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NCLEX - Valvular Disease

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Here are key facts for NCLEX from the Valvular Disease tutorial, as well as points of interest at the end of this document that are not directly addressed in this tutorial but should help you prepare for the boards. See the tutorial notes for further details and relevant links.
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VITAL FOR NCLEX
1. Primary Types of Valvular Disorders: Stenosis*: Narrowed valve opening (e.g., aortic stenosis). Regurgitation/Insufficiency*: Incomplete valve closure causes backflow (e.g., mitral regurgitation).
2. Signs and Symptoms of Valvular Disease:
  • Dyspnea, fatigue, orthopnea, crackles, murmurs, and palpitations are hallmark findings.
Aortic stenosis*: syncope, chest pain, dyspnea. Mitral stenosis*: fatigue, hemoptysis, atrial fibrillation.
3. Auscultation Clues: Mitral stenosis*: low-pitched diastolic murmur at apex (patient in left lateral position). Aortic stenosis*: systolic murmur over right second intercostal space. Mitral regurgitation*: holosystolic murmur radiating to axilla.
4. Nursing Role in Diagnostics:
  • Prepare client for echocardiogram (non-invasive), TEE, chest X-ray, or cardiac catheterization as ordered.
  • Monitor labs: BNP, troponins (if CHF or MI suspected).
5. Medical Treatment Goals:
  • Reduce workload on heart using diuretics, beta-blockers, ACE inhibitors, or vasodilators.
  • Treat arrhythmias (e.g., anticoagulation for atrial fibrillation).
6. Nursing Priorities:
  • Monitor for fluid overload, decreased cardiac output, activity intolerance, and impaired gas exchange.
  • Maintain bed rest during acute exacerbation.
7. Surgical Interventions:
  • Valve repair or replacement for severe or symptomatic cases.
  • Mechanical valves require lifelong anticoagulation; bioprosthetic valves may not.
8. Client Education for Valve Surgery:
  • Importance of anticoagulation (especially with mechanical valve).
  • Teach signs of bleeding, bruising, INR monitoring, and dietary considerations (vitamin K consistency).
9. Infective Endocarditis Prophylaxis:
  • Dental procedures: may require prophylactic antibiotics if prosthetic valve or history of endocarditis.
10. Heart Failure Monitoring:
  • Daily weights, strict I/O, low-sodium diet, fluid restrictions, elevate HOB.
  • Report weight gain of >2 lbs in 24 hours or 5 lbs in a week.
11. Activity Tolerance:
  • Encourage pacing of activities and clustered care to prevent fatigue.
  • Teach importance of rest periods between activities.
12. Preventing Complications:
  • Monitor for thromboembolism, stroke symptoms, arrhythmias, and pulmonary edema.
  • Provide oxygen therapy if needed.
13. Pregnancy Consideration:
  • Valve disease may worsen due to increased cardiac demand.
  • Bioprosthetic valves preferred; avoid warfarin in pregnancy unless absolutely necessary.
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HIGH YIELD
14. Valve Anatomy (Basic Understanding): Aortic and pulmonary valves* = semilunar valves (prevent backflow to ventricles). Mitral and tricuspid valves* = atrioventricular valves (control flow from atria to ventricles).
15. Signs of Valve Complication Post-Surgery:
  • Fever, new murmur, or signs of infection → possible endocarditis.
  • Call provider for bleeding, chest pain, shortness of breath, or arrhythmias.
16. Mechanical Valve Education:
  • Emphasize warfarin therapy, INR goal usually 2.5–3.5.
  • Avoid NSAIDs, use soft toothbrush, monitor for signs of bleeding.
17. Common Nursing Diagnoses:
  • Decreased cardiac output.
  • Activity intolerance.
  • Risk for ineffective tissue perfusion.
  • Impaired gas exchange.
18. Client Positioning:
  • High Fowler’s during dyspnea or pulmonary congestion.
  • Left lateral position enhances murmur auscultation for mitral stenosis.
19. Health Promotion and Maintenance:
  • Control HTN, lipids, and smoking to slow disease progression.
  • Encourage influenza and pneumococcal vaccines.
20. Endocarditis Red Flags:
  • Fever, chills, splinter hemorrhages, Janeway lesions, or petechiae require immediate evaluation.
21. Discharge Planning & Coordination:
  • Ensure follow-up for cardiology, anticoagulation monitoring, and rehabilitation services.
  • Provide referrals for home health if mobility or support is limited.
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Beyond the Tutorial
22. Balloon Valvuloplasty:
  • Used for mitral stenosis in selected cases.
  • Minimally invasive and done via catheterization.
23. Telemetry Monitoring:
  • Especially important in new or worsening valve disease to detect atrial fibrillation or ventricular arrhythmias.
24. Anticoagulation Reversal (NCLEX Safety Priority):
  • For warfarin, use vitamin K and possibly fresh frozen plasma (FFP) if bleeding occurs.
25. Patient Teaching Post-Procedure:
  • Avoid strenuous activity post-valve surgery.
  • Teach sternal precautions (no lifting >5–10 lbs, avoid pushing/pulling with arms).