Valvular Disorder: Mitral Stenosis Nursing Management

Notes

Definition
  • Mitral stenosis is the progressive thickening and contracture of the mitral valve leaflets and chordate tendineae that cause narrowing of the orifice and progressive obstruction to blood flow.
Risk Factors
  • Congenital
  • Infection
image credit to : http://www.heartpoint.com/

image credit to : http://www.heartpoint.com/

Pathophysiology
  • Normally, the mitral valve opening is as wide as three fingers. In cases of marked stenosis, the opening narrows to the width of a pencil. The left atrium dilates and hypertrophies because it has great difficulty moving blood into the ventricle and because of the increased blood volume the atria must now hold. Because there is no valve to protect the pulmonary veins from the backward flow of blood from the atrium, the pulmonary circulation becomes congested. The resulting high pulmonary pressure can eventually lead to right ventricular failure.
Assessment/Clinical Manifestations/Signs And Symptoms
  • Dyspnea on exertion (due to pulmonary venous hypertension) as the first symptom
  • Progressive fatigue (result of low cardiac output)
  • Hemoptysis and cough
  • Repeated respiratory infections
  • Weak and often irregular pulse (because of atrial fibrillation)
Medical Management
  • Prophylactic antibiotic therapy to prevent recurrence of infections
  • Treatment of anemia if required
  • Cardiotonics and diuretic for treatment of congestive heart failure
  • Surgical intervention (valvuloplasty, commissurotomy, or replacement of the mitral valve)
  • Percutaneous transluminal valvuloplasty for palliation of symptoms
  • 12-Lead ECG and echocardiogram
  • Cardiac catheterization with angiography to reveal the severity

Exam

Welcome to your MSN Exam for Valvular Diseases! This exam is carefully curated to help you consolidate your knowledge and gain deeper understanding on the topic.

 

Exam Details

  • Number of Questions: 10 items
  • Mode: Practice Mode

Exam Instructions

  1. Practice Mode: This mode aims to facilitate effective learning and review.
  2. Instant Feedback: After each question, the correct answer along with an explanation will be revealed. This is to help you understand the reasoning behind the correct answer, helping to reinforce your learning.
  3. Time Limit: There is no time limit for this exam. Take your time to understand each question and the corresponding choices.

Tips For Success

  • Read each question carefully. Take your time and don't rush.
  • Understand the rationale behind each answer. This will not only help you during this exam, but also assist in reinforcing your learning.
  • Don't be discouraged by incorrect answers. Use them as an opportunity to learn and improve.
  • Take breaks if you need them. It's not a race, and your understanding is what's most important.
  • Keep a positive attitude and believe in your ability to succeed.

Remember, this exam is not just a test of your knowledge, but also an opportunity to enhance your understanding and skills. Enjoy the learning journey!

 

Click 'Start Exam' when you're ready to begin. Best of luck!

💡 Hint

Focus on where the blood would back up as a result of the narrowed mitral valve, affecting the flow from the left atrium to the left ventricle.

1 / 10

1. Nurse Elizabeth is assessing Mrs. Miller, a 64-year-old woman diagnosed with mitral stenosis. Elizabeth knows that this condition can cause symptoms related to congestion in a specific part of the circulatory system. In which area does Nurse Elizabeth expect to find symptoms of congestion?

💡 Hint

Think about the relationship between types of dietary fats and their impact on cholesterol levels in the blood.

2 / 10

2. Nurse Ethan is conducting a health education session for Lisa, a 50-year-old patient who has recently been diagnosed with atherosclerosis. During the session, Ethan wants to clarify some misconceptions about cholesterol. Which statement is accurate for Nurse Ethan to share with Lisa about cholesterol?

💡 Hint

Think about the most comprehensive and respectful way to address the client's needs while also involving the family in the care plan.

3 / 10

3. Nurse Olivia is caring for Karen, a 45-year-old patient with severe hypertension who has been prescribed a 2-gram sodium diet. Karen is clearly unhappy with the diet and has requested her spouse to bring in some "good home-cooked food." What would be the most effective action for Nurse Olivia to take in this situation?

💡 Hint

Think about which aspect of a medical regimen is crucial for managing the symptoms and risks associated with mitral stenosis, especially when preparing for surgery.

4 / 10

4. Nurse Lucas is conducting a preoperative assessment on Mr. Jenkins, a 55-year-old man who has mitral stenosis and is scheduled for valve replacement surgery. Lucas is particularly interested in assessing Mr. Jenkins' history of compliance with medical regimens. Non-compliance with which of the following would pose the greatest risk to Mr. Jenkins' health?

💡 Hint

Consider the impact of mitral regurgitation on the heart's efficiency in pumping blood and how this would affect the patient's ability during physical activities.

5 / 10

5. Nurse Andrew is caring for Mr. Anderson, a 50-year-old man diagnosed with mitral regurgitation. While evaluating his clinical manifestations, Nurse Andrew wants to identify the sign or symptom most commonly associated with this condition. What would he most likely find?

💡 Hint

Consider which foods are most likely to contain unsaturated fats and would also be beneficial for someone with cardiac issues.

6 / 10

6. Nurse Maya is working with Paul, a 52-year-old patient with cardiac issues who has been advised to follow a diet rich in unsaturated fatty acids. In order to help Paul make more heart-healthy choices, what food group should Nurse Maya emphasize that he should increase in his diet?

💡 Hint

Think about the anatomical structure that endocarditis primarily affects and how that would manifest in the cardiac assessment.

7 / 10

7. Nurse Amelia is caring for Mr. Thompson, a patient who has been diagnosed with endocarditis and has recently developed a new heart murmur. Nurse Amelia understands that the new murmur is most likely attributable to what underlying condition?

💡 Hint

Consider what life-threatening complication can occur if fragments from the infected heart valve dislodge and travel through the bloodstream.

8 / 10

8. Nurse Olivia is monitoring Sarah, a 37-year-old woman admitted to the hospital under suspicion of bacterial endocarditis. Olivia knows she must be vigilant in observing for a particular complication that could arise in Sarah's condition. What should she constantly monitor for?

💡 Hint

Think about the typical childhood illness that can lead to heart valve issues, such as mitral stenosis and regurgitation, later in life.

9 / 10

9. Nurse Olivia is interviewing Mrs. Williams, a 68-year-old woman scheduled for a mitral valve replacement due to severe mitral stenosis and mitral regurgitation. Mrs. Williams mentioned that she was diagnosed during childhood but only started experiencing symptoms four years ago, despite being on digoxin and furosemide. What childhood health history is Nurse Olivia most likely to discover during this initial interview?

💡 Hint

Consider the basic features of a normal sinus rhythm and how the P wave is associated with atrial depolarization.

10 / 10

10. Nurse Andrew is overseeing George, a 72-year-old patient admitted with heart palpitations. George is connected to a cardiac monitor, and Nurse Andrew wants to ascertain if the monitor shows a normal sinus rhythm. What criteria should he use to determine this?