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Question:

Write about the Nursing for Mitral Stenosis.

 

Answer:

Introduction

This case study examines the condition of Mr Tupa Savea   who suffers from mitral stenosis though his condition is described as stable. The causes and risk factors of aortic stenosis are explicated in this case study in a very clear manner. Therefore, it would be important to note that the narrower the valve the severe the case and for that reason the patient needs immediate medical attention so as to reduce the volatility rate of risk factor to the said patient. The basic remedy for this condition is surgery so as to fully reinstate the situation and aid the patient from the high chances of fatality that is clearly evident of such cases if swift attention is not taken into consideration (Aronow & Fleg, 2004).  The major cause of this condition is the rheumatic heart diseases which is further facilitated by the bacterium that is produced by the body as it starts working to attack the heart resulting to such case. Other factors that results to this are calcification around the valve and congenital problems. There are various complications that are evident in this condition that may worsening the state of the patients. The commonest one is the heart failure which becomes very clear when the situation worsens and thereby making the patient have short breath and high retention of fluid due to the narrowness of the fluid in the system. This situation is further augmented by the fatigues of the entire body. A blood clot is another risk factor that is associated to this state as the blood may be blocked from travelling to the various parts of the body due to the clotting that is clear in that area of the heart (Johnson, 2008).  Anticoagulants such as the prescriptions indicated below are the common medication for this state. These are Rivaroxaban (Xarelto), Dabigatran (Pradaxa), Apixaban (Eliquis), Heparin (various) a Warfarin (Coumadin). It is incumbent to note that this type of medication is very expensive and thereby it is expected that the family will spend a lot of money to realize this medication. It is indeed burdensome for the family members to raise that amount of money on regular basis since this type of treatment is not a onetime process but a continual process to facilitate full recovery of the patient (Anderson, 2015).   In nutshell most of the medication for this conditions are very expensive and thereby it will be a herculean task for the family to solicit or rather raise such huge amount of money to cater for the medical bills most importantly if the firm has not enrolled in any scheme such as health insurance that can be at least relatively cheaper for the family.

Chest pain (angina

It is ideal to note that Mitral stenosis is the illness in which the mitral valve narrows and thereby hinders the general flow of blood through the valve causing some complications to the patient experiencing such condition.  This in essence cause the chest pain to the patient who undergoes the said condition due to complexity of the narrowness of the valve which further hinders the general flow of the blood and fluid in the heart to the other parts of the body (Desai & Allen, 2016).   The provision of Angiotensin-converting enzyme (ACE) inhibitors are good medicine to aid this state.

Rapidity in heart beats

Some of the notable symptoms of this conditions are chest pain or what is commonly referred to as angina, irregular heartbeats and, more so its rapid, reduction in doing a given activity as anticipated and lastly the murmuring of the heart (Chang, 2005).  This are general symptoms of aortic stenosis. Since the flow of the blood incredibly reduces and therefore this results to high rapidity of the heart beat which also raise the blood pressure as such.

 

syncope

Syncope is a medical term that means the loss of consciousness which in most cases makes one to faint. This condition is common to Mitral stenosis patient since the blood flow incredibly reduces to other parts of the body and most particularly to the brain and therefore making one faint (Sommers & Credo Reference (Firm), 2015). Anticoagulation medication is the best therapy to aid in the flow of blood so that there is smooth flow of blood to the rest of the body parts and thereby reduces the chances of one experiencing the syncope state.

Heart murmur

The heart murmur is another symptom that suggests that one undergoes Mitral stenosis. This is commonly felt when one wheezes. The wheezing rate increases as the person has difficulty in breathing normally and thereby struggles during this process. The best medication to aid this particular condition is Water' tablets (diuretics) (Todd & Higgins, 2005). The aforementioned medicines aids in breathlessness state for the patient to have general regular manner of breathing.

pressure

The narrowness of the valve is the major contributor of the fast rate of the flow of blood which in turn results to high pressure. Notably, it is ideal to state that there is corrective medical treatment for this condition. Apixaban (Eliquis) is the ideal medicine for this condition as it softens the valve to allow adequate supply of the blood and as such reducing the high pressure that is exhibited in this matter.

 

According to Ignatavicius and Workman (2015), the two main classes of drugs that can be administered at this stage and results to significant positive results are Calcium Channel Blockers which is ‘umbrellad’ in diuretics. It is important to state some of the prescriptions of this class as follows; Amlodipine (Norvasc, Lotrel), Diltiazem (Cardizem, Tiazac), Felodipine (Plendil), Nifedipine (Adalat, Procardia) and Nimodipine (Nimotop) among others. The second class of drugs that can play a very significant role in aiding the patient who does undergo this situation is the Anticoagulation medication (Du, Le & Coetzee, 2011). This mostly prescribed to those who have developed the atrial fibrillation. This has really helped in curbing the problem of blood clotting which in large extent has resulted to the high blood pressure kin a particular patient. If the two classes of medicine are administered in tandem with each other there is high probability of the patient recovering well since all the considerations would have been put in place to see to it that the patient who does experience the same symptoms does undergo the medical help to further recuperate to their state of normalcy (Landrum, 2012).  There are various ways in which mitral stenosis can be diagnosed.  A doctor may use the stethoscope to determine the magnitude of wheezing in the patients or what is commonly referred to as heart murmur.  The doctor may further diagnose this condition by determining the pulse rate of their patient so as to fully aid the patient in the process of recovering.  

