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Unit VI Promoting Health in Patients With Circulatory or Perfusion Disorders
Evaluating Care Outcomes The primary goal of care for a patient with pericarditis is pain relief. Early recognition and management of peri- cardial effusion are also important factors in the care of these patients. A well-managed patient is free from pain, shortness of breath, and indicators of cardiac tamponade. Ensuring that the patient and family are knowledgeable about the signs and treatment of the disease as well as the indicators of pericardial effusion is necessary to avoid the negative consequences associated with cardiac tamponade. Connection Check 30.3 Which order would the nurse question in the management of acute pericarditis? A. Aspirin
aortic stenosis (Fig. 30.7) and mitral regurgitation. The least commonly affected valves are the tricuspid and pulmonic valves because of the low-pressure system in the right heart. Valvular disease can affect one or more valves at the same time. Pathophysiology There are several types of valvular disease: stenosis, insuf- ficiency or regurgitation, and prolapse (Table 30.3). The pathophysiology of all valvular diseases is similar. Generally, in response to backward flow through the valve, referred to as regurgitation , or resistance to forward flow through the constricted or stenosed valve, signs of right- or left-sided HF develop. For instance, mitral valve regurgitation causes backward flow of blood into the left atrium. The increased blood volume raises the pressure in the atrium and pulmo- nary vessels and results in pulmonary edema and left-sided HF. Aortic valve stenosis obstructs the flow of blood from the left ventricle (LV), causing increased LV pressures. Left ventricle hypertrophy occurs to generate adequate force to open the valve. Over time, the LV fails, also resulting in the signs of left-sided HF. Insufficiency of the tricuspid valve causes backward flow and increased pressure in the right atrium, which results in signs of right-sided HF, such as JVD, generalized edema, and ascites. Clinical Manifestations Often, the first clinical sign of valvular disease is the aus- cultation of a murmur. A murmur can be the result of a high rate of blood flow through a valve, forward blood flow through a narrowed valve ( stenosis ), or backward blood flow through an incompetent valve (regurgitation). A cardiac murmur can be classified as systolic, diastolic,
B. Colchicine C. Ibuprofen D. Acetaminophen
VALVULAR DISEASE Epidemiology
The prevalence of valvular disease in the general popula- tion is approximately 2.5%; it increases with age and occurs equally in men and women. The risk factors include infectious diseases such as IE and rheumatic fever, myocardial infarction, heart failure, congenital defects, and degenerative changes. Pregnancy has been shown to increase the risk of valvular dis- ease because of the increased workload on the heart. Patients with risk factors for coronary artery disease are also at risk for valvular disease. The most common valvular diseases are
Normal aortic valve
Closed
Open
Aortic valve stenosis
Aortic valve
Closed
Open
Left ventricle
FIGURE 30.7 A comparison of a normal aortic valve with a valve narrowed in aortic stenosis.
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