Sunday, March 15, 2009

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



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