Question

I. 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

Subjective Data

Does not exercise, but was always able to do daily activities such as go up and down the stairs of her home and go grocery shopping

The last few weeks has noticed that she gets short of breath with her normal daily activities

Has been waking up at night short of breath

Denies any pain in her chest

Does not have any pain in her joints as long as she takes her “arthritis medicine”

Objective Data

Physical Examination

Temperature 98.5° F, pulse 88 and irregular, respirations 24, blood pressure 134/82, O₂ saturation 92%

Irregular heart rate with a grade III diastolic murmur

Crackles in bilateral bases of lungs

No peripheral edema noted

Diagnostic Studies

ECG shows atrial fibrillation with heart rate of 90

Echocardiogram reveals mitral valve stenosis with mild left-sided heart failure

Laboratory Studies:

Hemoglobin 12 g/dL

Hematocrit 37%

T₄ (total)5.1 mcg/dL

Discussion Questions

What is mitral stenosis? What could be the possible cause of L.S.’s mitral stenosis

What clinical manifestations of mitral valve stenosis does L.S. have?

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

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

What are the treatment options for L.S.?

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

What are the priority nursing interventions for these nursing diagnoses?

disregard

Answer 1

1.Mitral stenosis: It refers to the narrowing of the mitral valve which prevents the blood from left atrium to left ventricle. It usually occurs in children who had rheumatic fever. L. S has a history of Rheumatic fever, rheumatoid arthritis as a child which could be the possible reason for the development of mitral stenosis.

2.Clinical manifestations that L. S have:

• Shortness of breath which limits daily activities and arousal at night.
• On physical examination, she has a pulse rate of 88, irregular heart rate with grade 3 diastolic murmur, crackles heard in the bilateral bases of lungs, and oxygen saturation is 92%

3.Mitral stenosis to left-sided heart failure:

• The narrowing of the mitral valve results in obstruction to the blood flow ,which leads to increase in pressure in the lungs due to accumulation of fluid.
• Increase in the left atrial pressure leads to left atrium enlargement and thus resulting in atrial fibrillation and loss of atrial kick.
• In the case of severe mitral stenosis, the ventricular filling which is dependent on atrial kick results in decreased cardiac output and sudden development of congestive heart failure.

4. Clinical manifestations of left heart failure in the case of L. S:

• Irregular hear rate with grade III diastolic murmur. And pulse rate is 88 and irregular.
• Presence of crackles in the bilateral bases of lungs.

5.Treatment options for L. S:

• Control of atrial fibrillation by AV node blockers such as beta blockers, calcium channel blockers, or digitalis.
• Restoration of normal sinus rhythm.