VALVULAR HEART DISORDERS: NURSING MANAGEMENT
The nurse teaches all patients with valvular heart disease about the diagnosis, the progressive nature of valvular heart disease, and the treatment plan. The patient is taught to report any new symptoms or changes in symptoms to the health care provider. The nurse emphasizes the need for prophylactic antibiotic therapy be-fore any invasive procedure (eg, dental work, genitourinary or gastrointestinal procedure) that may introduce infectious agents to the patient’s bloodstream. The patient is taught that the in-fectious agent, usually a bacterium, is able to adhere to the diseased heart valve more readily than to a normal valve. Once attached to the valve, the infectious agent multiplies, resulting in endocarditis and further damage to the valve.
The patient’s heart rate, blood pressure, and respiratory rate are measured and compared with previous data for any changes. Heart and lung sounds are auscultated and peripheral pulses pal-pated. The nurse assesses patients with valvular heart disease for signs and symptoms of heart failure: fatigue, dyspnea with exertion, an increase in coughing, hemoptysis, multiple respiratory infec-tions, orthopnea, or paroxysmal nocturnal dyspnea . The nurse assesses for dysrhythmias by palpating the patient’s pulse for strength and rhythm (ie, regular or irregular) and asks if the patient has experienced palpitations or felt forceful heartbeats . The nurse also assesses for dizziness, syncope, increased weakness, or angina pectoris.
The nurse collaborates with the patient to develop a medica-tion schedule and teaches about the name, dosage, actions, side effects, and any drug-drug or drug-food interactions of the pre-scribed medications for heart failure, dysrhythmias, angina pec-toris, or other symptoms. The nurse teaches the patient to weigh daily and report the gain of 2 pounds in 1 day or 5 pounds in 1 week to the health care provider. The nurse may assist the pa-tient with planning activity and rest periods to achieve a lifestyle acceptable to the patient. If the patient is to have surgical valve replacement or valvuloplasty, the nurse teaches the patient about the procedure and anticipated recovery.