The nurse is caring for an 85-year-old woman admitted to the hospital with a dia
ID: 121789 • Letter: T
Question
The nurse is caring for an 85-year-old woman admitted to the hospital with a diagnosis of mitral stenosis. The patient has been experiencing dizziness and lightheadedness and fell before admission. During the physical examination, the nurse notes a diastolic murmur heard best at the left sternal border and crackles in the lungs. BP 130/80, P. 88, R. 16, Considering the diagnosis of mitral stenosis explain why the patient has both a diastolic murmur and crackles in the lungs. The patient is most concerned about her fall and the sensation of dizziness that has been progressing. Why would these symptoms be especially worrisome in a patient with mitral stenosis? Whenever a patient has an abnormal valve, there is an increased incidence of bacterial endocarditis. What are important preventive measures that should be included in this patient's education plan? (Learning Objectives 12, 15, 16, 17)Explanation / Answer
1. In case of severe mitral stenosis, the left atrium makes greater effort to pump blood to the left ventricle through the narrowed valve. There arrises a presuure in the left atrium which enlarges the walls of the atrium. On the other hand, there is an occurence of congestion of blood in the blood vessels which results due to back pressure of blood. In such severe cases, back pressure may extend in the lungs to the right ventricle. Therefore, patient has both a diastolic murmur and crackles in the lungs.
2. Fainting or dizziness results due to reduction of blood supplies to the ventricles and thereby the blood that reaches the body through ventricle is further reduced. This may lead to chest pain and further cardiac arrest.
3. The preventive measures due to bacterial endocarditis may be:
Use of clean, sterilized needles while injecting street drugs.
A proper oral and dental hygiene has to be maintained. Sometimes gum diseases enhances the bacteria to get into the bloodstream and may cause infective endocarditis.