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Valvular Heart Disease – Nursing Management and Home Care

Pre-operative

  1. Nursing diagnosis: Activity intolerance related to insufficient oxygenation secondary to decreased cardiac output and pulmonary congestion .

Goal: Achieves optimal level of activity.

  1. Nursing Diagnosis: Ineffective cardiopulmonary tissue perfusion related to reduced coronary blood flow.

Goal: Relief of chest pain/discomfort.

  1. Nursing Diagnosis: Potential ineffective air exchange related to fluid overload

Goal: Absence of respiratory difficulties

  1. Nursing Diagnosis: Potential ineffective peripheral tissue perfusion related to decreased cardiac output

Goal: Maintenance/attainment of adequate tissue perfusion

  1. Nursing Diagnosis: Anxiety related to fear of death, change in health status & impending surgery

Goal: Reduction of anxiety.

Post-operative

1. Nursing Diagnosis: Decreased cardiac output related to blood loss and compromised myocardial function

Goal: Restoration of cardiac output to maintain/attain desired lifestyle

2. Nursing diagnosis:Impaired gas exchange related to trauma of extensive chest surgery

Goal: Adequate gas exchange

3. Nursing Diagnosis: Risk for deficient fluid volume and electrolyte imbalance related to alterations in blood volume

Goal: Fluid and electrolyte balance

4. Nursing Diagnosis: Disturbed sensory perception related to excessive environmental stimulation, sleep deprivation, electrolyte imbalance

Goal: Reduction of symptoms of sensory perceptual imbalance; prevention of postcardiotomy psychosis

5. Nursing Diagnosis: Acute pain related to surgical trauma and pleural irritation caused by chest tubes .

Goal: Relief of pain

6. Nursing Diagnosis: Ineffective renal tissue perfusion related to decreased cardiac output, hemolysis, or vasopressor drug therapy

Goal: Maintenance of adequate renal perfusion

7. Nursing Diagnosis: Ineffective thermoregulation related to infection or postpericardiotomy syndrome

Goal: Maintenance of normal body temperature

8. Nursing Diagnosis: Deficient knowledge about self-care activities

Goal: Ability to perform self-care activities

Home care

1. Develop teaching plan for patient and family. Provide specific instructions for the following:

• Diet and daily weights

• Activity progression

• Exercise

• Deep breathing, FET (coughing), lung expansion exercises

• Temperature monitoring

• Medication regimen

• Pulse taking

• CPR, if appropriate for the family to learn

• Need for MedicAlert identification

2. Provide verbal and written instructions; provide several teaching sessions for reinforcement and answering questions.

3. Involve family in all teaching sessions.

4. Provide information regarding follow-up.

5. Make appropriate referrals: home care agency, cardiac rehabilitation program, community support groups.