Inflammatory Heart Disorders PDF

DISORDERS OF THE HEART NP02L021 ELO B · Version 2.0 Inflammatory Heart Disorders Foundations and Adult Health Nursing, 8th ed., pp. 1557-1563 TERMINAL LEARNING OBJECTIVE Determine nursing care for a patient with a disorder of the heart without error. ENABLING LEARNING OBJECTIVE Given a clinical s...

DISORDERS OF THE HEART NP02L021 ELO B · Version 2.0 Inflammatory Heart Disorders Foundations and Adult Health Nursing, 8th ed., pp. 1557-1563 TERMINAL LEARNING OBJECTIVE Determine nursing care for a patient with a disorder of the heart without error. ENABLING LEARNING OBJECTIVE Given a clinical scenario, determine nursing care approaches for a patient with an inflammatory heart disorders without error. INFLAMMATORY HEART DISORDERS 1. Rheumatic Heart Disease 2. Pericarditis 3. Endocarditis 4. Myocarditis 5. Cardiomyopathy RHEUMATIC HEART DISEASE ETIOLOGY/PATHOPHYSIOLOGY Ineffective treatment of infection results in delay and inflammation Heart tissues Central nervous system Joints Skin Subcutaneous tissues Rheumatic Fever Children between 5 and 15 years old Sudden onset of upper respiratory infections (Group A beta hemolytic streptococci (Example: scarlet fever) May progress for years prior to diagnosis ETIOLOGY/PATHOPHYSIOLOGY Pericardium, myocardium, or endocardium may be affected Affected tissue develops small areas of necrosis Once healed, leaves scar tissue Heart valves affected by vegetative growth in tissues Heart valves thicken and result in valvular stenosis and insufficiency CLINICAL MANIFESTATIONS Fever Increased pulse Epistaxis Anemia Joint involvement Nodules on joints Inflammation of heart tissues may develop (Carditis) ASSESSMENT Subjective: Joint pain, chest pain, lethargy, and fatigue Objective: Erythema marginatum, involuntary purposeless movement (Sydenham’s Chorea), valve involvement (heart murmur) Note: Rheumatic heart disease- characterized by heart murmurs resulting from stenosis or insufficiency of the valves. DIAGNOSTIC TESTS Diagnosis is made through sign and symptoms supported by laboratory study results EKG will show cardiac dysrhythmia Auscultation of cardiac murmurs or friction rub Elevated erythrocyte sedimentation rate (ESR) and leukocytes Serum antibodies against streptococci C-reactive protein abnormally high MEDICAL MANAGEMENT Preventative measures are most effective Rapid treatment for pharyngeal infection with prolonged antibiotic therapy Penicillin is preferred Patients without carditis- ambulatory Patients with carditis- bedrest until heart failure is controlled Non-steroidal anti-inflammatory drugs (NSAIDS) Well-balanced diet Surgical commissurotomy or valve replacement may be necessary NURSING INTERVENTIONS Bedrest during acute phase Proper positioning Bundle nursing care Provide emotional support and diversions Patient Teaching Focus on increasing understanding of disease process signs and symptoms Emphasize importance of diet and medical follow up Prophylactic antibiotics before surgery and dental procedures PERICARDITIS ETIOLOGY/PATHOPHYSIOLOGY Inflammation of the membranous sac surrounding the heart Acute Bacterial, viral, or fungal infection are associated with acute disease May be a complication of noninfectious conditions Example: azotemia, acute MI, neoplasms, trauma from cardiac surgery, lupus, radiation, drug reactions Chronic Fibrous constriction and thickening of the pericardium Causes compression that may prevent filing during diastole CLINICAL MANIFESTATIONS Patient will have debilitating pain Pain is aggravated by lying supine, deep breathing, coughing, swallowing, moving the trunk Pain alleviated by sitting up and leaning forward Dyspnea Fever Chills Diaphoresis Leukocytosis Hallmark finding – pericardial friction rub Decreased heart function ASSESSMENT SUBJECTIVE OBJECTIVE Patient description of Orthopneic positioning muscle aches Facial grimace on inspiration Fatigue Elevated temperature with Dyspnea chills Excruciating chest pain Nonproductive cough (radiates to the neck) Vital signs Patient verbalizes anxiety or Pulse rapid and forcible anticipation of danger Shallow breathing Pericardial friction rub DIAGNOSTIC TESTS EKG Echocardiogram