A client diagnosed with mitral stenosis asks the nurse what is wrong with her heart. How can the nurse best explain this health problem?

a. “The left side of your heart is having trouble overcoming the resistance in the blood vessels of your body.”

• This explanation is not specific to mitral stenosis. It describes systemic vascular resistance, which is a broader concept related to hypertension and vascular health. Mitral stenosis specifically involves narrowing of the mitral valve, which affects blood flow between the left atrium and left ventricle.

b. “When your heart beats, some of the blood that should leave the left ventricle is backing up through a leaking valve.”

• This explanation is more accurate for mitral regurgitation rather than mitral stenosis. Mitral regurgitation involves the leaking of blood backward through the mitral valve into the left atrium during ventricular systole. Mitral stenosis, on the other hand, involves narrowing or constriction of the mitral valve, which impedes the flow of blood from the left atrium to the left ventricle during diastole.

c. “The valve between your heart and lungs has become inelastic.”

• This explanation is not entirely accurate. While mitral stenosis does involve changes in the mitral valve structure, such as thickening and calcification, the term "inelastic" does not fully describe the pathology of mitral stenosis. Mitral stenosis is characterized by the narrowing (stenosis) of the mitral valve orifice, which restricts blood flow from the left atrium to the left ventricle.

d. “The mitral valve has become stiff and narrowed which slows the blood between the two chambers.”

• This explanation is the most accurate description of mitral stenosis. It correctly identifies the problem as the narrowing and stiffening (stenosis) of the mitral valve, which impedes the flow of blood from the left atrium to the left ventricle during diastole. This explanation helps the client understand how the condition affects the function of the mitral valve and the flow of blood within the heart.

In this scenario, the client is exhibiting signs of severe respiratory distress, which could indicate worsening acute heart failure and potential respiratory failure.

a. Check MAR for antianxiety medication: While anxiety may exacerbate the client's symptoms, the priority at this moment is to address the acute respiratory distress and ensure adequate oxygenation. Checking the medication administration record (MAR) for antianxiety medication can be done later but is not the immediate priority.

b. Ask when the dyspnea started: While obtaining a thorough history is important for understanding the onset and progression of the client's symptoms, it is not the first action to take in this critical situation. The client's current condition requires immediate intervention to ensure adequate oxygenation and stabilization.

c. Notify the provider: Notifying the provider is important, especially in a situation where the client's condition is deteriorating rapidly. However, this action may take some time, and the priority is to address the client's immediate needs first.

d. Increase oxygen from 3L/minute to 5L/minute: This is the most appropriate action to take first. The client is showing signs of severe respiratory distress with cyanosis and increased work of breathing. Increasing the oxygen flow rate from 3L/minute to 5L/minute can help improve oxygenation and alleviate hypoxemia, which is crucial in the management of acute heart failure exacerbation.