Adult health INFECTIOUS INFLAMMATORY DISORDERS OF THE HEART BLOOD VESSELS

MED/SURG Adult health CARING
FOR CLIENTS WITH INFECTIOUS & INFLAMMATORY DISORDERS OF THE HEART & BLOOD
VESSELS

RHEUMATIC FEVER & RHEUMATIC CARDITIS

Rheumatic Fever - Systemic inflammatory disease
due to group A strep infection of the throat

Rheumatic Carditis- inflammatory cardiac
manifestations; acute or later stages: affects heart valves, esp mitral
valve, endocardium, myocardium & pericardium – fig 29-1

S/S: most common in children 2-3 wks after a
strep infection; carditis, inflammation in the layers of the heart,
polyarthritis, rash, SQ nodules, chorea which is involuntary grimacing;
adults have more vague symptoms

RHEUMATIC FEVER & RHEUMATIC CARDITIS

Treatment – IV antx, PCN drug of choice, bedrest, aspirin,
steroids

Nursing care – administer meds, focused cardiac assessments;
education re: need for prophalactic antx before invasive procedures

INFECTIVE ENDOCARDITIS

Inflammation of the inner layer of the heart tissue

Caused by a bacteria or fungi, box 29-2

Persons with hx of rheumatic fever are most at risk

Nursing care: client teaching, med adm, lifelong susceptibility

MYOCARDITIS

Inflammation of the middle (muscle) layer of the
heart

Caused by viral, bacterial, fungal or parasitic
infection. Mostly viral cause in the US.

S/S: General chest discomfort, relieved by
sitting up, low-grade temp, tachycardia, arrhythmias

CARDIOMYOPATHY

Chronic condition

Structural changes in heart muscle

Table 29-1 – types

Med/surgical mgmt: drug therapy; pacemakers; surgical
intervention

PERICARDITIS

Inflammation of the pericardium – the saclike structure that
surrounds the heart

Can be primary or secondary due to endocarditis, myocarditis,
chest trauma, MI or cardiac surgery

Can have effusion or accumulation of fluid within the 2 layers
of tissue, fig 29-5

PERICARDITIS

If effusion occurs can lead to cardiac tamponade – acute
compression of the heart leading to impaired filling, fig 29-6

Pulsus paradoxus, nsy guidelines 29-1

S/S – fever, malaise, dyspnea, precordial pain, which is pain
in the anterior chest over the heart, this pain may mimic an MI

Treatment – r/o MI, rest, analgesics, antipyretics, NSAIDS,
steroids

THROMBOPHLEBITIS

See nursing process

Inflammation of a vein with clot formation; most common in the
veins deep in the lower extremities, DVT

Caused by venous stasis, altered blood coagulation, trauma to
the vein

THROMBOPHLEBITIS

Dx – clinical findings, venous doppler, venography

Treatment – bedrest, anticoagulants, warm, wet packs, if large
vein affected may have thrombectomy

Nursing care – prevention, exercises for at risk pts

See nursing process

THROMBOANGIITIS OBLITERANS (Buerger’s dz)

Intermittent spasms of arteries associated with formation of
inflammatory lesions which cause restricted blood flow to the extremities,
usually the legs; cause unknown

More common in young men, aggravated by smoking

S/S – intermittent claudication (cramps in the legs after
exercise), one or both feet cold with burning, numbness, tingling of the
feet, ulcers may development

THROMBOANGIITIS OBLITERANS (Buerger’s dz)

Treatment – restrict tobacco use, Buerger Allen exercises, nsy
guidelines 29-2

Sympathectomy, interrruption of the sympathetic nerve pathway
to relieve vasoconstriction may be performed

Nursing

teaching; tobacco restriction; exercises

pain control

GENERAL NUTRITIONAL CONSIDERATIONS

Anorexia & wt loss are common side effects of infections;
increase calories & protein prn. Encourage small, frequent feedings

Encourage weight loss in clients with thrombophlebitis

General Pharmacological Considerations

Most clients with PVD have pain, which may be
treated with non-narcotic analgesics.

Trental may be used to improve intermittent
claudication

Coumadin may be prescribed for those with venous
thrombosis. Monitoring of PT is very important.

Vitamin K is given as an antidote for Coumadin
OD.

Heparin may be given for clients with
thrombophlebitis

Clients receiving anticoagulant therapy must be
closely monitored for signs of bleeding tendency

General Gerontologic Considerations

Discourage older adults from using electric heating devices due
to their decreased temperature perception

Many older have peripheral vascular insufficiency manifested by
weak or absent pedal pulses; cold, clammy feet; thickened toenails, shiny
skin on the lower extremeties