- Pericarditis is inflammation (swelling) of the pericardium, which is the
fluid-filled sac that surrounds your heart.
1. Definition
and related terms
a.
in pericarditis, an infection
(from a bacterium, a fungus, Systemic Lupus Erythematosus (SLE), etc.) inflames
the pericardium.
b.
There may or may not be
pericardial effusion or constrictive pericarditis.
c.
dressler's Syndrome, also
called postmyocardial infarction syndrome, is a combination of pericarditis,
pericardial effusion and constrictive pericarditis. It occurs several weeks to
months after a myocardial infarction. Etiology unclear.
2.
Epidemiology
a.
may be acute or chronic and
may occur at any age.
b.
pericarditis occurs in up to
15% of persons with a transmural infarction.
3.
Findings
a.
sharp chest pain often
relieved by leaning forward
b.
pericardial friction rub
c.
dyspnea
d.
fever, sweating, chills
e.
dysrhythmias
f.
pulsus paradoxus
g.
client cannot lie flat without
pain or dyspnea
4.
Management
a.
antibiotics to treat
underlying infection
b.
corticosteroids: usually
reserved for clients with pericarditis due to SLE, or clients who do not
respond to NSAID
c.
NSAIDS/Asprin for pain and
inflammation
d.
oxygen: to prevent tissue
hypoxia
e.
surgical
i. emergency
pericardiocentesis if cardiac tamponade develops
ii. for
recurrent constrictive pericarditis, partial pericardiectomy (pericardial
window) or total pericardiectomy
5.
Nursing interventions
a. manage pain
and anxiety
b. the
cardio-care six
c. maintain a
pericardiocentesis set at the bedside in case of cardiac tamponade.
d. assess
respiratory, cardiovascular, and renal status often.
e. observe for
findings of infiltration or inflammation at the venipuncture site, a possible
complication of long-term IV administration. Rotate the IV sites often.
f. client and
family teaching - teach the cardio five
6.
Diagnostic studies
a.
EKG changes, arrythmias
b.
echocardiography to determine
pericardial efusion or cardiac tamponade
c.
history and physical exam
- Myocarditis
2.
Definition - an inflammatory condition of the myocardium
caused by
a.
viral infection
b.
bacterial infection
c.
fungal infection
d.
serum sickness
e.
rheumatic fever
f.
chemical agent
g.
as a complication of a
collagen disease, i.e. SLE
3.
Epidemiology
a.
may be acute or chronic and
may occur at any age.
b.
usually an acute virus and
self-limited, but it may lead to acute heart failure.
4.
Findings
a.
depends on the type of
infection, degree of myocardial damage, capacity of myocardium to recover, and
host resistance
b.
may be minor or unnoticed:
fatigue and dyspnea, palpitations, occasional precordial discomfort manifested
as a mild chest soreness and persistent fever
c.
recent upper-respiratory
infection with fever, viral pharyngitis, or tonsillitis
d.
cardiac enlargement
e.
abnormal heart sounds:
murmur, S3 or S4 or friction rub
f.
possibly findings of
congestive heart failure such as pulsus alternans, dyspnea, and crackles
g.
tachycardia disproportionate
to the degree of fever
5.
Diagnostic studies
a. EKG for
changes and arrythmias
b. labs
I.
increases ESR
II.
increases myocardial enzymes
such as:
i.
AST
ii.
CK
iii.
LDH
c. endomyocardial
biopsy (EMB)
d. myocardial
imaging
6.
Management
a.
antibiotics to treat
underlying infection
b.
corticosteroids to decrease
inflammation
c.
analgesics for pain
d.
oxygen to prevent tissue
hypoxia
7.
Nursing interventions
a.
the cardio-care six with
modified bedrest and less help with ADLs
b.
assess for edema; weigh
daily; record intake and output
c.
assess cardiovascular status
frequently
d.
observe for findings of
left-sided heart failure (dyspnea, hypotension and tachycardia)
e.
check often for changes in
cardiac rhythm or conduction; auscultate heart sounds
f.
evaluate arterial blood gas
levels as needed to ensure adequate oxygenation
g.
client and family teaching
I.
physical activity may be
slowly increased to sitting in chair, walking in room, then outdoors.
II.
avoid pregnancy, alcohol, and
competitive sports.
III.
immunize against infections.
IV.
teach client about
anti-infective drugs. Stress importance of taking drugs as ordered.
V.
teach clients taking digitalis
at home to:
i.
check pulse for one full
minute before taking the dose, and withhold the drug if heart rate falls below
60 beats/minute.
ii.
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.
VI.
teach client to report rapidly beating heart.
- Endocarditis
2.
Definition and related terms
a.
an infection of the
endocardium, heart valves, or cardiac prosthesis resulting from bacterial or
fungal invasion.
b.
endocarditis can be classified
as
I.
native valve endocarditis
II.
endocarditis in I.V. drug
users
III.
prosthetic valve endocarditis
3.
Epidemiology
a. with proper
treatment about 70% of clients recover.
b. the
prognosis is worse when endocarditis damages valves severely or involves a
prosthetic valve.
c. infective
endocarditis occurs in 50 to 60% of clients with previous valvular disorders.
d. systemic
lupus erythematosus (SLE) often leads to nonbacterial endocarditis.
e. 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.
4.