 

Similarly, anticoagulants are mostly used to aid a patient who suffers from heart attack and stroke. Warfarin is a type of anticoagulants that has to be taken cautiously so as to fully aid the patient in their recovery process.  However, it the prescription are not followed well, it may not be of any significant help to the patient. Dietary monitoring is another notable way of aiding the patient to recuperate from this mitral stenosis. It has been observed that the patient is expected to take low amount of vitamin K (Burke, LeMone & Mohn-Brown, 2007). 

The nurse ought to take a clear medical history of Mr Tupa Savea is a 54 who has a history of mitral stenosis. The early diagnostic indicates that Mr Savea’s diagnostic signs are PR 90 bpm and high body temperatures of about 36.9°C; SpO2 98% on oxygen 8L/min via Hudson It is important to underscore that mitral stenosis generally affects the aging people. Nevertheless, the same condition may also affect the young people due to problem associated with birth. Practically, as a registered nurse, close monitoring is very important for this type of patient. It is the prerogative of the nurse to see to it that the closely monitor the progress of their patient so as to determine how they are faring on the view of administering better medication for them (Ignatavicius, Workman, Blair, Rebar & Winkelman, 2016).  The best way to realize this is also by offering home based care which in most cases it has been seen to have played a very significant role in the whole process of recovery. The role of nurses at this stage is very important as they may be able to raise alarm if the situation continues to worsen. There are various nursing diagnostic measures that a nurse has to take into consideration so as to fully aid this particular patient. The acute pain should be critically looked into for appropriate medical help.

Within the first 24 hours of patient’s admission the nurse should collect the previous history of the patient so as to aid them in their process of subjecting the patient to medical treatment. Some of the key areas that the nurse has to handle or put into considerations is the pulsing rate of the patient, murmuring of the heart (Diali, Toulabi, Gholami, Khademi & Tarrahi, 2016). Moreover, the nurse should be able to identify whether the patient has been experiencing unconsciousness condition. Another notable question that the nurse should ask is whether the patient experience angina or rather the chest pain which is also associated to this stenosis condition. Most importantly the nurse should find out is the type of medication and treatment that the patient has previously been taking. This a very crucial question as it will assist the medic who would take after to know what are some of the precautionary measures that they have to employ in their process of dispensing their services (Clarke, 2015).  In order for the nurse to have a clear condition of their patient, it would be ideal for the nurse to collect clear symptoms of aortic stenosis. Now that Mr Savea’s has been readmitted to coronary care unit (CCU), it will be ideal for the nurses to take a keen look of his progress to aid in taking the medication that was prescribed to him.

 

References

Anderson, K. M. P. D. F. N. P. (2015). The Advanced Practice Nurse Cardiovascular Clinician.

Aronow, W. S., & Fleg, J. L. (2004). Cardiovascular disease in the elderly. New York: Marcel Dekker.

Burke, K. M., LeMone, P., & Mohn-Brown, E. (2007). Medical-surgical nursing care. Upper Saddle River, N.J: Pearson/Prentice Hall.

Chang, A. (2005). Magill's medical guide. Pasadena, Calif: Salem Press.

Clarke, G. M. (2015). A history of the Intensive Care Unit within the family of Royal Perth Hospital.

Desai, B., & Allen, B. R. (2016). Nailing the Written Emergency Medicine Board Examination. Cham: Springer International Publishing.

Diali, A. G., Toulabi, T., Gholami, M., Khademi, M., & Tarrahi, M. J. (2016). Challenges of nursing documentation in coronary care unit: A qualitative study of nurses’ experiences. Iioab Journal, 7, 134-140.

Du, P. L. J., Le, R. P., & Coetzee, A. R. (2011). Anaesthesia for transvenous transcatheter tricuspid valve-in-valve implantation: case study. Southern African Journal of Anaesthesia and Analgesia, 17, 4, 293-298.

Ignatavicius, D. D., & Workman, M. L. (2015). Medical-Surgical Nursing: Patient-Centered Collaborative Care.

Ignatavicius, D. D., Workman, M. L., Blair, M., Rebar, C. R., & Winkelman, C. (2016). Medical-surgical nursing: Patient-centered collaborative care.

Johnson, J. Y. (2008). Handbook for Brunner & Suddarth's textbook of medical-surgical nursing. Philadelphia: Lippincott Williams & Wilkins.

Landrum, M. A. (2012). Fast facts for the critical care nurse: Critical care nursing in a nutshell. New York: Springer Pub. Co.

Sommers, M. S., & Credo Reference (Firm), (2015). Diseases and disorders: A nursing therapeutics manual.

Todd, B. A., & Higgins, K. (2005). Recognizing aortic & mitral valve disease. Nursing, 35, 6, 58-63.

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