1. Management of Clients with Cardio-vascular Disorders
Infectious Diseases of the Heart
Hilal Alrahbi-MSN, RN
School of Nursing-UON
Hilal Alrahbi-Adult Nurs I

2. Hilal Alrahbi-Adult Nurs I
Heart Layers
Hilal Alrahbi-Adult Nurs I

3. Infectious Diseases of the Heart
Rheumatic Endocarditis
Infective Endocarditis
Myocarditis
Pericarditis
Hilal Alrahbi-Adult Nurs I

4. Rheumatic Endocarditis
Inflammation of the endocarium occurs as a result of Rheumatic Fever
Etiology of Rheumatic Fever:
Causes by group A beta-hymolytic streptococcal bacteria
Starts as infection in the upper respiratory tract (pharyngitis)
Occurs most often in school-aged children
Preventable if diagnosed and treated early with antibiotics
Other complications: (Rheumatic Hear Disease)
Heart mummer
Pericarditis
Mitral stenosis
Mitral regurgitation
Cardiomegaly
Hilal Alrahbi-Adult Nurs I

5. Cont. Rheumatic Endocarditis
Clinical Manifestations:
Present as Rheumatic Fever and Rheumatic Heart Disease:
Signs and symptoms of Reumatic Fever:
Sore throat (sudden onset)
Fever ( c)
Chills
Redness of throat with exudates on oropharynx
Enlarged and tender of lymph nodes
Abdominal pain
Acute sinusitis and otitis media
Signs and symptoms of RHD: (see “other complications” on previous slide)
Hilal Alrahbi-Adult Nurs I

6. Cont. Rheumatic Endocarditis
Assessment and diagnostic findings:
Diagnostic studies are not specific, symptoms may take years to develop (e.g. mitral stenosis, or regurgitation)
History of sore throat within 5 weeks
Assess S&S
Throat culture (group A beta-hemolytic streptococci)
Blood for erythrocyte sedimentation rate (ESR)
ECG (tachycardia, bradycardia, dysrhythias)
Hilal Alrahbi-Adult Nurs I

7. Cont. Rheumatic Endocarditis
Medical management:
Prevention:
Early detection of oropharyneal streptococcal infections
Early and adequate treatment of oropharyneal streptococcal infections
Medications:
Antibiotic penicillin is prescribed when suspected group A streptococcal infections
When diagnosis of R.Fever confirmed, prophylactic penicillin intramuscular injections will be given every 3-4 wks for 5 years or until 21 years old
Pain killers (valium) + Treat complications + prophylactic antibiotics for invasive procedures
Hilal Alrahbi-Adult Nurs I

8. Cont. Rheumatic Endocarditis
Nursing management:
Health education about the disease
Signs and symptoms
Complications
Follow scheduled long-term prophylactic antibiotics
Monitor pt. for signs and symptoms, complications
Hilal Alrahbi-Adult Nurs I

9. Infective Endocarditis
Infection of the endothelial surface of the heart
Common in older people
Aging process
Reduced immunity
Common in people with valular diseases
Causes by:
Streptococci, staphylococci, entrococci, pneumococci
Complications:
Valves destructions
Dysrhythmias ()
Thrombi formation and embolism
Hilal Alrahbi-Adult Nurs I

10. Cont. Infective Endocarditis
Clinical manifestations:
Fever
Heart murmur
Small painful nodules in fingers and toes
Hemorrhages (Bleeding) eye fundus, fingernails, toenails
tachycaria
Splenomegaly
Cardiomegaly
Hilal Alrahbi-Adult Nurs I

11. Cont. Infective Endocarditis
Diagnostic findings:
Assess signs and symptoms
Blood culture
Two separate sample in one hour apart
Negative result does not rule out infective endocaridit
Elevated white blood cells (WBC)
Elevated erythrocytes sedimentation rate (ESR)
Rheumatoid factor may be positive
Echocardiography
Hilal Alrahbi-Adult Nurs I

12. Cont. Infective Endocarditis
Medical management:
Prevention:
Prophylactic antibiotics for high risk patients (valvular diseases) when going for the following procedures:
Dental procedures
Tonsillectomy
Bronchoscopy
Endoscopy
Gall bladder surgery
Good dental and oral hygiene
Follow universal precautions when dealing with such pt. s
Hilal Alrahbi-Adult Nurs I

13. Cont. Medical management
Medications:
Antibiotics IV (penicillin) for 2-6 weeks
Surgical:
Excision of any abscess
Closure of any fistula
Replacement of valves
Hilal Alrahbi-Adult Nurs I

14. Hilal Alrahbi-Adult Nurs I
Nursing Management
Monitor of V/S and heart sounds (murmurs)
Monitor the pt. for signs of hear failure, pulmonary edema, systemic embolizations
Administer medications accordingly
Teach pt. and family about prophylactic antibiotics
Involve family in the car of pt.
Hilal Alrahbi-Adult Nurs I

15. Hilal Alrahbi-Adult Nurs I
Pericarditis
Inflammation of the pericardium
May occur after MI or pericadectomy (opening of the pericardium)
May lead to an accumulation of fluid in the pericardial sac causing pressure on the heart (cardiac temponade)
Signs and symptoms:
Chest pain (in the scapula)
Pain worsen with deep inspiration, lying down or turning
Friction rub can be heart at the lower sternum
Hilal Alrahbi-Adult Nurs I

16. Hilal Alrahbi-Adult Nurs I
Cont Pericarditis
Assessment and diagnostic findings:
Assess signs and symptoms CT
MRI
Echocardiography
ECG
Hilal Alrahbi-Adult Nurs I

17. Hilal Alrahbi-Adult Nurs I
Cont Pericarditis
Medical management:
Medication:
Analgesics and NSAIDs (aspirin, brufen) for pain and inflammation
Steroids (prednisone) for inflammation if severe
Surgical:
Pericaridal window (opening into the chest cavity)
Pericadectomy (release pressure from the ventricles )
Hilal Alrahbi-Adult Nurs I

18. Hilal Alrahbi-Adult Nurs I
Cont Pericarditis
Nursing management:
Relieve of pain
Reassurance
Minimize of activity if pain and rub friction persist
Monitor for S&S of heart failure
Monitor pt. for signs of cardiac temponade
Health education about the disease
Hilal Alrahbi-Adult Nurs I

19. Hilal Alrahbi-Adult Nurs I
Thanks
Questions ??
WE HEAT YOU MR. HILAL
Hilal Alrahbi-Adult Nurs I