Chapter 23: Caring for Clients With Infectious and Inflammatory Disorders of the Heart and Blood Vessels PDF

# Timby's Introductory Medical-Surgical Nursing, 13e ## Chapter 23: Caring for Clients With Infectious and Inflammatory Disorders of the Heart and Blood Vessels ### Infectious and Inflammatory Disorders of the Heart #1 - **Rheumatic Fever and Rheumatic Carditis** - **Pathophysiology and Etiolog...

# Timby's Introductory Medical-Surgical Nursing, 13e ## Chapter 23: Caring for Clients With Infectious and Inflammatory Disorders of the Heart and Blood Vessels ### Infectious and Inflammatory Disorders of the Heart #1 - **Rheumatic Fever and Rheumatic Carditis** - **Pathophysiology and Etiology** - Rheumatic fever: follows group A streptococcal infection - Rheumatic carditis: inflammatory cardiac manifestations of rheumatic fever - **Assessment Findings**: mild fever; rapid heart rate and abnormal rhythm; red, spotty rash on trunk but disappears quickly and leaves irregular circles on skin - Swollen joints: warm, red, and painful; heart murmur and pericardial friction rub ### Infectious and Inflammatory Disorders of the Heart #2 - **Diagnostic Findings:** ESR, ECG, C-reactive protein - **Medical and Surgical Management** - IV antibiotics: penicillin, vancomycin, Zithromax - Surgery for constrictive pericarditis and damage to heart valves - ASA-clot prevention, steroids, prophylactic antibiotics - See Box 23-1 - **Nursing Management** - Administer prescribed drug therapy, diversion activities, bed rest, prophylactic antibiotics ### Infectious and Inflammatory Disorders of the Heart #3 - **Infective Endocarditis** - **Pathology and Etiology**: inflammation of the inner layer of heart tissue; autoimmune response - Microorganisms that cause include bacteria, streptococci and staphylococci; fungi see Table 23-1 - Causes: prolonged IV therapy, insertion of cardiac pacemakers and cardiac catheterization, Foley - **Assessment Findings** - Fever, chills, muscle aches, joint pain, Osler nodes, splinter hemorrhages, Janeway lesions, Roth spots, petechiae, enlarged spleen, heart murmur ### Question #1 Which of the following histories of a client would relate to a diagnosis of bacterial endocarditis? A) Previous heart catheterization B) Strep throat 4 weeks earlier C) Open reduction internal fixation of the left hip last year D) Smokes two packs of cigarettes a day ### Answer to Question #1 B) Strep throat 4 weeks earlier **Rationale**: Bacterial endocarditis is generally associated with an upper respiratory infection caused by the streptococcus bacteria. ### Infectious and Inflammatory Disorders of the Heart #4 - **Diagnostic Findings:** anemia, leukocytosis, blood cultures, transesophageal echocardiography, ECG - **Medical and Surgical Management** - High doses of IV antibiotic therapy, bed rest, valve replacement See Drug Therapy Table 23-1 - **Nursing Management** - Limit activity; assess for changes in weight, pulse rate, and rhythm; administer antibiotics - See Client and Family Teaching 23-1 ### Infectious and Inflammatory Disorders of the Heart #5 - **Myocarditis** - **Pathophysiology and Etiology**: inflammation of the muscle layer of heart - Viral, bacterial, fungal, or parasitic infection - Coxsackie viruses A and B, influenza A and B viruses, measles, mumps, Epstein-Barr virus, COVID-19 - **Assessment Findings** - Sharp stabbing or squeezing chest discomfort (resembles MI), sitting up relieves the pain, low-grade fever, tachycardia, dysrhythmias, dyspnea, fatigue, cyanotic skin, crackles, S3 galloping rhythm ### Infectious and Inflammatory Disorders of the Heart #6 - **Diagnostic Findings** - WBC, C-reactive protein, ECG, chest radiography, echocardiography, radionuclide, biopsy - **Medical and Surgical Management** - Bed rest, sodium-restricted diet, cardiotonic drugs (digitalis), heart transplant - **Nursing Management** - Monitor cardiopulmonary status, VS, I&O, daily weights, LS, SpO2, maintains BR, O2 ### Infectious and Inflammatory Disorders of the Heart #7 - **Cardiomyopathy** - Three types: dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy See Table 23-2 - **Pathophysiology and Etiology**: heart muscle loses ability to pump blood efficiently - **Assessment Findings** - Dilated cardiomyopathy: dyspnea on exertion when lying down, fatigue, leg swelling, palpitations - Hypertrophic cardiomyopathy: syncope, chest pain; may be asymptomatic - Restrictive cardiomyopathy: exertional dyspnea, dependent edema in legs, ascites, hepatomegaly ### Infectious and Inflammatory Disorders of the Heart #8 - **Diagnostic Findings** - Chest radiography, ECG, echocardiogram, cardiac MRI, cardiac catheterization - **Medical and Surgical Management** See Table 23-3 - Medical: diuretics, digitalis, antihypertensives, antidysrhythmic, anticoagulants, corticosteroids, dietary sodium restriction - Surgical: pacemaker, defibrillator, ventriculomyomectomy, transplant - **Nursing Management** - Medical and family history, physical