Tricuspid valve stenosis

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tricuspid valve stenosis

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Tricuspid valve stenosis

  1. 1. TRICUSPID VALVE STENOSIS AND INSUFFICIENCY
  2. 2. INTRODUCTION TRICUSPID VALVE Known as RIGHT ATRIOVENTRICULAR VALVE Consists of the three flaps or cups Situated between the right atrium and right ventricle. Acts as valve to prevent backflow of the blood.
  3. 3. DEFINITION Narrowing or stiffening of theopening in the valve stenosis. TRICUSPID VALVE STENOSIS
  4. 4. TRICUSPIDVALVE STENOSIS
  5. 5. DEFINITIONThe valve does not close tightly TRICUSPIDenough to prevent REGURGITATION leakage TRICUSPID VALVE TRICUSPID VALVE INSUSFFICIENCY INCOMPETENCE
  6. 6. TRICUSPID INSUFFICIENCY
  7. 7. RHEUMATIC FEVER INFECTION CAUSES ACCOMPANIED BY VALVULAR DISEASES CONGESTION HEART FAILURE CONGENITALHEART DISEASES TUMOUR
  8. 8. RISK FACTOR• Rheumatic fever• Infection ( endocarditis)• Congenital malformation• Tumor (rare)• Diet medication called “Fen-Phen (phentermine and fenfluramine) or dexfenfluramine
  9. 9. PATHOPHYSIOLOGY BLOOD FLOW TO THE RIGHT ATRIUM TRICUSPID VALVE RIGHT VENTRICLES
  10. 10. PATHOPHYSIOLOGY BACKFLOW TO THE RIGHT ATRIUM HIGHER PRESSURE RIGHT ATRIUM, ENLARGEMENT, AND HYPERTROPHYHEPATOMEGALY SYSTEMIC VENOUS RETURN CONGESTION ASCITES
  11. 11. CLINICAL MANIFESTATION Asymptomatic Fatigue Palpitation Increased jugular vein distension Peripheral edema Dyspnea HypotensionDiastolic – mumbling murmur Pain at upper right abdomen
  12. 12. INVESTIGATIONLABORATORY TEST RADIOLOGY INVESTIGATION
  13. 13. INVESTIGATION LABORATORY TEST RESULT Polycythemia resultFULL BLOOD COUNT (FBC) Leukocytosis indicate ineffective endocarditis Mild elevation ofLIVER FUNCTION TEST (LFT) aminotransferases may present secondary to chronic hepatic venous congestion. BLOOD CULTURES Positive infective endocarditis.
  14. 14. INVESTIGATION• Physical examination• Pulse ▫ Abnormal pulse elevated in the jugular vein of the neck.• Auscultation with a stethoscope. ▫ The result is abnormal heart sounds and heart murmur.
  15. 15. INVESTIGATION
  16. 16. INVESTIGATIONTransesophageal CT - Scanechocardiogram Chest X-ray Ultrasound 12 lead ECG MRI Stress test cardiac Echocardiogram catheterization
  17. 17. CHEST X-RAY RIGHT ATRIUM ENLARGEMENT
  18. 18. 12 LEAD ECG
  19. 19. ECHOCARDIOGRAM
  20. 20. CARDIACCATHETERIZATION
  21. 21. ULTRASOUND
  22. 22. CT SCAN
  23. 23. MRI SCAN
  24. 24. TRANSESOPHAGEALECHOCARDIOGRAM
  25. 25. STRESS TEST
  26. 26. TREATMENT SURGICAL TREATMENT MEDICALTREATMENT
  27. 27. MEDICAL TREATMENT• Mild- no symptoms no require treatment.• Medication as prescribed to relief the symptoms only .• Types of medication prescribed depends on the condition of patient.  Antibiotics  Diuretics  Anticoagulants  Antiplatelets  Vasodilators  Cardiac glycosides
  28. 28. MEDICATIONGROUP EXAMPLE ACTIONANTIBIOTICS PENICILLIN G Inhibit cell wall POTASSIUM synthesis in (PFIZERPEN) susceptible organism cell death.ANTICOAGULANTS WARFARIN SODIUM Prevent thrombosis (COUDIUM) and prolong clotting timeCARDIAC GLYCOSIDES DIGOXIN Increasing cardiac (LANOXIN) output by slowing heart rate and increase the force contraction.
  29. 29. MEDICATIONGROUP EXAMPLE ACTIONANTIPLATELETS TICLOPIDINE Reduces the clot HYDROCHLORIDE production by (TICLID) interfering with platelets aggregation.VASODILATORS GTN To vasodilators the ISORDIL blood vessels.DIURETICS FRUSEMIDE To reduce the (LASIX) edema.
  30. 30. SURGICAL TREATMENT Annuloplasty ValvuloplastyReplacement heart valve Commissurotomy
  31. 31. ANNULOPLASTY• Procedure to reduce the an enlarged annulus (fibrous ring) surrounding the valve.• Prosthetic ring sutured into the circumference of tricuspid annulus and the stitches are pulled towards to prosthesis .
  32. 32. ANNULOPLASTY
  33. 33. VALVULOPLASTY• Involves direct repair to torn leaflets by open surgery.
  34. 34. COMMISSUROTOMY• Incision of stenos valve leaflets at their borders. OPEN Performed median COMMISSUROTOMY sternotomy CLOSED Insert finger through a small COMMISSUROTOMY incision
  35. 35. OPEN CLOSEDCOMMISSUROTOMY COMMISSUROTOMY
  36. 36. REPLACEMENT HEART VALVE• Replacement valve can replace to overcome the congenital or obstructive of valvular disorders.• Types of replacement valve • Natural valve • Modified natural valves (animal donors) • Artificial or mechanical valve
  37. 37. MODIFIED NATURAL VALVEPIG TISSUE VALVE PORCINE VALVE COW VALVE
  38. 38. MECHANICAL VALVE
  39. 39. COMPLICATION OF TRICUSPID VALVE STENOSIS AND INSUFFICIENCY
