Pathophysiology

Dx: Mitral Valve Prolapse

c

Non Modifiable factors:
Age-- Risk increases as you get older
Gender-- Men have a greater risk of heart
attack.
Menopause For women, risk increases
after menopause.
Family historyRisk increases if family
members have heart problems
Modifiable factors:
Lifestyle(being overweight or obese, poor
nutrition, low physical activity, smoking)

Medical conditions (high blood pressure,
stroke, diabetes, low HDL or good
cholesterol, high HDL or bad
cholesterol)

Excess connective tissue that
thickens the spongiosa and separates
collagen bundles in the fibrosa
Due to an excess of dermatan sulfate,
a glycosaminoglycan
Physical changes such as
thickening and abnormal shapes
of the valves
Myxomatous proliferation
Myxomatous degeneration of the
loose spongiosa and fragmentation
of the collagen fibrils
Legend:
Diagnostic test:
Signs/Symptoms:
Nursing Diagnosis:


























This weakens the leaflets and adjacent tissue,
resulting in increased leaflet area and elongation
of the chordae tendineae (may also cause by
rupture)
Diagnostic test:
Echocardiogram

Abnormal displacement of the mitral
valve leaflets into the left atrium during
ventricular systole
Palpitation Chest pain
Decreased cardiac ouptut related to
palpitations
Acute pain related to myocardial blood
flow

Nursing Care Plan
Dx: Mitral Valve Prolapse
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective:
I feel that Im
having palpitations
right now, as
verbalized by the
patient.

Objective:
-Tachycardia
-Difficulty in
breathing
-Restlessness
Decreased cardiac
ouptut related to
palpitations

After 8 hours of
nursing
intervention, the
patients feeling of
palpitations will be
diminished as well
as its symptoms

Independent:
-Review diagnostic
studies

-Keep client on bed
or chair in position
of comfort. In
congestive state,
semi-fowlers is
performed. May
raise legs 20-30
degrees in shock
situation.

-Assess skin color
and temperature








-Monitor vital signs



Dependent:
-Administer high-
flow oxygen via
mask or ventilator
as indicated

-Helps determine
underlying causes

- Decrease oxygen
consumption and
risk of
decompensation






-Cold, clammy skin
is secondary to
compensatory
increase in
sympathetic
nervous system
stimulation and low
cardiac output and
desaturation

- To note any
significant changes
that may be
brought about by
the disease
-to increase oxygen
available for cardiac
function and tissue
perfusion
After 8 hours of
nursing
intervention, the
patients feeling of
palpitations was
diminished as well
as its symptoms.
Goal met.


Dx: Mitral Valve Prolapse
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective:
Laging sumasakit
tong dibdib ko, as
verbalized by the
patient.
Pain as 7 in the
scale of 1-10 as
verbalized by the
patient

Objective:
-Tachycardia
-Elevated blood
pressure of 130/100
mmHg
Acute pain related
to myocardial blood
flow

After 8 hours of
nursing
interventions and
health teachings
the patient will:
- Remain free from
pain
-Maintain stable vital
signs.
-Maintain relaxed
body posture.

Independent:
-Assess for vital signs
and symptoms of
pain such as facial
grimacing, rubbing
of neck or jaw,
reluctance to move,
increased blood
pressure
and tachycardia.
Note onset,
duration, location,
and pattern of pain.

- Use a pain rating
scale to assess the
patients perception
of the pains
severity





Dependent:
-Administer
sublingual
nitroglycerin as
ordered by the
physician

-To differentiate
angina pain from pain
related to other
causes









- To monitor the
effectiveness of
medications given
for pain relief.







-To decrease
myocardial oxygen
demands through
vasodilation,preload
and after load
reduction


After 8 hours of
nursing
interventions and
health teachings
patient was free from
pain, maintains
stable vital signs,
and had a relaxed
body posture.
Goal met.

Pathophysiology
Dx: Mitral Regurgitation




















Non Modifiable factors:
Age-- Risk increases as you get older
Gender-- Men have a greater risk of heart
attack.
Menopause For women, risk increases
after menopause.
Family historyRisk increases if family
members have heart problems
Modifiable factors:
Lifestyle(being overweight or obese, poor
nutrition, low physical activity, smoking)

Medical conditions (high blood pressure,
stroke, diabetes, low HDL or good
cholesterol, high HDL or bad
cholesterol)

Preload increases and the LV dilates in order to
maintain a normal forward flow
Produces volume overload of the left
ventricle (LV) and left atrium
Chordal rupture with resultant
flail segment.
Progressive myxomatous
degeneration
Legend:
Diagnostic test:
Signs/Symptoms:
Nursing Diagnosis:
Medication:






















Afterload may be variably
reduced initially in mitral
regurgitation and typically
becomes elevated only in later
stages of the disease as LV size
increases further
Increase in afterload resulting from LV dilatation
is offset by the fact that the ventricle is pumping
much of its volume, including regurgitant
volume, into a low-impedance circuit, the left
atrium
Lead to myxomatous degeneration of
the loose spongiosa and
fragmentation of the collagen fibrils
Diagnostic test:
Echocardiogram
Electrocardiogram (ECG)
Chest X-ray
Palpitations
Shortness of
breath
Fatigue (tiredness),
dizziness, or anxiety
Chest discomfort.