Leukocytosis Erythrocyte sedimentation rate (ESR) Blood cultures C-reactive protein (CRP) Chest x-ray MEDICAL MANAGEMENT Analgesia Oxygen Parenteral fluids Antibiotics Salicylates Corticosteroids Anti-inflammatory agents (Example: indomethacin) Pericardiocentesis (with cardiac tamponade) NURSING INTERVENTIONS Evaluate vital signs Auscultate heart and lung sounds Observe for complications Maintain bedrest and promote healing Elevated head of bed Explain all procedures thoroughly Patient Problem Nursing Interventions Insufficient Cardiac Output, related to inflammatory 1. Maintain bed rest with head of bed elevated to 45 process degrees 2. Assess vital signs q 2-4 hr as indicated by patient’s condition 3. Administer medications as ordered 4. Monitor intake and output 5. Provide planned rest periods Discomfort, related to inflammatory process 1. Assess and record pain type and quality 2. Administer analgesics according to need, as ordered 3. Maintain the patient on bed rest with the head of bed elevated to 45 degrees and provide a padded overbed table Fluid volume overload, related to ineffective myocardial 1. Use comfort measures to provide physical and pumping action emotional support 2. Restrict sodium in diet as prescribed 3. Monitor intake and output 4. Weigh daily 5. Administer diuretic therapy 6. Monitor electrolyte values 7. Observe respiration and pulse quality 8. Assess for dyspnea and peripheral edema ENDOCARDITIS ETIOLOGY/PATHOPHYSIOLOGY Infection or inflammation of the inner membranous lining of the heart, particularly the heart valves Causative organisms Most common organisms Infective or bacterial Streptococcus viridans Fungi S. Pyogenes Chlamydiae Staphylococcus aureus Rickettsiae S. Epidermidis Viruses Enterococci Bacteria ETIOLOGY/PATHOPHYSIOLOGY Fibrin and calciferous growths of vegetation may grow and cause scars on the valves Growths may break away causing Emboli Infection Abscess in organs Loss of lesions cause embolization Systemic embolization from: Left-sided heart vegetation – infarction of an organ Right-sided heart vegetation – embolize to the lungs ETIOLOGY/PATHOPHYSIOLOGY General risk factors, history of: Rheumatic heart disease Degenerative heart disease IV drug use Patient population at risk: As a result of unhealthy teeth and gums After invasive dental procedures, minor surgery, gynecologic examinations, needs used for tattooing or body piercing, or insertion of indwelling urinary catheter CLINICAL MANIFESTATIONS Acute endocarditis S/S progress rapidly Subacute S/S progress gradually Damage occurs over a long period of time ASSESSMENT SUBJECTIVE OBJECTIVE Petechiae in the conjunctiva, Flu-like symptoms oral mucosa, neck, and Recurrent fever anterior chest Undue fatigue Splinter hemorrhages in nailbeds Chest pain Nontender macular lesions on Headache palms and soles Joint pain Elevated nodules on pads of Chills fingers and toes Microemboli, vasculitis, and embolism Weight loss Pulse May cause murmur (aortic and mitral valves commonly affected.) DIAGNOSTIC TESTS EKG changes Chest x-ray Transesophageal echocardiogram Leukocytosis ESR CBC Blood cultures MEDICAL MANAGEMENT Embolization Anticoagulation- NOT recommended Complete bed rest with elevated temperature and symptoms of heart failure Antibiotics – as long as 1 to 2 months Prophylactic antibiotic treatment recommended of patient is high risk of developing infective endocarditis NURSING INTERVENTIONS Observe for petechiae Pain Vomiting, fever In acute phase Decreased activity Provide calm, quiet environment Monitor vital sign signs (apical pulse) Adequate nutrition PATIENT TEACHING Focus ID causative agent Precautions Dietary requirements Gradually increasing activity Advise patient of need for prophylactic antibiotics Report symptoms of recurrent infection MYOCARDITIS ETIOLOGY/PATHOPHYSIOLOGY Rare Inflammation of the myocardium May originate from: Rheumatic heart disease Viral, bacterial, or fungal infection Endocarditis Pericarditis In the United States- coxsackie virus type B is most significant CLINICAL MANIFESTATIONS Variable by patient Symptoms: Mirror upper respiratory tract infection Fever Chills Sore throat Abdominal pain and nausea Vomiting