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Cardiovascular 2

    1. Management
      1. antibiotics to treat underlying infection
      2. corticosteroids to decrease inflammation
      3. analgesics for pain
      4. oxygen to prevent tissue hypoxia
    2. Nursing interventions
      1. the cardio-care six with modified bedrest and less help with ADLs
      2. assess for edemaweigh daily; record intake and output
      3. assess cardiovascular status frequently
      4. observe for findings of left-sided heart failure (dyspnea, hypotensionand tachycardia)
      5. check often for changes in cardiac rhythm or conduction; auscultateheart sounds
      6. evaluate arterial blood gaslevels as needed to ensure adequate oxygenation
      7. client and family teaching
        1. physical activity may be slowly increased to sitting in chair, walking in room, then outdoors.
        2. avoid pregnancy, alcohol, and competitive sports.
        3. immunize against infections.
        4. teach client about anti-infective drugs. Stress importance of taking drugs as ordered.
        5. 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.
        6. teach client to report rapidly beating heart.
    1. Endocarditis
    2. Definition and related terms
      1. an infection of the endocardium, heart valves, or cardiac prosthesis resulting from bacterial or fungal invasion.
      2. endocarditis can be classified as
        1. native valve endocarditis
        2. endocarditis in I.V. drug users
        3. prosthetic valve endocarditis
    3. Epidemiology
      1. with proper treatment about 70% of clients recover.
      2. the prognosis is worse when endocarditis damages valves severely or involves a prosthetic valve.
      3. infective endocarditis occurs in 50 to 60% of clients with previous valvular disorders.
      4. systemic lupus erythematosus(SLE) often leads to nonbacterial endocarditis.
      5. 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.
      1. Findings of endocarditis
          1. cardiac murmurs in 85 to 90% of clients 
          2. fever
          3. especially, a murmur that changes suddenly, or a new murmur that develops in the presence of a fever
          4. pericardial friction rub
          5. anorexia
          6. malaise
          7. clubbing of fingers
          8. neurologic sequelae of embolus
          9. petechiaeof the skin (especially on the chest)
          10. splinter hemorrhageunder the nails
          11. infarction of spleen: pain in the upper left quadrant, radiating to the left shoulder, and abdominal rigidity
          12. infarction in kidney: hematuria, pyuria, flank pain, and decreased urine output
          13. infarction in brain: hemiparesis, aphasia, and other neurologic deficits
          14. infarction in lung: cough, pleuritic pain, pleural friction rub, dyspneaand hemoptysis
          15. peripheral vascular occlusionnumbness and tingling in an arm, leg, finger, or toe, or signs of impending peripheral gangrene
        1. Management - clients at risk for prosthetic valves
          1. prophylaxis - to prevent endocarditis; i.e. MVP, cardiac lesions
          2. antibiotics - to treat underlying infection
          3. antipyretics - to control fever
          4. anticoagulants - to prevent embolization
          5. oxygen - to prevent tissue hypoxia
          6. surgical - possible valve replacement
        2. Nursing interventions
          1. the cardio-care six 
          2. observe for findings of infiltration or inflammation at venipuncture site; rotate sites often.
          3. client and family teaching
            1. explain all procedures in a simple and culturally sensitive manner.
            2. involve the client and family in scheduling the daily routine activities. Allow client and family to participate in care.
            3. teach client relaxation techniques (meditation, visualization, or guided imagery) to cope with stress, pain, or insomnia.
            4. explain endocarditis and the need for long-term therapy.
            5. explain the need for prophylactic antibiotics before dental work and other invasive procedures.
            6. teach client to report fever, tachycardia, dyspneaand shortness of breath.
        3. Diagnostic studies
          1. health history
          2. lab data
            1. CBC
            2. blood cultures
            3. ESR
          3. CXR - to detect CHF
          4. EKG - transesophageal echocardiogram to detect vegetation and abscess on valves
      2. Rheumatic heart disease (rheumatic endocarditis)
        1. Definition and related terms
          1. rheumatic heart disease is damage to the heart by one or more episodes of rheumatic fever. Pathogen is a group A streptococci.
          2. 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.
        2. Epidemiology
          1. worldwide, 15 to 20 million new cases of rheumatic fever are reported each year.
          2. rheumatic fever follows a group A streptococcal infection. We could prevent it by finding and treating streptococcal pharyngitis.
          3. where malnutrition and crowded living are common, rheumatic fever is commonest in children between ages 5 and 15.
          4. rheumatic fever strikes most often during cool, damp weather. In the U.S., it is most common in the northern states.
          5. it is unknown how and why group A streptococcal infections cause the lesions called Aschoff bodies.
          6. damage depends on site of infection: most often the mitral valve in females and the aortic valve in males.
          7. 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.
        1. Findings
          1. streptococcal pharyngitis
            1. sudden sore throat
            2. throat reddened with exudate
            3. swollen, tender lymph nodes at angle of jaw
            4. headache and fever to 104 degrees Fahrenheit
          2. polyarthritis manifested by warm and swollen joints
          3. carditis
          4. chorea
          5. erythema marginatum (wavy, thin red-line rash on trunk and extremities)
          6. subcutaneous nodules
          7. fever to 104 degrees Fahrenheit
          8. heart murmurs pericardial friction ruband pericardial rub
          9. no lab test confirms rheumatic fever, but some support the diagnosis.