Migraine
headaches
Medications
Beta blockers (acebutolol,atenolol,
metoprolol, propranolol)
Diuretics
Aspirin
Prescription anticoagulants (Warfarin,
heparin, dabigatran)
Innefective breathing pattern


Acute pain related to myocardial
blood flow

Nursing Care Plan
Dx: Mitral Regurgitation
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective:
Hindi ako
makahinga ng
maayos, as
verbalized by the
patient.

Objective:
-Shortness of
breath
-Difficulty of
breathing
-Altered breath
depth
-Nasal flaring
Innefective
breathing pattern

After 4 hours of
nursing
intervention, the
patient will be able
to do coping
mechanisms to
improve his
breathing pattern

Independent:
-Auscultate chest




-Monitor pulse
oximetry


-Evaluate HOB or
have client sit up in
chair

-Monitor vital signs




Collaborative:
-Administer oxygen
at lowest
concentration
indicated and
prescribed
respiratory
medication as
prescribed by the
physician

-Encourage
slower/deeper
respirations, use
purse lip technique

-To evaluate
pressure and
character of breath
sounds

- To verify
maintanance in
oxygen saturation

-Promote
physiologic ease to
maximal inspiration

- To note any
significant changes
that may be
brought about by
the disease

-For management
of underlying
pulmonary
condition






-Assist client in
taking control of
the situation
After 4 hours of
nursing
intervention, the
patient did the
coping mechanisms
to improve his
breathing pattern
Goal met.



























Dx: Mitral Regurgitation
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective:
Masakit tong
dibdib ko lalo na
pag humihinga
ako, as
verbalized by
the patient.
Pain of 6 out of
1-10 pain scale


Objective:
-Restlessness
-Blood pressure
and pulse rate
changes
-Increased/
decreased
respiratory rate
Acute pain
related to
myocardial
blood flow

After 8 hours of
nursing
interventions
patient will
demonstrate
relief of pain as
evidenced by
stable vital signs,
absence of
muscle tension
and restlessness

Independent:
- Identify precipitating
event, if any;
frequency, duration,
intensity, and location
of pain.

- Observe for
associated symptoms,
e.g., dyspnea,
nausea/vomiting,
dizziness, palpitations,
desire to micturate




- Evaluate reports of
pain in jaw, neck,
shoulder, arm, or hand
(typically on left side).


- Elevate head of bed if
patient is short of
breath.

- Monitor heart
rate/rhythm.









- Helps differentiate this
chest pain, and aids in
evaluating possible
progression to unstable
angina

- Decreased cardiac output
(which may occur during
ischemic myocardial episode)
stimulates
sympathetic/parasympathetic
nervous system, causing a
variety of vague sensations
that patient may not identify
as related to anginal episode.

- Cardiac pain may radiate,
e.g., pain is often referred to
more superficial sites served
by the same spinal cord nerve
level.

- Facilitates gas exchange to
decrease hypoxia and
resultant shortness of breath.

- Patients with unstable
angina have an increased risk
of acute life-threatening
dysrhythmias, which occur in
response to ischemic changes
and/or stress.




After 8 hours of
nursing
interventions
patient was free
from pain,
maintains stable
vital signs, and
had a relaxed
body posture.
Goal met.

Dependent:
- Provide supplemental
oxygen as indicated.


- Administer
antianginal
medication(s)
(Nitroglycerin)promptly
as prescribed by the
physician


- Increases oxygen available
for myocardial
uptake/reversal of ischemia.


