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Valvular ht disease
pn 141 test 1 book: med surg nursing pg 658
| Question | Answer |
|---|---|
| what does it interfere with | the blood flow to and from the heart |
| what is the most common cause of it | rheumatic heart disease (also from endocarditis, or MI |
| what are the two types of heart valve disorders | stenosis, and reguritation |
| What is stenosis | occurs when valve leaflets fuse together and are unable to open or close fully. The valve opening narrows impairing the forward blood flow |
| what is regurgitation or incompetent valves | they do not close completely which allows backflow (regurgitation) of the blood through the incompletety closed valve into the area it just left |
| Where is pressure and blood flow affected | in front and behind the affected valve |
| Why does stenosis increase the work of the chamber behind the affecte valve | b/c the heart has to attempt to push blood through the narrowed opening |
| What causes the chambers to dilate behind valves that regurgitate | excessive blood volume |
| Why is blood volume and pressures reduced in front of the diseased valve | b/c flow is impeded through a stenotic valve and backflow occurs in a regurgitated valve |
| What happens to the heart muscle | it atrophies in its attempt to maintain CO |
| What two valves are the most subject to valvular heart disease; why? | the mitral and aortic; they are on the left side of the heart and have higher pressure |
| why is there a murmer | because blood flow through the heart becomes turbulent as blood moves through the damaged valve |
| Mitral Stenosis: What is it | the narrowing of the mitral valve |
| Mitral Stenosis: Where is the blood flow obstructed and when? | it is obstructed from the left atrium into the left vetricle during diastole |
| Mitral Stenosis: What will the murmer sound like | continuous rumble, increasing during the end of diastole, heard in the apical region |
| Mitral Stenosis: what is the cause of it | rheumatic heart disease |
| Mitral Stenosis: this impairs what | left vetnricular filling, CO |
| Mitral Stenosis: what chamber of the heart will dilate and atrohpy | the left atrium |
| Mitral Stenosis: because of this pressure in the left atrium where where does the blood back up into | the pulmonary system |
| Mitral Stenosis: what sided heart failure can eventually occur | right |
| Mitral Stenosis: chronic atrial dilation/ distention can lead to what | atrial dysrhythmias (fibrillation) |
| Mitral Stenosis: what could form in the left atrium (serious) | thrombi |
| Mitral Stenosis: what is the earliest s/s of it; other s/s | DOE; cough, hemoptysis, frequent respiratory infections (PNA, bronchitis), paraxysmal noctural dyspnea, orthopnea, weakness, fatigue, palpitations |
| Mitral Stenosis: as it becomes more severe what s/s will develop | s/s of r. sided heart failure (distended neck vein, peripheral edema), cyanosis |
| Mitral Stenosis: WM w/ it may be asymptomatic until when | when they become pregnent |
| Mitral regurgitation: what is it | it is when blood flow is allowed to flow back into the left atrium during dsystole because the valve does not completely close |
| Mitral regurgitation: what is the common cause of this | rheumatic heart disease |
| Mitral regurgitation: where does the blood go | only a portion of the blood is ejected into systematic circulation and the rest returns to the left atrium through the valve |
| Mitral regurgitation: what happens to the left atrium because of this extra blood there | it dilates to accomodate the extra volume |
| Mitral regurgitation: why does the left ventricle dilate | to compensate for increased preload and low CO |
| Mitral regurgitation: s/s | fatigue, weakness, exertional dyspnea, orthopnea, |
| Mitral regurgitation: what are the s/s when it becomes severe | left sided heart failure s/s (pulmonary congestion edema), right sided heart failure can develop too |
| Mitral regurgitation: what will the murmer sound like, and where is it located | loud high pitched and rumbling ("cooing, sea gull like"), best heard over the apex |
| Mitral valve prolapse: what is it | a form of mitral insufficiency that occurs when the posterior cusp of the mitral valve flops back into the left atrium during systole |
| Mitral valve prolapse: causes and who gets it most | probably congenital and wm ages 14-30 |
| Mitral valve prolapse: s/s | chest pain r/t fatigue, dysrhythmias, light headedness, syncope |
| Mitral valve prolapse: what will the murmer saound like | high pitchted whoop, |
| aortic stenosis: what is it | it obstructs the blood flow from the left ventricle into the aorta during systole |
| aortic stenosis: what gender is it most common in | males |
| aortic stenosis: causes | ideopathic, congential and rheumatic heart disease, or from changes while aging |
| aortic stenosis: what does the left ventricle have to do inorder to eject the blood through the narrowed valve | it has to work harder |
| aortic stenosis: what happens to the left ventricle because it is working harder | it hypertrophies the maintain CO |
| aortic stenosis: what happens to the myocardial oxygen needs (do they increase or decrease); why? | they increase because of the increased workload on the heart |
| aortic stenosis: what happens to the pulmonary vascular system | congestion and pulmonary edema can occur |
| aortic stenosis: at what age do s/s develop | usually after age 50 |
| aortic stenosis: s/s | dyspnea on exertion, angina, and exertional syncope (light headeness w/ activity) |
