Primary Nursing Diagnosis

Activity intolerance related to imbalance between oxygen supply and demand

OUTCOMES. Endurance; Energy conservation; Self-care; Ambulation: Walking; Circulation status; Cardiac pump effectiveness; Rest; Respiratory status; Symptom severity; Nutritional status: Energy

INTERVENTIONS. Activity therapy; Energy management; Circulatory care; Exercise therapy: Ambulation; Oxygen therapy; Self-care assistance; Nutrition management

U PLANNING AND IMPLEMENTATION Collaborative

MEDICAL. Most patients with AS are placed on activity restrictions to decrease cardiac workload. Patients on bedrest should use the bedside commode because research has shown it creates less workload for the heart than using the bedpan. Fluid restrictions and diuretics may be ordered to reduce pulmonary congestion. Supplemental oxygenation will enhance oxygen levels in the blood to decrease labored breathing and chest pain.

SURGICAL. Surgical repair or replacement is the most common treatment of AS. The average survival rate after the appearance of symptoms is less than 5 years for patients with AS who are treated medically. Surgical treatment increases the survival rate dramatically. The stenotic valve can be replaced with a synthetic valve or a biologic valve, such as a pig valve. The choice of valve type is based on the patient's age and the potential for clotting problems. The biologic valve usually shows structural deterioration after 6 to 10 years and needs to be replaced. The synthetic valve is more durable but also more prone to thrombi formation.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Digoxin

0.25 mg PO qd

Cardiotonic

May be useful in the presence of heart

0 0

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