Diarrhea Myalgia Signs appear up to 6 weeks before patient has signs of myocarditis MYOCARDITIS Cardiomyopathy is a complication May result in dysrhythmias Early detection assists treatment Diagnostic tests include: Chest x-ray ECG Echocardiography MRI Cardiac catheterization MYOCARDITIS Medical management Treat symptoms Bed rest Oxygen Antibiotics Anti-inflammatory agents Careful assessments Correction of dysrhythmias Goal is to preserve cardiac function and prevent complications CHECK ON LEARNING A 48-year-old patient is admitted for tachycardia, shortness of breath, and chest pain eased by sitting up and leaning forward. The nurse auscultates a high-pitched scratchy sound at the left sternal border of the chest. The patient most likely has: a. Heart failure. b. Pericarditis. c. Pneumonia. d. Aortic stenosis. RECOGNIZING CLUES A 48-year-old patient admitted for tachycardia, shortness of breath, and chest pain eased by sitting up and leaning forward, with a high-pitched scratchy heart sound at the left sternal border. Identify the concerning cues that would need to be reported to the physician. CHECK ON LEARNING Mr. Postma, age 72-years-old, is diagnosed with rheumatic heart disease. He has been experiencing fatigue and shortness of breath when walking the dog for a mile and has gained 5 lbs. over the past week. What is going on with this patient and what cues lead you to that conclusion? CARDIOMYOPATHY ETIOLOGY/PATHOPHYSIOLOGY Term used to describe a group of heart muscle diseases Primarily affects structural heart disease; structural heart function Not associated with: Coronary artery disease Hypertension Vascular disease Pulmonary disease CLASSIFICATION Classified as: Primary Secondary Primary – heart muscle disease of unknown cause Classified as dilated, hypertrophic, or restrictive PRIMARY CARDIOMYOPATHY Dilated Ventricular dilation Most common type Hypertrophic Increased size and mass of the heart Decreased ventricular size Restrictive Rigid ventricular walls SECONDARY Infective Peripartum Viral Drugs Bacterial Fungal Radiation therapy Protozoal Systemic lupus Metabolic erythematosus Nutritional deprivation Rheumatoid arthritis Alcohol “Crack” -induced CLINICAL MANIFESTATIONS Angina Syncope Fatigue Syncope Dyspnea on exertion Most common – severe exercise intolerance Patient may show signs/symptoms of left-sided and right- sided heart failure DIAGNOSTIC TESTS Diagnosis made by clinical manifestations EKG Chest x-ray Echocardiogram CT scan Nuclear imaging studies MUGA scanning Cardiac catheterization Endomyocardial biopsy MEDICAL MANAGEMENT Treatment of underlying causes Medications Diuretics ACE Inhibitors Antidysrhythmics Beta-adrenergic blockers Occasionally- automatic internal defibrillator If patients with advanced disease no longer respond to medical treatment  heart transplant is considered CARDIAC TRANSPLANT Patients will be treated with immunosuppressive therapy Azathioprine (Imuran) Corticosteroids Goal is to reduce rejection of new organ Leading cause of death after transplant –infection NURSING INTERVENTIONS/PATIENT TEACHING Focus on relief of symptoms Prevent complications Provide emotional and psychological support Monitor for dysrhythmia Prognosis Most patients with severe cardiomyopathy die within 2 years of onset Death due to heart failure of ventricular dysrhythmias CHECK ON LEARNING While discussing cardiomyopathy with a student, the nurse explains that the underlying weakness of the left ventricle results in decreased cardiac output and back up of fluid in the pulmonary system. The student nurse anticipate which signs and symptoms? CHECK ON LEARNING The nurse providing teaching for patient taking immunosuppressants will include which information? a. The mouth and tongue should be inspected carefully for white patches. b. Allergic reactions to these drugs are rare. c. Patient should avoid crowds to minimize the risk of infection. d. Patient should take oral forms with food to avoid gastrointestinal upset. e. Patients should report any fever, sore throat, chills and joint pain. REVIEW OF MAIN POINTS Inflammatory heart disorders Rheumatic Heart Disease Pericarditis Endocarditis Cardiomyopathy QUESTIONS?