15.15: Aortic Regurgitation IV: Nursing Management

A nurse managing a patient with aortic regurgitation begins with a comprehensive assessment, including a review of the patient's medical history, family history, and lifestyle factors. During the cardiac examination, the nurse listens for heart sounds and checks for signs of valve abnormalities. The nurse also observes for symptoms such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea and assesses the patient's endurance and daily activity tolerance.

Based on the findings, the nurse formulates nursing diagnoses, such as ineffective tissue perfusion (peripheral) related to decreased arterial blood flow, as evidenced by cool, clammy skin, delayed capillary refill, and diminished peripheral pulses. Another diagnosis could be the risk for decreased cardiac perfusion related to altered heart structure and function, as evidenced by changes in heart sounds, chest pain, and decreased endurance.

Goals are set to optimize tissue perfusion and improve cardiac perfusion. The nurse plans interventions to address the identified diagnoses and achieve the goals.

The nurse implements several strategies, including:

• Positioning the patient in a semi-Fowler position facilitates breathing and enhances cardiac output, improving peripheral circulation.
• Leg elevation should be recommended to promote venous return and reduce peripheral edema.
• Encouraging progressive exercise within the patient’s limitations enhances blood flow and improves tissue perfusion.
• Teach the patient to monitor and report any signs of worsening peripheral perfusion, such as increased swelling or persistent cool, clammy skin.
• Instructing the patient on deep breathing exercises and effective coughing techniques to promote lung expansion and improve oxygenation.
• Encouraging a gradual increase in physical activity within the patient's tolerance to strengthen the heart muscle and improve cardiac function.
• Educating the patient on the importance of adhering to prescribed medications.
• Advising the patient on maintaining a cardiac-healthy diet, avoiding smoking, and engaging in regular, moderate physical activity to support heart health.
• Educating the patient on managing fluid intake and adhering to a low-sodium diet to reduce fluid retention and cardiac workload.

The nurse ensures routine echocardiograms to track the progression of aortic regurgitation and cardiac function. The care plan is modified or adjusted based on the patient's response to interventions.