  40. 40. COMPLICATION CHRONIC HEART FAILURE ENDOCARDITIS LIVER CIRHOSIS
  41. 41. COMPLICATIONHEPATOMEGALY ASCITES
  42. 42. HEALTHTEACHING
  43. 43. HEALTH TEACHING
  44. 44. NCP 1 NURSING DIAGNOSIS : DECREASED OF CARDIAC OUTPUT RELATED TO THE TRICUSPID VALVE STENOSIS AND INSUFFICIENCY. EXPECTED OUTCOME: CARDIAC OUTPUT WILL ELEVATED AND MAINTAIN.
  45. 45. NURSING INTERVENTIONNURSING INTERVENTION RATIONALEMonitor vital signs , hemodynamic To report any changes /abnormalityparameters, cardiac rhythm. reading.Monitor intake and output chart. To detect loss of function of the renal perfusion or renal failure.Weight daily. To evaluate the elevation of weight due to fluid retention.Restrict the fluid as ordered. To reduce cardiac workload.Monitor oxygen saturation and ABG To allow the assessment of oxygenation.results.Administer oxygen as ordered. To improve alveolar ventilation and oxygenation.Encourage rest on the bed. To decrease cardiac workload.Administer medication as prescribed. To reduce fluid volume and cardiac workElevate the head of the bed. To promote breathing mechanism.
  46. 46. NCP 1 EVALUATION CARDIAC OUTPUT INCREASING , THE HEART RATE, BLOOD PREESSURE AND URINE OUTPUT WITHIN THE NORMAL RANGE.
  47. 47. NCP 2 NURSING DIAGNOSIS: ACTIVITIY INTOLERANCE RELATED TO THE TRICUSPID VALVE STENOSIS AND INSUFFICIENCY EXPECTED OUTCOME : CLIENT WILL TOLERATE ACTIVITY WITHOUT DYSPNEA OR TACHYCARDIA
  48. 48. NURSING INTERVENTIONNURSING INTERVENTION RATIONALEMonitor vital signs before and during To report any abnormalities reading.activity.Encourage self-care and gradually To improve client self-esteem andincreasing activities as a lower and sense of power.tolerated.Provide assistance as needed. To reducing the energy expenditure to help maintain a balance oxygen balance.Consult with cardiac rehabilitation , To improve the strength and promotephysical therapy for in-bed exercise good circulation.and activity plan.Discuss ways to conserve the energy. To maintain oxygen level in the body.
  49. 49. NCP 2 EVALUATION CLIENT MANAGE SELF-CARE AND MODERATE ACTIVITY WITHOUT BECOMING DYSPNEA AND MAINTAIN HEART RATE.
  50. 50. NCP 3 NURSING DIAGNOSIS: RISK FOR INFECTION RELATED TO THE TRICUSPID VALVE STENOSIS AND INSUFFICIENCY EXPECTED OUTCOME : CLIENT WILL FREE OF INFECTION
  51. 51. NURSING INTERVENTIONNURSING INTERVENTION RATIONALEUse aseptic technique for all invasive To prevents infection.procedures.Assess the wound and catheter sites To reduce the risk of infection.for redness, swelling, warmth, pain .Administer antibiotics as ordered. To treat and prevent the infection.Monitor WBC and TWDC results. To notify the leukocytosis and leucopenia. EVALUATION: CLIENT FREE FROM NOSOCOMIAL INFECTION
  52. 52. NCP 4 NURSING DIAGNOSIS: DEFICIT KNOWLEDGE OF SELF-CARE RELATED TO THE TRICUSPID VALVE SYENOSIS AND INSUFFICIENCY EXPECTED OUTCOME : CLIENT WILL ACCURATEKY DESCRIBE DISCHARGE INSTRUCTION
  53. 53. NURSING INTERVENTIONNURSING INTERVENTION RATIONALECompletely explain all treatment. To improve the understanding disease process.Consult the physician about To prevent infection.prophylactic antibiotics therapybefore or invasive treatment.Avoid vigorously activities and To reduces cardiac workload.competitive sports.Avoid caffeine and over-the –counter To reduce the high risk of congestionmedications cardiac failure. EVALUATION: CLIENT MORE UNDERSTANDING AND KNOWLEGEABLE.
  54. 54. CONCLUSION• Tricuspid valve stenosis and insufficiency are the heart valvular disease.• Both of them caused by the rheumatic heart diseases.• It can be corrected by the repairment of the valve and replacement of the valve for good circulation of blood in the body and improve breathing process.
  55. 55. REFERENCES• http://www.nlm.nih.gov/medlineplus/en cy/article/000169.htm• http://emedicine.medscape.com/article /158484-followup#showall• http://heart_emedtv.com/tricuspid- stenosis/tricuspid-stenosis.html• http://www.tricuspidvalvestenosis.com/• http://www.mayoclinic.org/tricuspid- valve-disease/
  56. 56. REFERENCES• Luckmann and sorenser’s Medical surgical nursing ( A Psychophysiology approach) fourth edition, JOYCE M.BLACK & ESTHER MATASSARIN (1234&1235)• PEARSON INTERNATIONAL EDITION (2008),Medical- surgical nursing critical thinking in client care.(Fourth edition),PRISCILLA LEMONE AND KAREN BURKE,(2008)• Lippincott Williams and Wilkins, Introduction medical surgical nursing (ninth edition), BARBARA R.TIMBY & NANCY E.SMITH.

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