Nursing Care Plan for Heart Valve Disorders
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.
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.
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
May be asymptomatic except heart murmur. If cardiac output is compromised, may see these symptoms:
- Chest pain
- Shortness of breath
- 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:
- Is it an S1 or S2 murmur?
- Which valve are you listening to?
- 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
- 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
- Shortness of Breath
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.
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
For more information, visit www.nursing.com/cornell