心脏瓣膜病 （15p）

Valvular Heart Disease NR40 Valvular Heart Disease Stenosis Regurgitation (Insufficiency) Prolapse Causes of Valvular Disease Endocarditis Congenital Defects Inflammation STD Rheumatic Fever Myocardial Infarction Forms of Valvular Disease MVP- Mitral Valve Prolapse Blood regurgitates from LV to LA during systole One leaflet doesnt close correctly. More common in women. Clinical Manifestations Tx and Nsg Management Mitral Stenosis Blood flow obstruction from LA to LV. Mitral valve thickens, usually viral cause (rheumatic fever) Clinical Manifestations Tx and Nsg Management Mitral Valve Regurgitation Valve doesnt close properly during systole, blood flow back from LV to LA Tx and Nsg Management Aortic Stenosis Blood flow obstruction between LV and aorta. Causes afterload and eventual LVH Clinical Manifestations Tx and Nsg Management Aortic Regurgitation Back flow of blood from aorta back into LV during diastole, because valve doesnt close properly. Clinical Manifestations Tx and Nsg Management Nursing Diagnoses Activity Intolerance Anxiety Decreased cardiac output Surgical Valve Repair Valvuloplasty Valve replacement - Mechanical valve - Xenograft - Homograft/allograft - Autograft Anticoagulants Parenteral: Heparin Lovenox Fragmin Labtest: aPTT Norm: _ DVT Prophylaxis: aPTT_ Antidote:_ Oral: Coumadin Labtests: PT/ INR Norm PT:_ Norm INR:_ DVT Prophylaxis: PT _ INR _ Antidote:_ Antiplatelets Action: Ticlopidine (Ticlid) Clopidogrel ( Plavix) ASA Glycoprotein IIb/IIIa inhibitors Hemorrheologics Action: Pentoxfylline (Trental) Thrombolytics Action: Streptokinase T-PA Retavase Nursing Intrventions Assessment and monitoring Assess for bleeding Patient teaching and followup: Coumadin: blood work medi alert bracelet Limit ETOH to