MEDSURG CHAPTER 29

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MED/SURG CHAPTER 29

• CARING FOR CLIENTS WITH INFECTIOUS INFLAMMATORY
  DISORDERS OF THE HEART BLOOD VESSELS

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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

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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
• Box 29-1

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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

• Acute onset less than 1 week from previously
  healthy
• Insidious onset slight fever, h/a, malaise,
  fatigue. Later may have purplish, painful
  nodules pads of fingers toes (Oslers nodes),
  black longitudinal lines on the fingernails
  (Splinter hemorrhages), pethechiae
• Treatment high doses of antx, drg therapy table
  29-1, valve replacement

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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

• Treat the underlying cause, if bacterial give IV
  antibiotics prevent complications
• Monitoring CP status, daily wts, vs, I O,
  bedrest

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CARDIOMYOPATHY

• Chronic condition
• Structural changes in heart muscle
• Table 29-1 types
• Med/surgical mgmt drug therapy pacemakers
  surgical intervention

• Nursing mgmt
• Hx
• focused physical exam
• O2 therapy
• medication teaching

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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

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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
• See nursing process

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THROMBOPHLEBITIS

• 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

• Risks inactivity, reduced cardiac output,
  compression of the veins in pelvis or legs,
  injury, birth control pill use, irritating IV
  drugs
• S/S pain in the affected extremity Homans
  sign, heat, redness, edema to vein

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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

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THROMBOANGIITIS OBLITERANS (Buergers 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

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THROMBOANGIITIS OBLITERANS (Buergers 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

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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

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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

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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