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inflamatory heart di
| Question | Answer |
|---|---|
| Generalized Signs and symptoms | Increased pulse Epistaxis Joint involvement Anemia Nodules found on the joints and subcutaneous tissues |
| Subjective Data: | Joint pain (polyarthritis Abdominal pai Lethargy Fatigue |
| Objective Data | Skin manifestations of small erythemtous circles Erythema marginatum: Hallmark symptom is a heart murmur. Involuntary purposeless movement (Sydenham’s Chorea (d) Hallmark symptom is a heart murmur. |
| Diagnostic Tests | S/S to aid in the diagnosis Echocardiogram: determins the extent of the heart valve damage Lab values: indicate inflammation EKG: to show any cardiac dysrhythmia |
| Medical management Prevention is more effective than treatment | Rapid and prolonged treatment of group A Strep pharyngitis with PCN Carditis present: BR until the heart failure is controlled NSAID’s for joint pain, and inflammation Well balanced diet. valve replacement or surgical commissurotomy |
| What are subjective symptoms of rheumatic heart disease? | Joint pain, fatigue, lethargy, and abdominal pain |
| Nursing Interventions Rheumatic heart disease | Stress the importance of optimal nutrition Stress the importance of prophylactic antibiotic therapy Facilitate patient’s understanding of the disease proc Focus on minimizing the joint pain. Maintain bedrest for patients with carditis. |
| pericarditis | pericarditis : Inflammation of the pericardium, the membranous sac enveloping the heart. |
| pericarditis physiology | Fibrous constriction occurs gradually and causes severe compression to prevent normal filling during diastole |
| pericarditis cuases | (1) Acute or chronic, bacterial, viral and fungal infection. (2) Chest trauma (3) MI (4) Especially common after thoracic surgery. (5) Malignant Disorders: |
| pericarditis Malignant Disorders | (a) Hodgkin’s Breast Cancer (b) Lung Cancer |
| pericarditis Connective tissue disorders: | pericarditis |
| pericarditis Clinical Manifestations | Often mimics the pain of an MI. Hallmark symptom is a pericardial friction rub Cardiac Tamponade May produce partial or complete cardiac tamponade CHF: Pulsus Paradoxus the neck veins may be distended progresses, cardiac tamponade |
| Subjective Data of pericarditis: | (a) Anxiety (b) Malaise (c) Dyspnea (d) Muscle Aches (e) Excruciating Precordial pain (anterior chest overlying heart) |
| Excruciating Precordial pain (anterior chest overlying heart) | Excruciating Precordial pain (anterior chest overlying heart) 1) Acute onset begins suddenly over the sternum and radiates to the neck. 2) Pain increased by moving and deep breathing. 3) Relieved by sitting up and leaning forward. |
| pericarditis Objective Data: | (a)*(1)Pericardial friction rub. (b) Often difficult to auscultate with a stethoscope. (c) Heart sounds distant and muffled. (d) Elevated temperature. (e) Nonproductive cough. (f) VS: rapid forcible pulse, rapid shallow breathing |
| Myocarditis | Inflammation of the myocardium or muscle layer of the heart. (1)May be caused by viral infection, bacterial infection, fungal infection, endocarditis or pericarditis. (2)May also be idiopathic |
| Myocarditis symptoms | S/S often vague and vary depending on the site of infection |
| Myocarditis Signs | a)Cardiac enlargement (b)Murmur (c)Gallop (d)Tachycardia (e)Dysrhythmias |
| Myocarditis Medical Management | Similar to endocarditis treatment: bedrest, O2, antibiotics, anti-inflammatory meds. Therapy is symptomatic |
| . Nursing Interventions Myocarditis | (1)Careful assessment to monitor all subj and obj data (2)Monitor cardiomyopathy. (3)Prevent nosocomial infections. (4)Relieve activity intolerance. (5)Further teaching for the patient with infectious and inflammatory disorders of the heart. |
| Cardiac Output decreased related to inflammatory process Nursing interventions | (a)Maintain bedrest with head of bed elevated at 45 degrees. (b)Assess vital signs every 2-4 hours as needed per patient’s condition. (c)Administer medications as ordered. |
| Cardiac Output Pain related to inflammatory process Nursing interventions: | (c)Administer analgesics as ordered according to patient’s level of pain. (b)Use comfort measures to provide physical and emotional support a)Assess and record pain type and quality |
| Fluid volume excess related to ineffective pumping action- Nursing interventions | a)Restricted sodium in diet as prescribed. (b)Monitor Intake and output (c)Daily weights, compare values. d)Diuretics as ordered. (e)Monitor electrolytes. (f)Assess for dyspnea. (g)Assess peripheral edema. |
| What are three nursing diagnosis R/T nursing care of a patient with pericarditis, endocarditis, and myocarditis? | Cardiac Output decreased R/T inflammatory process, Fluid volume excess R/T ineffective pumping action |
| Indications for a Cardiac Transplant Major Indications | (1)Severe weakness of the cardiac muscle (cardiomyopathy) (a)Accounts for 50% of all transplants (2)End stage inoperable CAD (Coronary Artery Disease) (a)Accounts for 40% of all transplants |
| Contraindications for Transplant | (1)Systemic disease with poor prognosis 2)Active infection. |
| Cardiac Transplant Factor Considered | (1)Patient’s overall health; ie. general condition of patient’s vital organs. (2)Age (3)Emotional outlook. (4)Presence of other chronic conditions. (5)Availability of support system. (6)Tissue typing necessary to match recipient with a donor. |
| 50% of heart transplants are done due to? | Cardiomyopathy. |
| heart transplants Nursing Intervention --Goal | Goal (a)Patient will understand all aspects of transplant procedure, pre, intra, and post-operatively. (b)Patient to be mentally, physically, and spiritually prepared for surgery |
| heart transplants Nursing Intervention-- give (2) | Hx on admission to include: (a)Past and most recent hx. (b)Allergy & dietary hx. (c)Tx, both past and present. (d)List of all prescribed and OTC meds. (e)Current list of all tests performed prior to admit. (f)Hx of substance use, legal and illegal. |
| heart transplants Nursing Intervention-- give (2)more | Evaluate the patient’s emotional state. Provide emotional and psychological support. Focus patient teaching on the readjustment of lifestyle. |
| Immunosuppressants Pharmacological Profile: Transplant rejection drugs | The following are used with corticosteroids for the prevention of transplantation rejection reactions |
| Muromonab-CD3 | a recombinant immunoglobulin antibody that alters T-cell function. |
| Basiliximab and daclizumab | monoclonal antibodies. |
| azathioprine and cyclosporine | primarily for their immunomodulating properties |
| cyclophosphamide and methotrexate | are used to suppress the immune responses in certain disease states (nephrotic syndrome of childhood and severe rheumatoid arthritis). |
| example of Immunosuppressants | a)azathioprine (Imuran). (b) cyclosporine (Neoral, Sandimmune, Gengraf) (c) muromonab-CD 3 (Orthoclone OKT3). (d) mycophenolate (CellCept). (e) tacrolimus: 1) Oral/IV: Prograf. 2) Topical: Protopic |
Created by:
ninja3lake
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