N211: Health Differences Across the Lifespan I Mitral valve prolapse is one or both valve leaflets protruding into the left atrium. It has an unknown etiology. ECG shows prolapse of the mitral valve into the left atrium. 1.18 Tricuspid Insufficiency Tricuspid insufficiency results in blood flowing back into the right atrium during systole (squeeze). The blood flow to the lungs and left side of the heart is decreased. Fluid overloads in the right side of the heart. The causes include endocarditis, rheumatic fever and trauma. Diagnosis is with echocardiography which shows systolic prolapse of the tricuspid valve. ECG shows right atrial or ventricular hypertrophy. X-ray shows right atrial dilation and right ventricular enlargement. Nursing Assessment Client presents with fatigue, dyspnea, orthopnea, hemoptysis, pulmonary edema, murmurs, irregular cardiac rhythm and angina. Nursing Diagnosis • Activity intolerance related to decreased oxygen supply • Ineffective management of therapeutic response related to knowledge about disease process • Altered tissue perfusion related to decreased cardiac output Nursing Interventions are to monitor the client for atrial fibrillation with thrombus formation, teach necessary prophylactic antibiotic therapy before any invasive procedure, such as dental procedures, that is likely to produce gingival or mucosal bleeding; bronchoscopy, esophageal dilation, upper endoscopy, colonoscopy, sigmoidoscopy or colonoscopy. Prepare the client for surgical repair or replacement of the heart valves. Instruct clients receiving valve replacement of the need for lifelong anticoagulant therapy to prevent thrombus formation. 1.19 Endocarditis Endocarditis is an infection or inflammation of the endocardium, heart valves or cardiac prosthesis caused by bacterial or fungal invasion. Vegetative growths form on the heart valves, endocardial lining of the heart chamber, or endothelium of a blood vessel. Organisms travel through the blood, the valve surface or endocardium, and can break off and become emboli. Untreated endocarditis is usually fatal. Risk factors include coarctation of the aorta, Marfan’s syndrome, pulmonary stenosis, IV drug use, cardiac surgery, immunosuppression, dental procedures invasive procedures, tetralogy of fallot and ventricular septal defects.
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