115-NCLEX-RN Review Made Incredibly Easy, Fifth Edition (Incredibly Easy...

Polish up on client care 65

DIAGNOSTIC TEST RESULTSAortic insufficiency Cardiac catheterization shows reduction in arterial diastolic pressures. Echocardiography shows left ventricular enlargement. ECG shows sinus tachycardia and left ven-tricular hypertrophy. X-ray shows left ventricular enlargement and pulmonary vein congestion.

Mitral insufficiency Cardiac catheterization shows mitral insufficiency and elevated atrial pressure and PAWP. Echocardiography shows abnormal valve leaflet motion. ECG may show left atrial and ventricular hypertrophy. X-ray shows left atrial and ventricular enlargement.

Mitral stenosis Cardiac catheterization shows diastolic pressure gradient across the valve and ele-vated left atrial and pulmonary artery wedge pressures. Echocardiography shows thickened mitral valve leaflets. ECG shows left atrial hypertrophy. X-ray shows left atrial and ventricular enlargement.

Mitral valve prolapse Color-flow Doppler studies show mitral insufficiency. ECG shows prolapse of the mitral valve into the left atrium.

Tricuspid insufficiency Echocardiography shows systolic prolapse of the tricuspid valve. ECG shows right atrial or right ventricular hypertrophy. X-ray shows right atrial dilation and right ventricular enlargement.

NURSING DIAGNOSES Activity intolerance Anxiety Decreased cardiac output

TREATMENT Diet: sodium restrictions (in cases of heart failure) Surgery: open-heart surgery using cardiopulmonary bypass for valve replacement (in severe cases)

Drug therapy Anticoagulant: warfarin (Coumadin) to prevent thrombus formation around diseased or replaced valves

INTERVENTIONS AND RATIONALES Watch closely for signs of heart failure or pulmonary edema and for adverse effects of drug therapy to prevent cardiac decompensation. Place the client in an upright position to relieve dyspnea. Maintain bed rest and provide assistance with bathing, if necessary, to decrease oxygen demands on the heart. If the client undergoes surgery, watch for hypotension, arrhythmias, and thrombus formation. Monitor vital signs, ABG levels, intake, output, daily weight, blood chem-istries, chest X-rays, and pulmonary artery catheter readings to detect early signs of postoperative complications and ensure early intervention and treatment. Allow the client to verbalize concerns over being unable to meet life demands because of activity restrictions to reduce anxiety.

Teaching topics Explanation of the disorder and treatment plan Medications and possible adverse effects Following diet restrictions and medication schedule Need for consistent follow-up care Incorporating rest into the daily routine

The heart of the matter is youre almost through

with this chapter. Just quiz yourself with the practice questions on the next few pages

before moving on.

313419NCLEX-RN_Chap03.indd 65313419NCLEX-RN_Chap03.indd 65 4/8/2010 7:01:53 PM4/8/2010 7:01:53 PM

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