A small compilation of nurse anesthesia care plans

These anesthesia care plans are meant to inspire nurse anesthesia residents when they are making their care plans. Always make sure you fully understand and "own" your care plan. Your plan must be specific for your patient and should always be with the most up-to-date information.

Mitral Regurgitation

Problem

During systole - backflow to LA

  • Increased LVEDV, LVEDP, and decreased LVESV

What to Optimize

LV Preload

Maintain

HR

SR 80-90, avoid bradycardia

Contractility

Maintain constant

SVR

Avoid increases, decrease to decrease MR, facilitate forward flow

PVR

Avoid increases

Etiology

Acute MR

  • Rupture Chordae Tendineae
  • Papillary Muscle dysfunction - MI/Ischemia

Chronic MR

  • Rheumatic heart disease
  • Mitral valve prolapse (20-70%)
  • Chronic ischemic heart disease with cardiomyopathy and remodeling
  • Endocarditis
  • Annular dilation due to LV dilation
  • Myxoma (syncope episodes)
  • Congenital

Symptoms

Dyspnea, PND, orthopnea

Fatigue

Pulmonary HTN, RV failure

Hemoptysis

Systemic embolization in A-fib

Acute MR

Sudden volume overload of LA with pulmonary edema

Compensatory: Increase contractility, tachycardia, increase MVO2= LV failure, RVF

Chronic MR

Mild - asymptomatic with comp. changes

Moderate – symptomatic

Severe - terminal

Preoperative Considerations

  • Fatigue and malaise (decreased CO)
  • Holosystolic murmur, S3 gallop
  • A-fib
  • EKG - Left atrial enlargement in chronic
  • ECHO - etiology and severity, use of color Doppler flow
  • PAP
  • V wave
  • Overestimate LVEDP
  • PAEDP best estimate for LVEDP
  • Increase risk of PA perforation with pulmonary HTN

Surgical Technique

MV Replacement

Bioprosthetic valve

  • No anticoagulation
  • Life expectancy less

Mechanical Valve

  • Life expectancy unlimited
  • Anticoagulation

MV Repair

Valvuloplasty

No anticoagulation

Preserve LVEF

Surgical Technique

Median sternotomy with bicaval cannulation

CPB 28-32 C