Nursing Care Plan (NCP) for Heart Valve Disorders
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Outline
Lesson Objective for Heart Valve Disorders Nursing Care Plan:
Your heart has four valves, and their job is like doors that open and close to control blood flow inside your heart. These valves make sure blood flows in the right direction. In Heart Valve Disorders, something is wrong with one or more of these valves.
There are two main types of valve disorders:
- Stenosis: This is when a valve doesn’t open fully, so the heart has to work harder to push blood through the narrow opening. Imagine trying to squeeze a big ball through a small hole; it’s tough!
- Regurgitation: This happens when a valve doesn’t close properly. It’s like a leaky door that lets blood flow backward, which isn’t the way it’s supposed to go.
Upon completion of this nursing care plan for Heart Valve Disorders, nursing students will be able to:
- Understand Heart Valve Anatomy and Function:
- Demonstrate a comprehensive understanding of normal heart valve anatomy and function, including the role of each valve in ensuring proper blood flow through the heart.
- Identify Common Heart Valve Disorders:
- Develop the ability to identify and differentiate common heart valve disorders, such as stenosis and regurgitation, and understand the underlying causes and hemodynamic consequences.
- Implement Hemodynamic Monitoring:
- Acquire skills in implementing hemodynamic monitoring techniques to assess the severity of heart valve disorders, including the interpretation of echocardiographic findings, to guide appropriate interventions.
- Facilitate Preoperative and Postoperative Care:
- Provide effective preoperative and postoperative care for individuals undergoing heart valve surgery. This includes comprehensive assessment, education, and support to optimize outcomes and ensure a smooth recovery process.
- Educate Patients on Lifestyle Management:
- Educate patients with heart valve disorders on lifestyle modifications, medication adherence, and the importance of regular follow-up to manage symptoms, prevent complications, and improve overall cardiovascular health.
Pathophysiology
Heart valve disorders happen when the valves in the heart don’t work properly. Valves are like doors that control blood flow in and out of the heart. When these valves are damaged or don’t close tightly, it can affect how well the heart pumps blood.
- Mitral Regurgitation – The mitral valve cannot close completely, therefore blood back-flows into the left atrium (LA)
- Mitral Stenosis – The mitral valve cannot open fully or is narrowed, therefore blood can’t go into the left ventricle (LV)
- Aortic Regurgitation – The aortic valve cannot close completely, therefore blood back-flows into the LV
- Aortic Stenosis – The aortic valve cannot open fully or is narrowed, therefore blood can’t get out of LV
When the blood can’t flow in the direction it’s supposed to flow, cardiac output is compromised.
Etiology
- Congenital Anomalies:
- Congenital heart valve anomalies, present at birth, can contribute to heart valve disorders. Malformations or abnormalities in the structure of the valves may lead to stenosis, regurgitation, or other issues.
- Rheumatic Fever:
- Rheumatic fever, caused by untreated or inadequately treated streptococcal infections, can result in damage to heart valves. Rheumatic heart disease is a common cause of valvular stenosis and regurgitation, particularly affecting the mitral and aortic valves.
- Degenerative Changes:
- Degenerative changes in the valves, often associated with aging, can lead to valvular disorders. Progressive wear and tear on the valve tissue may result in stenosis or regurgitation.
- Infective Endocarditis:
- Infective endocarditis, an infection of the inner lining of the heart chambers and valves, can cause damage to heart valves. Bacterial or fungal infections may lead to valvular dysfunction.
- Connective Tissue Disorders:
- Certain connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, can affect the structure and function of heart valves. Connective tissue abnormalities may contribute to valve prolapse or other issues.
Desired Outcome
- Optimize Hemodynamic Stability:
- Aim to optimize hemodynamic stability by managing heart valve disorders to maintain adequate blood flow and prevent complications such as congestive heart failure.
- Minimize Symptoms and Improve Quality of Life:
- Work towards minimizing symptoms associated with heart valve disorders, such as dyspnea, fatigue, and chest pain, to improve the overall quality of life for affected individuals.
- Prevent Progression of Valve Dysfunction:
- Implement strategies to prevent the progression of valve dysfunction, including monitoring for changes in valve function and intervening promptly to address worsening conditions.
- Facilitate Successful Surgical Interventions:
- Provide comprehensive preoperative and postoperative care for individuals undergoing heart valve surgery. Aim for successful surgical interventions and support a smooth recovery process.
- Educate on Lifestyle Management:
- Educate individuals with heart valve disorders on lifestyle modifications, medication adherence, and the importance of regular follow-up to manage symptoms, prevent complications, and improve overall cardiovascular health.
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 Assessment Heart Valve Disorders
- Patient History:
- Collect a detailed patient history, focusing on any past diagnoses of heart valve disorders, including the type of valve affected and the timing of the diagnosis. Inquire about symptoms such as fatigue, shortness of breath, chest pain, irregular heartbeats, or swelling in the extremities.
- Physical Examination:
- Conduct a thorough physical examination with a focus on the cardiovascular and respiratory systems. Pay special attention to heart sounds, detecting any murmurs, clicks, or abnormal sounds that may indicate valve abnormalities. Assess pulses, capillary refill, skin color, and temperature for signs of decreased perfusion.
