SEMINAR subject: Medical surgical nursing: SEMINAR subject: Medical surgical nursing By Robin Edison John M.Sc Nursing 1 st year VSPM’s COLLEGE OF NURSING AND RESEARCH CENTRE introduction: introduction Vital system Two closely related system Essential to maintain adequate tissue perfusion Cardio vascular and respiratory system Structural abnormality of heart Affects flow of the blood through the heart Valvular heart disease *(VHD) SEMINAR ON VALVULAR HEART DISEASE: SEMINAR ON VALVULAR HEART DISEASE By Robin Edison John M.Sc Nursing 1 st year VSPM’s COLLEGE OF NURSING AND RESEARCH CENTRE DEFINITION: DEFINITION Valvular heart disease can be defined as a structural heart disease or disorder involving malfunction of one or more valve in which the valves fails to fully open ( stenosis ) or close (regurgitation) causing obstruction to the normal blood flow and impaired perfusion of heart and distal tissue PREVELANCE of valvular heart disease: PREVELANCE of valvular heart disease VHD in Adolescent and children is mainly because of congenital cause 2% of population suffer mitral regurgitation 1.8 to 11 per thousand school going student are affected by rheumatic disease Elderly people are the common victims of Aortic stenosis and mitral stenosis 2% of people over the age of 65 years 3% of people over the age of 75 years 4% of people over the age of 85 years Anatomy and physiology: Anatomy and physiology Heart sound: Heart sound S1 S2 Heart valves: Heart valves clasification: clasification Mitral valve prolapse (displacement) Mitral valve regurgitation (insufficiency) Mitral valve stenosis (narrowing) Aortic valve regurgitation Aortic valve stenosis Tricuspid valve regurgitation Tricuspid valve stenosis Pulmonic stenosis Pulmonic regurgitation Etiology: Etiology Congenital Val v e Disease improper valve size Malformed leaflets Ac quire d Val v e Diseases Rheumatic heart disease Infective endocarditis Structural Valve Disease chordae tendineae or papillary muscles damage fibro- calcific degeneration dilatation of the valve annulus. Mitral valve disease: Mitral valve disease Mitral valve stenosis: Mitral valve stenosis PowerPoint Presentation: MITRAL VALVE Stenosis Calcified & immobile Narrowing of Orifice Prevent normal flow of blood from Left Atrium (LA ) to Left Ventricle Increased LA Pressure Increased Pulmonary Venous Pressure Right Ventricular Hypertrophy Hypertrophy Of LA Decreased Cardiac Output Right Ventricular Failure PowerPoint Presentation: MITRAL VALVE Regurgitation Insufficiency, Scarring Retraction of Leaflets Blood Flows Backward Into Left Atrium (LA ) From Left Ventricle (LV) Enlargement Dilatation and Hypertrophy Increased LA Pressure Right Sided Heart Failure Hypertrophy Of LV Increased Pulmonary pressure Left Ventricular Failure PowerPoint Presentation: MITRAL VALVE Prolapse Cusps Billow Upward Into the LA Prolapse may Be Because of The Cusps may be Enlarged or Thickened Chordaetendineae Lengthen, allowing the valve cusps to stretch Upward MITRAL VALVE Regurgitation Aortic valve disease: Aortic valve disease PowerPoint Presentation: AORTIC VALVE Stenosis Congenital , calcification Stiffining Prevent normal flow of blood from Left Ventricle (LV ) to Aorta Increased LV Pressure Left Ventricular Hypertrophy And Dilatation Right Ventricular Hypertrophy Increased Pulmonary Hypertension Decreased Cardiac Output Decreased Cardiac Out Put PowerPoint Presentation: AORTIC VALVE Regurgitation Congenital , degenerative Connective tissue Disorder Blood Regurgitates Back into Left Ventricle (LV ) From Aorta Volume Overload Increased left ventricular end diastol volume Right Ventricular Hypertrophy and Dilatation Decreased Cardiac Output Decreased Cardiac Out Put Tricuspid valve disease: Tricuspid valve disease Tricuspid stenosis : Tricuspid stenosis Tricuspid regurgitation: Tricuspid regurgitation Pulmonic valve disease: Pulmonic valve disease Pulmonary stenosis: Pulmonary stenosis Pulmonary regurgitation: Pulmonary regurgitation Diagnostic studies for vhd: Diagnostic studies for vhd History and Physical examination Echocardiogram (echo) Electrocardiogram Chest X-Ray Cardiac catheterization Magnetic resonance imaging Radionuclide scans Medical management (non surgical): Medical management (non surgical) prevention of recurrent rheumatic fever and Infective endocarditis . vasodilators, positive inotropes B-adrenergic blockers diuretics and a low-sodium diet are recommended Anticoagulant digoxin , ( atrial dysrhythmias ) B-Adrenergic blockers ( atrial fibrillation) Percutaneous Transluminal Balloon Valvuloplasty Percutaneous Transluminal Balloon Valvuloplasty: Percutaneous Transluminal Balloon Valvuloplasty MANAGEMENT (SURGICAL ) : MANAGEMENT (SURGICAL ) There are two types of valve surgery Valve repair surgery and Valve replacement surgery. Types of Valve repair surgery : Types of Valve repair surgery Commissurotomy Quadrangle Resection of Leaflet Annulus Support Patched Leaflets Bicuspid Aortic Valve Repair . Commissurotomy: Commissurotomy Quadrangle Resection of Leaflet: Quadrangle Resection of Leaflet Annulus Support: Annulus Support Patched Leaflets: Patched Leaflets Bicuspid Aortic Valve Repair: Bicuspid Aortic Valve Repair Valve replacement surgery: V alve repla c ement surgery Biological Valves Replacement Mechanical Valves Replacement Switch Operation (Ross Procedure) Minimally Invasive Valve Surgery Biological Valves Replacement : Biological Valves Replacement Biological Valves ( tissue or bioprosthetic valves) cow tissue (bovine) pig tissue (porcine) human