Mitral Regurgitation IV: Nursing Management

Nursing management of mitral regurgitation involves reviewing the patient's history for factors like rheumatic fever, infective endocarditis, or degenerative valve changes.

During the physical examination, the nurse auscultates for a high-pitched "blowing" holosystolic murmur at the apex and assesses for heart failure signs, such as leg swelling, jugular vein distension, and pulmonary congestion.

Based on these assessments, potential nursing diagnoses include:

Decreased cardiac output related to impaired myocardial efficiency, as evidenced by fatigue and diminished peripheral pulses.

Impaired gas exchange related to pulmonary fluid overload, as evidenced by dyspnea and lung crackles.

The primary goals are to improve cardiac output, optimize gas exchange, and enhance activity tolerance.

To achieve these goals, the nurse positions patients in a semi-Fowler's position, teaches diaphragmatic breathing and effective coughing techniques, monitors fluid intake to manage overload, and educates patients on medication adherence and a low-sodium diet.

Lastly, patient responses are regularly evaluated to adjust the care plan accordingly.