Primary Nursing Diagnosis

Activity intolerance related to diminished cardiac output

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


Physicians place most patients with advanced mitral insufficiency on activity restrictions to decrease cardiac workload. Research suggests that if the patient is on bedrest, the use of a bedside commode creates less workload for the heart than using a bedpan. Fluid restrictions and diuretics may be ordered to reduce pulmonary congestion. Supplemental oxygen enhances gas exchange and oxygenation to decrease dyspnea and chest pain.

Most patients with mitral insufficiency can compensate or be stabilized with medical treatment for their entire lives. Surgical repair or valve replacement is considered in patients with progressive severe disease. Mitral valve repair (valvuloplasty) is preferred over replacement whenever possible. The choice of valve type is based on the patient's age and the potential for clotting problems. A biologic valve (such as a porcine valve from a pig) usually shows structural deterioration after 6 to 10 years and needs to be replaced. A synthetic valve is more durable but is also more prone to thrombi formation. If the incompetent valve is replaced surgically with a synthetic valve, patients are prescribed long-term anticoagulant therapy, such as warfarin (Coumadin). (See Coronary Artery Disease, p. 248, for a further discussion of the collaborative and independent management of patients after open-heart surgery.)



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