examination, VS, LS, heart sounds, edema, abdominal enlargement, SpO2, cardiac monitoring, O2 therapy, emotional support see Client and Family Teaching 23-2 ### Infectious and Inflammatory Disorders of the Heart #9 - **Pericarditis** - **Pathophysiology and Etiology**: inflammation of pericardium: primary or secondary with or without effusion - Secondary to endocarditis, myocarditis, chest trauma, MI, postcardiac surgery - Cardiac tamponade: acute compression of the heart; pulsus paradoxus See Nursing Guidelines 23-1 - **Assessment Findings** - Fever, malaise, heaviness in chest, precordial pain, moving and breathing worsen the pain, sitting upright and leaning forward relieves the pain, pericardial friction rub, severe hypotension ### Infectious and Inflammatory Disorders of the Heart #10 - **Diagnostic Findings:** ST segment of ECG is elevated, chest radiography, echocardiogram, WBC, ESR - **Medical and Surgical Management** - Medical: rest, analgesics, antipyretics, NSAIDs, corticosteroids - Surgical: pericardiocentesis, pericardiostomy, pericardiectomy, decortication - **Nursing Management** - Pain assessment, auscultating heart sounds, JVD, persistent cough, dyspnea, fainting, anxiety, changes in pulmonary function ### Nursing Process: Pericarditis - **Interventions** - Monitor for tachycardia, pulsus paradoxus, neck vein distention, cough, syncope, and muffled sounds every 4 hours. - Cover site of the pericardiocentesis with a sterile dressing and inspect the dressing for bleeding or leaking fluid. - **Rationale**: Compromised skin and underlying tissue creates a potential for blood and fluid loss as well as an entry site for microorganisms. - **Evaluation:** Client states pain is relieved, VS is stable, normal cardiac rhythm, and cardiac tamponade is managed. ### Question #2 A client with pericarditis has been admitted to the cardiac intensive care unit. The nurse caring for the client knows that the most common clinical assessment of pericarditis is what? Select all that apply. A) Diaphoresis B) Chest pain C) Elevated cardiac enzymes D) Friction rubs E) All of the above ### Answer to Question #2 E) All of the above **Rationale**: The signs and symptoms of the inflammatory disorders of the heart include all of the following. Other symptoms include arrhythmias, heart murmurs, and cardiac enlargement. ## Inflammatory Disorders of the Peripheral Blood Vessels #1 - **Thrombophlebitis** - **Pathophysiology and Etiology**: inflammation of a vein accompanied by a clot or thrombus formation; DVT, PE - Inner vein is irritated or injured; platelets clump together, forming a clot. - Virchow triad: venous stasis, altered blood coagulation, and trauma to the vein - **Assessment Findings** - Discomfort in affected extremity; calf pain that increases on dorsiflexion (Homans sign); heat, redness, and swelling; capillary refill less than 2 seconds; fever; malaise; fatigue; anorexia ## Inflammatory Disorders of the Peripheral Blood Vessels #2 - **Diagnostic Findings:** Doppler ultrasound, venography, impedance plethysmography (IPG) - **Medical and Surgical Management** (see Evidence-Based Practice 32-1) - Medical: ambulation; compression bandaging; anticoagulant therapy; continuous warm, wet packs - Surgical: thrombectomy, ligation - **Nursing Management** - History of blood clots, risk factors, obesity, contraceptive use, Homans sign, pain or tenderness in calf, capillary refill, PE (chest pain and dyspnea) ## Inflammatory Disorders of the Peripheral Blood Vessels #3 - **Thromboangiitis Obliterans (Buerger disease)** - **Pathophysiology and Etiology**: inflammation of blood vessels associated with clot formation and fibrosis of the blood vessel wall - **Assessment Findings** - Cold, numbness, burning, and tingling in feet, intermittent claudication: leg cramps after exercise, pain at rest, cyanosis and redness of feet and legs - Skin: mottled purplish-red and appears thin and shiny, sparse hair growth, black gangrenous areas on toes and heels ## Inflammatory Disorders of the Peripheral Blood Vessels #4 - **Medical and Surgical Management** - Tobacco restriction, Buerger-Allen exercises, analgesics, sympathectomy - **Nursing Management** - History; pain: increases or decreases; examine extremities, nails, skin temperature, peripheral pulses, capillary refills - See Client and Family Teaching 23-4 ### Question #3 A nurse is educating the client on the causes of Buerger disease. Which of the following would indicate a client's understanding of the disease process? A) Large arteries of the legs are primarily affected. B) The condition has no familial tendencies. C) The condition is associated with smoking. D) The disease caused pain with activity. ### Answer to Question #3 C) The condition is associated with smoking. **Rationale**: Buerger disease is an inflammatory process affecting primarily the medium-sized arteries or veins of the legs and causes occlusion of circulation. Smoking, which causes vasoconstriction, can exacerbate the disease process.