Question

Part B: Critical Thinking-

Ms. Moscato Read the case study and answer the questions. Ms. Moscato, age 74, has aortic stenosis and is scheduled for an aortic valve replacement. She reports fatigue and dyspnea with exertion. 1. What may be the cause of Ms. Moscato’s aortic stenosis? 2. When obtaining Ms. Moscato’s medical history, what should the nurse ask that is relevant to the cause of aortic stenosis? 3. How does the heart compensate for aortic stenosis? 4. What should the nurse anticipate may occur in severe aortic stenosis? 5. Why is angina a common symptom of aortic stenosis?

Answer 1

1.The causes of Ms Moscato's aortic stenosis is age

Calcium buildup on the valve. With age, heart valves may accumulate deposits of calcium (aortic valve calcification). Calcium is a mineral found in your blood. As blood repeatedly flows over the aortic valve, deposits of calcium can build up on the valve's cusps.

2.The nurse should ask patient about birthdefects, rheumatic Fever,any radiation Th therapy.

Birth Defects
A normal aortic valve contains three leaflets. But sometimes people are born with an aortic valve that has one, two, or four leaflets. When defects are present, the aortic valve may leak and this can cause valve problems.so nurse must ask the patient whether she had any birthdefects.

Rheumatic Fever
Sometimes strep throat can lead to rheumatic fever which can cause scar tissue to form within the heart. When this happens, the aortic valve may not be able to open and close as it normally should so nurse must ask about the recent history of fever.

Radiation Therapy
Some people may develop inflammation and scar tissue after receiving radiation therapy. This can make the aortic valve stiff and unable to function properly.Nurse must ask that she had any radiation therapy .

3.To compensate for the increasing resistance at the aortic valve, the muscles of the left ventricle thicken to maintain pump function and cardiac output. This muscle thickening causes a stiffer heart muscle which requires higher pressures in the left atrium and the blood vessels of the lungs to fill the left ventricle.

4.Nurse anticipation in aortic stenosis:nursing has to expect, predict, or prepare for something outside the routine should be available for patient all the time

.Use an infusion pump when administering ACE inhibitors intravenously.

• Monitor blood pressure closely for 2 hours following first dose.

• Monitor serum potassium levels; ACE inhibitors can cause hyperkalemia (this is less of a concern with ARBs).

• Monitor white blood cell (WBC) count for potential neutropenia. report to the physician

.evaluate patients shortness of breath,dyspnea and fatigue.

.cardiac assesment

.monitor patients oxygen saturation Via pulse oximeter.

.check fluid volume intake

5.The thickened heart muscle must pump against high pressure to push blood through the narrowed aortic valve. This increases heart muscle oxygen demand in excess of the supply delivered in the blood, causing chest pain (angina).