indicates turbulent blood flow or abnormal blood flow through the valve. Remember, if a valve should be open, but doesn’t open fully, this is stenosis, and if a valve should be closed, this will be regurgitation. To help with identifying the presence of a murmur,  identify, Is it an S1 or S2 murmur, realize which valve you are actually listening to, and what should the valve be doing at this time? We also must assess and monitor the cardiovascular status of these patients as valve disorders can compromise cardiac output. By assessing their cardiovascular status, we can help to determine if there is decreased perfusion to the tissues. Be sure to assess closely, their blood pressure, their heart rate, pulses, capillary refill, their skin color and temperature as the skin will be cool, pale and clammy with a decreased cardiac output, and also the presence of any arrhythmias. 

So assessing respiratory status is also important because think about it, if blood is not moving forward or backing up,this can create pulmonary congestion and lead to pulmonary edema. We would see decreased SATs, crackles in their lungs, and the patient can even have pink, frothy sputum. We also want to make sure we notify the provider of any new or sudden onset of murmurs, especially if accompanied by poor perfusion or pulmonary edema as a papillary muscle rupture and mitral valve prolapse can occur suddenly. So, these issues are often accompanied with chest pain, shortness of breath, and other signs of heart failure. 

 

Guys, this is an emergency that requires surgical intervention immediately. So, if your patient did require a surgical intervention like a valve replacement, it is necessary to educate them about the postoperative requirements. First of all, these patients will require lifelong anticoagulant therapy, which means they must be educated on precautions like using electric razors and soft bristle toothbrushes, and how often they require monitoring. Patients with artificial heart valves are at a super high risk of endocarditis, so they need to be educated on how to prevent this issue like receiving prophylactic antibiotics if a procedure is necessary and also maintaining good oral hygiene, that is super important. So, you guys really need to stress that as silly as it may sound. There is a ton of research on how bacteria moves from the oral cavity and becomes lodged in the valve. So with this, they should not undergo any dental procedures up to six months after valve surgery. 

 

Okay, guys, here is a look at a completed care plan for heart valve disorders. Okay, let’s do a quick review with heart valve disorders. Blood flow direction is compromised through the valves, which means cardiac output is compromised. Heart valve disorders include mitral regurgitation, mitral stenosis, aortic regurgitation, and aortic stenosis. The patient may be asymptomatic or just have a murmur. Subjective data if cardiac output is compromised, may include chest pain, shortness of breath, weakness or fatigue. Objective data may include decreased blood pressure, increased heart rate, weak pulses, slow capillary refill, and pale/ cool, clammy skin.  Assess heart sounds for murmurs, respiratory status for signs of pulmonary edema and cardiovascular status to assess for decreased perfusion. Notify the provider of new onset murmurs as this could indicate an issue like a papillary muscle rupture, which requires a surgical intervention. Educate valve replacement patients on the lifelong anticoagulant therapy need and the prevention of endocarditis. 

 

Okay guys, that is it for this lesson on heart valve disorders. We love you guys. Now, go out and be your best self today and as always, happy nursing!

 

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