TimbySmith Introductory MedicalSurgical Nursing 10e Chapter 23 Caring

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 23: Caring for Clients with Infectious and Inflammatory Disorders of the Heart and Blood Vessels Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Rheumatic Fever and Rheumatic Carditis • Systemic inflammatory disease that can follow Strep A throat infection, which can manifest in cardiac structures • Cause: Antibodies cross-react against host cardiac tissue resulting in valvular damage, pancarditis • Diagnostics: O titer; ESR; C-reactive protein; ECG; echocardiograph • Signs/Symptoms: Acute rheumatic fever; Carditis; Polyarthritis; Rash, subcutaneous nodules; Chorea; Inability to use skeletal muscles • Treatment: Drugs: IV antibiotics, ATB therapy, aspirin, steroids; Surgery; Bed rest • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? Rheumatic carditis is the name of the infection which manifests in cardiac structures. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer True. Rheumatic carditis is the name of the infection which manifests in cardiac structures after a client has a rheumatic fever. Rheumatic fever is a systemic inflammation. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Rheumatic Fever and Rheumatic Carditis Copyright © 2010 Wolters Kluwer Health | Lippincott Williams

Infective Endocarditis • Inflammation of the endocardium (inner layer of cardiac tissue) • Cause: Bacteria, fungi • Diagnostics: Blood culture; transesophageal echocardiography; ECG • Signs/Symptoms: Fever; Chills; Muscle aches; Joint pain; Osler’s nodes; Splinter hemorrhages; Janeway’s lesions; Roth’s spots; Enlarged spleen; Petechiae • Treatment: IV antibiotic; Antibiotic therapy; Bed rest; Surgery: Valve replacement • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Myocarditis • Inflammation of the myocardium (muscle layer of the heart) • Cause: Microbial infection; Et. OH, cocaine abuse; Radiation therapy; Autoimmune disorders • Diagnostics: WBC count; C-reactive protein test; Cardiac isoenzyme levels; ECG; Echocardiography; Radionuclide studies; Myocardial biopsy • Signs/Symptoms: Chest pain; Low-grade fever; Tachycardia; Dysrhythmias; Dyspnea, etc. • Treatment: ATB; Cardiotonic meds; Heart transplant (severe case) • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Cardiomyopathy • Cause: Chronic condition of structural changes in cardiac muscle resulting in the inability of the heart muscle to pump blood efficiently • Diagnostics: Chest radiography; Echocardiogram; ECG; Cardiac catheterization; Endomyocardial biopsy; Radionuclide studies • Signs/Symptoms: Heart murmur; Forceful heart contractions − Dilated: Dyspnea, fatigue, swollen legs, palpitations, chest pain − Hypertrophic: Chest pain, syncope, fatigue, short of breath, acute illness after strenuous exercise Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? Cardiomyopathy is a chronic cardiac structural condition resulting in the heart pumping inefficiently. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer True. Cardiomyopathy is a chronic cardiac structural condition. Copyright © 2010 Wolters Kluwer

Cardiomyopathy • Signs/Symptoms (Cont’d) − Restrictive: Exertional dyspnea, edema in legs, ascites, hepatomegaly • Treatment: – Medications: Diuretics; Antidysrhythmics; Cardiac glycosides; Anticoagulants; Antiinflammatories – Surgery: Ventriculomyomectomy; Artificial pacemaker; Heart transplant • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Cardiomyopathy Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pericarditis • Inflammation of the pericardium usually secondary to cardiac disorders, surgery resulting in cardiac tamponade; Pulsus paradoxus • Diagnostics: ECG; Chest radiography; Blood tests; Echocardiography • Signs/Symptoms: Fever; Malaise; Dyspnea; Precordial pain • Treatment: Rest; Analgesics; Antipyretics; NSAIDs; Corticosteroids; Pericardiocentesis; Pericardiostomy; Pericardiectomy • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pericarditis Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Thrombophlebitis • Inflammation of vein resulting in clot formation (DVT – lower extremities), pulmonary embolus (Clot migrating toward pulmonary circulation); Postphlebitic syndrome; Virchow’s triad • Diagnostics: Venography; Doppler ultrasound; Impedance plethysmography • Signs/Symptoms: Affected extremity discomfort; + Homans’ sign; Heat; Redness; Edema; Fever; Malaise; Anorexia • Treatment: Complete rest of extremity; continuous warm, wet packs; Anticoagulant therapy; Oral anticoagulants; Surgery; Filter placement • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Thromboangiitis Obliterans (Buerger’s Disease) • Lower extremity arterial lumen spasms: Restrict blood flow causing vascular occlusions resulting in hypoxia, anoxia, ulcerations, gangrene • Diagnostics: Doppler ultrasound; IPG; Angiography • Signs/Symptoms: Cold, numb, burning, tingling feet; Cyanosis; Redness of feet and legs; Mottled skin; Leg ulcers; Black, gangrenous toes and heels; Thick nails; Peripheral pulses disappear with activity; Intermittent claudication • Treatment: Tobacco restriction; Buerger-Allen exercises; Analgesics; (Leg ulcers): Moist dressings; Topical antiseptics; Antibiotic ointments; (Surgery): Sympathectomy; Wound debridement; Amputation • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? Buerger’s disease can result in amputation

Answer True. Buerger’s disease can result in amputation of the lower extremities. Surgeons only amputate as necessary and then only as much as needs removed to keep the client safe. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins