Question

Read Chapter 36 from your Text Book and PP

II. NCLEX Review Questions Chapter 36 from Evolve Resources

III. Case Study: Mitral Stenosis

Patient Profile

L.S. is a 59-year-old female who goes to see her primary care provider because of increasing fatigue and shortness of breath with activity. She has a history of hypertension, hypothyroidism, rheumatoid arthritis, and rheumatic fever as a child. She is taking the following medications:

Triamterene/hydrochlorothiazide 37.5/25 mg PO daily

Levothyroxine 150 mcg PO daily

Methotrexate 15 mg PO every Sunday

          

3. .How did the mitral valve stenosis contribute to the development of left-sided heart failure?

4. What clinical manifestations of left-sided heart failure does L.S. have?

5.What are the treatment options for L.S.?

6. What would be some pertinent nursing diagnoses and goals for L.S.?

7 What are the priority nursing interventions for these nursing diagnoses?

            Discussion Questions

Answer 1

3.

In case of mitral valve stenosis mitral valve is coming to narrow . A narrowed mitral valve interferes with blood flow . This can cause pressure to build in lungs ,leading to fluid accumulation . The fluid build up strains the left side of heart ,leading to left sided heart failure . when blood and fluid back up into lungs ,it can cause a condition known as pulmonary edema .

4. CLINICAL MANIFESTATION :

• Awakening at night with shortness of breathing .

• Chronic coughing and wheezing

• Fatigue

• Fluid retention causing swelling or edema .

• Lack of appetite and nausea.

• Irregular heart beat.

• Sudden weight gain.

5. TREATMENT :

The primary treatment for L.S is mitral valve repair or replacement surgery.

6 & 7. NURSING DIAGNOSIS :

Decrease cardiac output related to valvular defects as evidenced by increase heart rate ,dysrhythmia.

GOAL:

Patient will demonstrate adequate cardiac output as evidenced by vital sign with acceptable limit .

INTERVENTION:

• Auscultate apical pulse.

• Assess heart rate and rhythm.

• Note heart sound.

• Palpate peripheral pulse.

• Monitor blood pressure.

• Inspect skin color for pallor and cyanosis.

• Monitor urine output.