evaluate arterial blood gaslevels as needed to ensure adequate oxygenation
client and family teaching
physical activity may be slowly increased to sitting in chair, walking in room, then outdoors.
avoid pregnancy, alcohol, and competitive sports.
immunize against infections.
teach client about anti-infective drugs. Stress importance of taking drugs as ordered.
teach clients taking digitalis at home to:
check pulse for one full minute before taking the dose, and withhold the drug if heart rate falls below 60 beats/minute.
observe for findings of digitalis toxicity (anorexia, nausea, vomiting, blurred vision, cardiac arrhythmias) and for factors that may increase toxicity, such as electrolyte imbalance and hypoxia.
teach client to report rapidly beating heart.
Endocarditis
Definition and related terms
an infection of the endocardium, heart valves, or cardiac prosthesis resulting from bacterial or fungal invasion.
endocarditis can be classified as
native valve endocarditis
endocarditis in I.V. drug users
prosthetic valve endocarditis
Epidemiology
with proper treatment about 70% of clients recover.
the prognosis is worse when endocarditis damages valves severely or involves a prosthetic valve.
infective endocarditis occurs in 50 to 60% of clients with previous valvular disorders.
in 12% to 35% of clients with subacute endocarditis, lesions produce clots that show the findings of splenic, renal, cerebral or pulmonary infarction, or peripheral vascular occlusion.
observe for findings of infiltration or inflammation at venipuncture site; rotate sites often.
client and family teaching
explain all procedures in a simple and culturally sensitive manner.
involve the client and family in scheduling the daily routine activities. Allow client and family to participate in care.
teach client relaxation techniques (meditation, visualization, or guided imagery) to cope with stress, pain, or insomnia.
explain endocarditis and the need for long-term therapy.
explain the need for prophylactic antibiotics before dental work and other invasive procedures.
teach client to report fever, tachycardia, dyspneaand shortness of breath.
Diagnostic studies
health history
lab data
CBC
blood cultures
ESR
CXR - to detect CHF
EKG - transesophageal echocardiogram to detect vegetation and abscess on valves
Rheumatic heart disease (rheumatic endocarditis)
Definition and related terms
rheumatic heart disease is damage to the heart by one or more episodes of rheumatic fever. Pathogen is a group A streptococci.
rheumatic endocarditis is damage to the heart, particularly the valves, resulting in valve leakage (regurgitation) and/or stenosis. To compensate, the heart's chambers enlarge and walls thicken.
Epidemiology
worldwide, 15 to 20 million new cases of rheumatic fever are reported each year.
rheumatic fever follows a group A streptococcal infection. We could prevent it by finding and treating streptococcal pharyngitis.
where malnutrition and crowded living are common, rheumatic fever is commonest in children between ages 5 and 15.
rheumatic fever strikes most often during cool, damp weather. In the U.S., it is most common in the northern states.
it is unknown how and why group A streptococcal infections cause the lesions called Aschoff bodies.
damage depends on site of infection: most often the mitral valve in females and the aortic valve in males.
malfunction of these valves leads to severe pericarditis, and sometimes pericardial effusionand fatal heart failure. Of those who survive this complication, about 20% die within ten years.
