Question

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?

Answer 1

Mitral Stenosis

1. Definitiion: it is the progressive thickening and contracture of the mitral valve leaflets and chordae tendineae that causes narrowing of the orifice and progressive obstruction to blood flow from the left atrium into the left ventricle.

2. Causes of mitral stenosis:

• Rheumatic fever
• Calcium deposits
• Congenital heart defect
• Mitral valve prolapse
• Lupus

Here L.S have got a history of rheumatic fever in the childhood and she is a known case of rheumatoid arthritis.

3. Clinical Manifestations:

• dyspnea on exertion
• Progressive fatigue
• Dry cough or wheezing
• Hemoptysis
• Palpitations
• Orthopnea
• Paroxysmal nocturnal dyspnea
• Repeated respiratory infections
• Weak and often irregular pulse ( because of atrial fibrillation)
• shortness of breath

​​​​​​​L.S has got increasing fatigue and shortness of breath with activity, irregular heart rate, orthopnea.

4. How does mitral valve stenosis contribute to left side heart failure?

​​​​​​​the left atrium dilates and hypertrophies because it has great difficulty moving blood into the ventricle and because of the increased blood volume the atria must now hold. Because there is no valve to protect the pulmonary veins from the backward flow of blood from the atrium , the pulmonary circulation becomes congested . The resulting high pulmonary pressure can eventually lead to ventricular failure.