- Nitroglycerin has been the
standard for treating and
preventing anginal pain for
more than 100 yr. Today it is
available in many forms and
is still the cornerstone of
antianginal therapy














Pathophysiology
Dx: Mitral Stenosis

















c


Non Modifiable factors:
Age-- Risk increases as you get older
Gender-- Men have a greater risk of heart
attack.
Menopause For women, risk increases
after menopause.
Family historyRisk increases if family
members have heart problems
Modifiable factors:
Lifestyle(being overweight or obese, poor
nutrition, low physical activity, smoking)

Medical conditions (Rheumatic fever,
congenital mitral stenosis, malignant
carcinoid disease, systemic lupus
erythematosus, rheumatoid arthritis)

Cardiac output increases and the
velocity of flow through the mitral
valve increases
Autoimmune attack on the mitral
valve produces thickening of the
valve leaflets
Obstruction in blood flow from the
left atrium to left ventricle
Increase in pressure within the left atrium,
pulmonary vasculature, and right side of the
heart
Legend:
Diagnostic test:
Signs/Symptoms:
Nursing Diagnosis:
Medication:



























Transmitted pressure gradient becomes
exponentially larger
Diagnostic test:

Transthoracic
echocardiogram
Electrocardiogram (ECG)
Chest X-ray
Cardiac catheterization

Large increase in Left Atrium pressure
Fatigue Swollen feet
or legs
Decreased cardiac output related to
reduced myocardial perfusion
Risk for falls related to hypostatic
hypotension as evidenced by headache,
fainting when standing, and dizziness
Shortness of
breath
Heart palpitations -
sensations of a rapid,
fluttering heartbeat

Dizziness/Fainting

Medications

Diuretics (water pills)
Anticoagulant (heparin, warfarin)
Beta blockers or calcium channel
blockers
Anti-arrhythmics
Antibiotics


Nursing Care Plan
Dx: Mitral Stenosis
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective:
I feel that Im
having palpitations
right now, as
verbalized by the
patient.

Objective:
-Tachycardia
-Difficulty in
breathing
-Restlessness
Decreased cardiac
output related to
reduced
myocardial perfusion

Short term goals:
After 8 hours of
nursing
intervention:
-Patients lungs
sounds will be clear
to auscultation

-Patient will have
no signs of dyspnea

-Patient will
demonstrate an
increase in activity
intolerance

Long term goal:
Patient will display
hemodynamic
stability (BP, cardiac
output, urinary
output and
peripheral pulses
WNL)

Independent:
- Assess patient
respirations by
observing
respiratory rate and
depth and use of
accessory muscles

- Observe patient
for restlessness,
agitation, confusion
and (late stages)
lethargy





- Auscultate lungs
for presence of
normal or
adventitious lung
sounds





- Weigh patient
daily at same time
with same clothing
on same scale.


- Increased
respiratory rate and
use of accessory
muscles may be
seen in patients
with hypoxia

- Changes in
behavior and
mental status can
be early signs of
impaired gas
exchange which will
result from
decreased cardiac
output

- Crackles may
indicate heart
failure which can
contribute to
decreased cardiac
output. Respiratory
distress/failure
often occurs as
shock progresses.

- Weight gain can
be one of the
earliest indicators
of heart failure as a
result of impaired
After 8 hours of
nursing
intervention, the
patients feeling of
palpitations was
diminished as well
as its symptoms.
Goal met.






Collaborative:
- Administer
supplemental
Oxygen as indicated
by cannula, mask,
or ET/trach tube.




- Educate patient
and caregivers
about the
importance of
taking prescribed
medications at
prescribed times
ventricular pumping
ability. An acute
gain in weight of
1kg. can signal a l
liter gain in fluid

- Supplemental
oxygen helps to
improve cardiac
function by
increasing available
oxygen and
reducing oxygen
consumption

- Patient is often on
multiple
medications which
can be difficult to
manage, thus
increasing the
likelihood that
medications can be
missed or
incorrectly used








Dx: Mitral Stenosis
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective:
Nahihilo po ako at
sumasakit ang ulo
ko,
As verbalized by the
patient


Objective:
-Headache
-Fainting when
standing or
extending neck
Risk for falls related
to hypostatic
hypotension as
evidenced by
headache, fainting
when standing, and
dizziness

After 8 hours
of nursing
intervention, the
patient will be
able to be free of
injury
Independent:
-Raise side rails


-Observe individuals
genera health status







-Assess muscle
strength, gross and
ne
motor coordination


-Evaluate clients
cognitive status(e.g.,
brain injury,
neurological
disorders
;depression)

- Assess mood, coping
abilities, personality
styles

-To protect the patient
from falling

-Noticing factors that
might affect safety,
such as chronic
or debilitating
conditions, use
of multiple
medications, recent
trauma

-Altering coordination,
gait, and balance



-Affects ability to
perceive own
limitations
or recognize danger



-Individuals
temperament, typical
behavior,
stressors, and level of
self-esteem can affect
attitude toward safety
issues, resulting in
carelessness
or increased risk-
taking without
consideration of
consequences
After 8 hours
of nursing
intervention, the
patient was able
to be free of
injury
Goal met.