| aortic stenosis: what happens to the pulse pressure as stroke volume and cardiac output fall | it narrows |
| aortic stenosis: what does the murmer sound like | thrill, continuous, s3 and s4 can be heard |
| aortic reguritation: what is it | the aortic valve fails to close completely allowing blood to flow back into the left ventricle from teh aorta during diastole |
| aortic reguritation: what is the cause of it | rheumatic heart disease |
| aortic reguritation: blood from the aorta causes volume overload where | in the left ventricle |
| aortic reguritation: what happens to the left ventricle | it dilates |
| aortic reguritation: what happens to the stroke volume | it increases and hypertrophies |
| aortic reguritation: what happens to cardiac ouput | it falls |
| aortic reguritation: what sided heart failure can develop; why | right sided heart failure; from increased pressures on the left side of the heart |
| aortic reguritation: unlike other valve disorders, what can actually hep reduce regurgitation and improve heart function in this disorder? | exercise |
| aortic reguritation: s/s of mild or moderate | palpitations in lying positions, the heart beat is visible as a throbing pulse in the arteries of the neck, sometimes the force of the contraction can cause a head bob that shakes the whole body, dizziness, fatigue,angina |
| aortic reguritation: when does he angina often occur | at night and may not respond to common tx |
| aortic reguritation: what happens to he pulse pressure | it often widens |
| aortic reguritation: where is the murmer heard, what does it sound like | heard in the diastole as blood flows back into the left ventriclefrom the aorta, it soudns like a blowing high pitched sound (an s3 or s4 may be heard) |
| what is the initial s/s that a pt has valvular disease | a murmer |
| what is used to diagnose it | an ECG |
| what is used to evaluate the effects of the valve disease | cardiac catheterization |
| do asymptomatic pt and those with mild manifestations need tx | no |
| why does valve damage increase the risk for infective endocarditis | beacuse the deformed valve alters blood flow through the heart allowing bacteria to colonize heart tissue |
| why are antibiotics give prophylactically during dental work, invasive procedures and surgery | because pt is at increased risk for endocarditis |
| what is the treatment for heart failure | meds and diet |
| when is surgery done | when medical tx no longer controls the disease |
| Percutaneous balloon valvuloplasty: what type of valve disease does it treat | stenotic valve disease |
| Percutaneous balloon valvuloplasty: what is done | a balloon cath is inserted into the femoral vein or artery and is advanced to the stenotic valve. the balloon is inflated for 90 seconds to divided the fused leaflets and enlarge the valve opening |
| Surgery: why is it done | to restore valve function, relieve s/s, and prevent complications |
| Valvuloplasty: def | a general term for reconstruction or repair of heart valve |
| Valvuloplasty: what is done | patching perforated portion of the leadlet, resecting excess tissue, removing vegetations or calcification and other techniques |
| replacing valves- what types of valves are used for replacement | mechanical, animal or human |
| replacing valves- why is a biologic one better then a mechanical one | because they allow more blood flow and are less likely to cause clots |
| replacing valves- what are the pros of a mechanical one, cons | the are more durable; they require a life time use of anticoagulants to prevent clots |
| Nursing Dx: why is "ineffective protection" a dx used for a valve replacement | because with a replacement you have to have anticoagulant therapy and that increases the risk for hemmorage |
| what side of the heart are the two valves that commonly need replacing | left side |
| valve dysfunction is seen in what age | 70-80 yo |
| WHen can one get a valve replacement (why do they have to wait sooooooooo long?) | because the insurance company will not pay until there are s/s |
| when ppl are Dx with valve disease, do they initially have s/s | no |
| tissue replacement (human/pig): life span of it >65 yo | 10-15 years |
| tissue replacement (human/pig): life span of it <65 yo | 8-12 yrs |
| what are the firs s/s of valve disease; why | SOB, fatigue; ventricle or atria is failing, blood is backing into the lungs, fatigue b/c not enough o2 blood in body |
| open heart surgery: post op | icu for 24 hours 1 on1 care, cehck vs frequently, |
| open heart surgery: what is the biggest issue post op with the cardiac rhythm | the rhythm is not returning to normal |
| what is pump head? | when one comes off the pump, they are foggy, it usually clears. But if it doesn't clear it could be perminent (impulsive, mem. loss) |
| POST op open heart surgery: why is pt at increased risk for acute renal failure | b/c body gives blood primarily to lungs and heart and brain the kindeys take a big hit |
| POST op open heart surgery: what happens with your hormones; how long can this change last | both male and females have massive amounts released, they are weepy, whiny and grumpy; 6 weeks post op |
| MEd: coumadin (Warfarin): use | thrombosis/embolism, prophylaxis, given for life with mechanical valve |
| MEd: coumadin (Warfarin): | bleeding, fatigue, dizziness, abdominal cramping |
| MEd: coumadin (Warfarin): action | it interferes with the clotting mechanism of the blood; vit k clotting factorby the liver |
| complications of open heart surgery | hemmorage, shock, dysrythmias, stroke, anoxia, mi respiratory failure |
Created by:
jmkettel
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