- Cardiovascular Assessment:
- Measure blood pressure in both arms, noting any discrepancies that may indicate vascular abnormalities. Assess for peripheral edema, particularly in the lower extremities, which may signify heart failure or compromised cardiac output.
- Respiratory Assessment:
- Evaluate respiratory status by auscultating lung sounds for crackles or wheezing. Measure oxygen saturation (SpO2) to assess for potential hypoxia. Inquire about any history of shortness of breath, especially during exertion or while lying flat.
- Diagnostic Tests:
- Order and review diagnostic tests, including echocardiography, which provides detailed information about the structure and function of heart valves. ECG can identify irregular heart rhythms, and chest X-rays may reveal changes in heart size or pulmonary congestion.
- Review Medication History:
- Assess the patient’s medication history, specifically looking for anticoagulant therapy, as individuals with valve disorders often require lifelong anticoagulation. Ensure understanding of medication adherence and any potential side effects.
- Assess for Complications:
- Look for signs of complications such as endocarditis, which may include fever, chills, or unexplained fatigue. Assess for embolic events, considering symptoms like sudden weakness, vision changes, or speech difficulties.
- Functional Assessment:
- Evaluate the patient’s functional capacity by inquiring about their ability to perform daily activities and any limitations imposed by symptoms. Assess exercise tolerance and any factors that exacerbate or alleviate symptoms.
- Psychosocial Assessment:
- Consider the psychosocial impact of a heart valve disorder. Assess for anxiety, depression, or concerns related to lifestyle changes. Encourage open communication to address emotional well-being and coping mechanisms.
- Collaborative Communication:
- Collaborate with other healthcare professionals, including cardiologists and specialists, to ensure a comprehensive understanding of the patient’s condition. Facilitate open communication between the patient and the healthcare team to promote informed decision-making.
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
- 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 the 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.
- Administer medications as ordered to optimize cardiac contracility and output, including:
- Beta-blockers
- Diuretics
- ACE inhibitors
- Angiotension-2 receptor blockers
- Administer oxygen as ordered to maintain perfusion
- Monitor laboratory results, including:
- Electrolyte levels (especially for patients on potassium-wasting diuretics), because electrolyte imbalances can lead to cardiac arrythymias and complications
- Hemoglobin and hematocrit
- B-natriuretic peptide (BNP), which is an indicator of heart failure and fluid overload
- Implement cardiac, low-sodium diet and fluid restriction as ordered to help maintain fluid balance
- Monitor intake and output to assess for fluid volume overload or deficits
- Educate patient about pacing activities of daily living when dyspnea is present
- 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 before any invasive procedures.
Oral hygiene is imperative for the 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.
Evaluation for Heart Valve Disorder Care Plan
- Hemodynamic Monitoring:
- Regularly monitor hemodynamic parameters, including echocardiographic findings and other relevant diagnostic tests, to assess the effectiveness of interventions in optimizing blood flow and preventing complications.
- Fluid Balance:
- Monitoring the patient’s intake and output closely will provide information about the patient’s fluid balance and the effectiveness of interventions such as diuretics and fluid restrictions
- Symptom Assessment:
- Assess and evaluate the severity of symptoms associated with heart valve disorders, such as dyspnea, chest pain, and fatigue. Monitor for changes in symptoms and adjust interventions accordingly.
- Postoperative Recovery:
- Evaluate the postoperative recovery process for individuals who have undergone heart valve surgery. Monitor for complications, assess wound healing, and ensure a smooth transition to self-care and rehabilitation.
- Valve Function Monitoring:
- Monitor changes in heart valve function over time through repeated echocardiographic assessments. Evaluate the impact of interventions on preventing the progression of valve dysfunction.
- Medication Adherence:
- Assess medication adherence and the effectiveness of pharmacological interventions in managing heart valve disorders. Address any barriers to adherence and adjust medication regimens as needed.
- Patient Education Retention:
- Evaluate the retention and application of patient education on lifestyle management. Assess the individual’s ability to implement recommended lifestyle modifications, adhere to prescribed medications, and recognize signs of worsening symptoms.
References
- https://www.mayoclinic.org/tests-procedures/heart-valve-surgery/about/pac-20384901
- https://www.hopkinsmedicine.org/healthlibrary/test_procedures/cardiovascular/heart_valve_repair_or_replacement_surgery_92,P07975
- https://www.webmd.com/oral-health/endocarditis-prevention
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Example Nursing Diagnosis For Nursing Care Plan (NCP) for Heart Valve Disorders
- Decreased Cardiac Output: Aortic stenosis results in reduced blood flow from the left ventricle, leading to decreased cardiac output. This diagnosis addresses the impact on cardiac function.
- Activity Intolerance: Patients with aortic stenosis may have limited tolerance for physical activity due to reduced cardiac output. This diagnosis helps plan appropriate levels of activity.
- Risk for Ineffective Tissue Perfusion: Aortic stenosis can compromise systemic circulation, increasing the risk of inadequate tissue perfusion and related complications.
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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