L.S. is a 59-year-old female who goes to see her primary care physician because of increasing fatigue and shortness of breath with activity. She has a history of hypertension, hypothyroidism, rheumatoid arthritis, and rheumatic fever as a child. She is taking the following medications:
Triamterene/hydrochlorothiazide (Dyazide) 37.5/25 mg PO daily
Levothyroxine (Synthroid) 150 mcg PO daily
Methotrexate (Rheumatrex) 15 mg PO every Sunday
Subjective Data
Does not exercise, but was always able to do daily activities such as go up and down the stairs of her home and go grocery shopping
The last few weeks has noticed that she gets short of breath with her normal daily activities
Has been waking up at night short of breath
Denies any pain in her chest
Does not have any pain in her joints as long as she takes her arthritis medicine
Objective Data
Physical Examination
Temperature 98.5° F, pulse 88 and irregular, respirations 24, blood pressure 134/82, O2 saturation 92%
Irregular heart rate with a grade III diastolic murmur
Crackles in bilateral bases of lungs
No peripheral edema noted
Diagnostic Studies
ECG shows atrial fibrillation with heart rate of 90
Echocardiogram reveals mitral valve stenosis with mild left-sided heart failure
Laboratory Studies:
Hemoglobin 12 g/dL
Hematocrit 37%
T4 (total) 5.1 mcg/dL
Discussion Questions
1. What is mitral stenosis? What could be the possible cause of L.S.s mitral stenosis?
2. What clinical manifestations of mitral valve stenosis does L.S. have?
3. How did the mitral valve stenosis contribute to the development of left-sided heart failure?
4. What clinical manifestations of left-sided heart failure does L.S. have?
5. What are the treatment options for L.S.?
6. What would be some pertinent nursing diagnoses and goals for L.S.?
7. What are the priority nursing interventions for these nursing diagnoses?