Findings of endocarditis
a.
cardiac murmurs in 85 to 90%
of clients
b.
fever
c.
especially, a murmur that
changes suddenly, or a new murmur that develops in the presence of a fever
d.
pericardial friction rub
e.
anorexia
f.
malaise
g.
clubbing of fingers
h.
neurologic sequelae of embolus
i.
petechiae of the skin
(especially on the chest)
j.
splinter hemorrhage under the
nails
k.
infarction of spleen: pain in
the upper left quadrant, radiating to the left shoulder, and abdominal rigidity
l.
infarction in kidney:
hematuria, pyuria, flank pain, and decreased urine output
m.
infarction in brain:
hemiparesis, aphasia, and other neurologic deficits
n.
infarction in lung: cough,
pleuritic pain, pleural friction rub, dyspnea and hemoptysis
o.
peripheral vascular
occlusion: numbness and tingling in an arm, leg, finger, or toe, or signs
of impending peripheral gangrene
5.
Management - clients at risk for prosthetic valves
a.
prophylaxis - to prevent
endocarditis; i.e. MVP, cardiac lesions
b.
antibiotics - to treat
underlying infection
c.
antipyretics - to control
fever
d.
anticoagulants - to prevent
embolization
e.
oxygen - to prevent tissue
hypoxia
f.
surgical - possible valve
replacement
6.
Nursing interventions
a.
the cardio-care six
b.
observe for findings of
infiltration or inflammation at venipuncture site; rotate sites often.
c.
client and family teaching
I.
explain all procedures in a
simple and culturally sensitive manner.
II.
involve the client and family
in scheduling the daily routine activities. Allow client and family to
participate in care.
III.
teach client relaxation
techniques (meditation, visualization, or guided imagery) to cope with stress,
pain, or insomnia.
IV.
explain endocarditis and the
need for long-term therapy.
V.
explain the need for
prophylactic antibiotics before dental work and other invasive procedures.
VI.
teach client to report fever, tachycardia, dyspnea and
shortness of breath.
7.
Diagnostic studies
a.
health history
b.
lab data
I.
CBC
II.
blood cultures
III.
ESR
c.
CXR - to detect CHF
d.
EKG - transesophageal
echocardiogram to detect vegetation and abscess on valves
- Rheumatic heart disease (rheumatic endocarditis)
2.
Definition and related terms
a.
rheumatic heart disease is
damage to the heart by one or more episodes of rheumatic fever. Pathogen is a
group A streptococci.
b.
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.
3.
Epidemiology
a.
worldwide, 15 to 20 million
new cases of rheumatic fever are reported each year.
b.
rheumatic fever follows a
group A streptococcal infection. We could prevent it by finding and treating
streptococcal pharyngitis.
c.
where malnutrition and crowded
living are common, rheumatic fever is commonest in children between ages 5 and
15.
d.
rheumatic fever strikes most
often during cool, damp weather. In the U.S., it is most common in the northern
states.
e.
it is unknown how and why
group A streptococcal infections cause the lesions called Aschoff bodies.
f.
damage depends on site of
infection: most often the mitral valve in females and the aortic valve in
males.
g.
malfunction of these valves
leads to severe pericarditis, and sometimes pericardial effusion and fatal
heart failure. Of those who survive this complication, about 20% die within ten
years.
4.
Findings
a.
streptococcal pharyngitis
I.
sudden sore throat
II.
throat reddened with exudate
III.
swollen, tender lymph nodes at
angle of jaw
IV.
headache and fever to 104 degrees
Fahrenheit
b.
polyarthritis manifested by
warm and swollen joints
c.
carditis
d.
chorea
e.
erythema marginatum (wavy,
thin red-line rash on trunk and extremities)
f.
subcutaneous nodules
g.
fever to 104 degrees
Fahrenheit
h.
heart murmurs
pericardial friction rub and pericardial rub
i.
no lab test confirms rheumatic
fever, but some support the diagnosis.
5.
Management
a. give
antibiotics steadily to maintain level in blood.
b. provide
analgesics - for pain/inflammation
c. oxygen to prevent
tissue hypoxia.
d. surgical -
commissurotomy, valvuloplasty, prosthetic heart valve
6.
Nursing interventions
a.
the cardio-care six
b.
help the client with chorea to
grasp objects; prevent falls.
c.
encourage family and friends
to spend time with client and fight boredom during the long, tedious
convalescence.
d.
client and family teaching
I.
explain all tests and
treatments
II.
nutrition
III.
hygienic practices
IV.
to resume ADLs slowly and
schedule rest periods
V.
to report penicillin reaction:
rash, fever, chills
VI.
to report findings of
streptococcal infection
i.
sudden sore throat
ii.
diffuse throat redness and
oropharyngeal exudate
iii.
swollen and tender cervical
lymph glands
iv.
pain on swallowing
v.
temperature of 101 to 104
degree Fahrenheit
vi.
headache
vii.
nausea
II.
keep client away from people
with respiratory infections
III.
explain necessity of long-term
antibiotics
IV.
arrange for a visiting nurse
if necessary
V.
help the family and client
cope with temporary chorea
7.
Diagnostic studies
a.
antistreptolysin 0 titer -
increased
b.
ESR - increased
c.
throat culture - positive for
streptococci
d.
WBC count - increased
e.
RBC parameters - normocytic,
normochromic anemia
f.
C-reactive protein - positive
for streptococci
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