Page 162 - Critical Care Nursing Demystified

Chapter 3 CARE OF THE PATIENT WITH CRITICAL CARDIAC AND VASCULAR NEEDS 147

into the atria instead of going forward from the ventricle into the aorta. The
poor heart can never catch up as it recycles blood back and hardly forward. So
again, in each chamber both atria and ventricles have to work harder to build
up pressure to open the valves.

Hallmark Signs and Symptoms
• Asymptomatic at first

• Dyspnea that increases with exertion
• Fatigue
• Murmur over the valve that is affected
• Signs and symptoms of heart failure: right-sided failure if it is a right heart
valve like the tricuspid and pulmonic, and left-sided failure if it is the mi-
tral and aortic valves (see section on heart failure and Table 3–16).

Prognosis
Valvular problems are progressively disabling and affect the ADLs as signs and
symptoms of HF worsen. A valve replacement is needed to help with the qual-
ity of life. Prognosis is good if this occurs. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Valves can be replaced with either porcine (pig) or mechanical valves. If the
patient chooses a mechanical heart valve he or she will have to take anticoagu-
lant medications for life, because platelets adhere to the valves possibly leading
to stroke or PE.

NURSING ALERT

Patients who opt to have a mechanical heart valve will need to take coumadin for
life. They will need frequent prothrombin time/international normalized ratio (PT/
INR) assessments to evaluate their level of anticoagulation. They must also wear
medical alerts so health care workers can take precautions to prevent bleeding.

Interpreting Test Results

• See tests for HF.
• Cardiac catheterization on the side that the valve has affected.
• Echocardiography will show either a stenotic or regurgitant valve.

Nursing Diagnoses for Valvular Dysfunction Expected Outcomes
See section on heart failure (HF)