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

2. 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

3. 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.

4. 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.

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Rheumatic Fever and Rheumatic Carditis

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Myocarditis Inflammation of the myocardium (muscle layer of the heart) Cause: Microbial infection; EtOH, 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

8. 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

9. 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.

10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. Cardiomyopathy is a chronic cardiac structural condition.

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

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

13. 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

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

15. 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

16. 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

17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Buerger’s disease can result in amputation of the lower extremities.

18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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.

19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation