Chapter 24

Management of Patients with Structural, Infectious, and Inflammatory Cardiac Disorders

Valvular Disorders

  • Regurgitation:

    • The valve does not close properly, causing blood to flow back through the valve.

  • Stenosis:

    • The valve does not open completely, which reduces blood flow.

  • Valve Prolapse:

    • Stretching of the valve leaflet into the atrium during systole.

Specific Valvular Disorders

  • Mitral Valve Disorders:

    • Mitral valve prolapse

    • Mitral regurgitation

    • Mitral stenosis

  • Aortic Valve Disorders:

    • Aortic regurgitation

    • Aortic stenosis

Nursing Management of Valvular Heart Disorders

  • Patient Education:

    • Understand symptoms and treatment options.

  • Vital Sign Monitoring:

    • Monitor vital signs trends, heart and lung sounds, and peripheral pulses.

  • Complication Monitoring:

    • Watch for symptoms of heart failure, arrhythmias, dizziness, syncope, and angina.

  • Medication Schedule and Education:

    • Discuss medication adherence and side effects.

  • Daily Weights:

    • Monitor for unexpected weight gain, which can indicate fluid retention.

  • Activity Planning:

    • Include rest periods to avoid overexertion.

Education for Clients with Mitral Valve Prolapse (MVP)

  • Teaching Plan Includes:

    • Acknowledge MVP may not be hereditary.

    • Caffeine can be tolerated in moderation.

    • Avoid alcohol and tobacco products.

    • Prophylactic antibiotics are typically not prescribed before dental procedures.

  • Rationale for Recommendations:

    • First-degree relatives might need screening for MVP.

    • Counseling on lifestyle modifications can improve outcomes (e.g., reducing caffeine and alcohol).

Surgical Management of Valvular Heart Disorders

  • Types of Procedures:

    • Valvuloplasty: Various methods (commissurotomy, balloon valvuloplasty, annuloplasty)

    • Valve Replacement:

      • Types of valves (mechanical, tissue, bioprosthesis, homografts, autografts)

Nursing Management Post-Procedure

  • Post-Balloon Valvuloplasty Care:

    • Monitor for heart failure symptoms and emboli. Assess heart sounds every 4 hours.

  • Post-Surgical Care (Valvuloplasty or Replacement):

    • Focus on hemodynamic stability and recovery from anesthesia.

    • Frequent assessments, especially neurologic, respiratory, and cardiovascular systems.

Cardiomyopathy Overview

  • Definition:

    • A series of progressive events leading to impaired cardiac output.

  • Types:

    • Dilated cardiomyopathy (DCM)

    • Hypertrophic cardiomyopathy (HCM)

    • Restrictive/constrictive cardiomyopathy (RCM)

    • Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)

    • Unclassified cardiomyopathy

Cardiomyopathies Leading to Congestive Heart Failure

  • Characteristics:

    • Dilation of ventricles in DCM

    • Hypertrophy of left ventricle in HCM

    • Restriction of blood fill in RCM

Assessment of Patients with Cardiomyopathy

  • Key Factors:

    • Family history, chest pain, symptoms like orthopnea and syncope, and psychosocial impacts.

    • Include thorough physical assessment and vital signs monitoring.

Collaborative Problems and Potential Complications

  • Risks:

    • Heart failure, arrhythmias, cardiac conduction defects, and embolisms.

Goals for Patients with Cardiomyopathy

  • Primary Goals:

    • Improve cardiac output and peripheral blood flow.

    • Increase activity tolerance and reduce anxiety.

    • Effective self-management.

Nursing Interventions for Cardiomyopathy Patients

  • Improving Cardiac Function:

    • Manage activity and ensure suitable positioning for comfort and oxygenation.

  • Activity Tolerance:

    • Monitor and instruct on recognizing when to rest.

  • Reducing Anxiety and Powerlessness:

    • Counseling regarding disease management and coping strategies.

  • Home and Community-Based Care:

    • Include family education on CPR and understanding the disease process.

Evaluation of Cardiomyopathy Patients

  • Success Indicators:

    • Maintained or improved cardiac function, activity tolerance, and reduced anxiety.

    • Effective self-care management, including adherence to medication and diet.

Infectious Diseases of the Heart

  • Overview:

    • Infectious processes can affect any heart layer, diagnosed via symptoms and echocardiogram.

    • Management primarily focuses on prevention and IV antibiotics.

  • Types:

    • Rheumatic Endocarditis:

      • Linked to untreated group A streptococcal infections.

    • Infective Endocarditis:

      • Common in patients with prosthetic valves and IV drug users.

    • Pericarditis:

      • Can lead to effusion and tamponade.

    • Myocarditis:

      • Mostly viral pathogens, leading to cardiomyopathy.

Clinical Manifestations and Diagnostics

  • Symptoms:

    • Include fever, murmurs, fatigue, and dyspnea.

  • Diagnostic Tools:

    • Blood cultures, echocardiogram, and laboratory tests (CBC, CRP).

Prevention of Infectious Heart Diseases

  • Recommended Practices:

    • Utilize antibiotic prophylaxis, maintain oral hygiene, careful catheter management, and immunizations.

Management of Digoxin in Restrictive Cardiomyopathy

  • Patient Plan of Care:

    • Adjust digoxin dosage as necessary, monitor for signs of toxicity (anorexia, nausea).

    • Educate on avoiding certain medications like nifedipine due to potential complications.