Primary Nursing Diagnosis

Activity intolerance related to pulmonary congestion and decreased blood supply to meet the demands of the body

OUTCOMES. Energy conservation; Coping; Knowledge: Disease process; Mood equilibrium; Symptom severity; Health beliefs: Perceived control; Knowledge: Medication; Treatment regimen

INTERVENTIONS. Energy management; Counseling; Exercise promotion; Hope instillation; Security management; Security enhancement; Presence; Medication management; Teaching: Prescribed diet and medications

^ PLANNING AND IMPLEMENTATION Collaborative

Once symptomatic, a patient usually progresses from mild to total disability in 5 to 10 years. This downhill course can be accelerated by conversion from a normal cardiac rhythm to atrial fibrillation or by pregnancy, bacterial endocarditis, or embolization.

Definitive therapy for mitral stenosis is surgical replacement of the stenotic valve, particularly when the valve has marked stenosis with an orifice less than 1 cm2. Postoperative anticoagulation is not required. Therefore, even patients with mild symptoms are candidates for surgery. Patients who have more severe, disabling symptoms are more likely to require valve replacement. Either a bioprosthetic or a mechanical valve is used by the surgeon, depending on the patient's condition and the surgeon's preference. Percutaneous valvuloplasty may be used in young patients without calcification, by symptomatic pregnant women, and by elderly individuals who are poor risks for open heart surgery. (See Coronary Artery Disease, p. 248, for collaborative and independent interventions for the patient who is undergoing open-heart surgery.)

Pharmacologic

Highlights

Your Heart and Nutrition

Your Heart and Nutrition

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