tissue (allograft or homograft). Not need life-long anticoagulant therapy Not considered as durable Mechanical Valves Replacement: Mechanical Valves Replacement Need to take anticoagulant medications for the rest of their lives. Very durable and is designed to last a lifetime. Mechanical valves are made of metal or carbon Bileaflet valve is the most common type of mechanical valve prosthetic valves: prosthetic valves Switch Operation (Ross Procedure): Switch Operation (Ross Procedure) It is used to treat aortic valve disease . During this procedure, the patient’s own pulmonic valve is removed and used to replace a diseased aortic valve. The pulmonic valve is then replaced by a homograft valve. Most patients who undergo the Ross procedure do not need to take anticoagulant medications for the rest of their lives. This procedure is mainly used in children or young adults with aortic valve disease. Minimally Invasive Valve Surgery: Minimally Invasive Valve Surgery Minimally invasive valve surgery techniques include endoscopic or keyhole approaches (also called port access, thoracoscopic or video-assisted surgery) and robotic-assisted surgery. 3 to 4 inches instead of the 6- to 8-inch incision with traditional surgery valve repairs and valve replacements stay in the hospital (3 to 5 days) reduced risk of infection, less bleeding, less pain and trauma Nursing Management: Nursing Management Nursing Diagnosis (Activity intolerance) : Nursing Diagnosis (Activity intolerance ) Activity intolerance related to insufficient oxygenation secondary to decreased cardiac output and pulmonary congestion as evidenced by weakness, fatigue, shortness of breath, increase or decrease in pulse rate, BP changes GOAL Achieves optimal level of activity INTERVENTIONS AND RATIONALES Monitor cardiorespiratory response to activity (e.g., pulse rate, respirations, BP) to plan appropriate interventions. Encourage altemate rest and activity periods to conserve energy and decrease cardiac demands. Encourage patient to choose activities that gradually build endurance to increase cardiac tolerance. Assist the patient/significant other to establish realistic activity goals to promote feelings of accomplishment. Nursing Diagnosis (Excess fluid volume) : Nursing Diagnosis (Excess fluid volume) Excess fluid volume related to heart failure secondary to incompetent valves as evidenced by peripheral edema , weight gain, adventitious breath sounds, neck vein distention GOAL: Achieves fluid and electrolyte balance INTERVENTIONS AND RATIONALES Monitor changes in peripheral edema to detect hypenxolemia . Monitor respiratory pattern for symptoms of difficulty (e.g., dyspnea, tachypnea ) to assess for fluid congestion in the lungs. Monitor vital signs and intake and output to assess hemodynamic response to and effectiveness of interventions. Weigh patient daily and monitor trends (noting gain of >2 Ib [0.9 kg]/ day or >5 lb [2.3 kg]/wk) to monitor indicators of hypenrolemia . Administer prescribed diuretics to assist with removal of fluid. Provide restricted sodium diet as ordered to prevent fluid retention. Nursing Diagnosis (Decreased cardiac output): Nursing Diagnosis (Decreased cardiac output) Decreased cardiac output related to valvular incompetence as evidenced by murmurs, dyspnea, dysrhythmias , peripherai edema GOAL: Maintains adequate tissue and organ perfusion Maintains normai cardiac function PowerPoint Presentation: INTERVENTIONS AND RATIONALES Monitor vital signs, cardiovascular status, and respiratory status to assess for manifestations of decreased cardiac output (e. g., fatigue. malaise, shortness of breath, dyspnea on exertion, palpitations, angina, widened pulse pressure). Monitor for cardiac dysrhythmias , including disturbances of both rhythm and conduction, to detect changes from baseline. heemodynamic Regulation Administer inotropic medication as ordered to increase myocardial contractility. Elevate head of bed to reduce venous return, reduce O2 demand, and maximme chest excursion. Promote bed rest!activity limitation to decrease cardiac workload and O2 demand. Nursing Diagnosis (Deficient knowledge) : Nursing Diagnosis (Deficient knowledge) Deficient knowledge re/ ated to lack of experience and exposure to information about disease and treatment process as evidenced by verbalization of misconceptions about measures to preventcomplications and requests for information GOAL: Patient describes disease process and appropriate measures to prevent complications PowerPoint Presentation: INTERVENTIONS AND RATIONALES Explain pathophysiology of disease process to ensure knowledge base. Describe disease process and possible chronic complications (e.g., heart failure, infective endocarditis ) to ensure early reporting and treatment of complications. Instruct patient on measures to prevent complications (e.g., importance of notifying dentist, urologist, gynecologist , and other health care providers of valvular disease so prophylactic antibiotic treatments can be initiated prior to invasive procedures) and to wear Medic Alert bracelet. Discuss lifestyle changes to prevent complications and/or control the disease (e.g., smoking cessation) to prevent an increased cardiac workload and the oxygen depleting effect of carbon monoxide. Instruct patient on signs and symptoms to report to health care provider to assure appropriate interventions. Instruct patient on purpose and action of each medication. Provide patient with written information about action, purpose, and side effects of each medication.