12 cardio-infectious
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Transcript of 12 cardio-infectious
ALTERED OXYGENATION:
CARDIOVASCULAR
DISTURBANCES IN OXYGEN TRANSPORT MECHANISM
Structural Cardiac Disorders
HEART VALVES
MITRAL VALVE
MITRAL VALVE PROLAPSE
MITRAL VALVE PROLAPSE
• Directed at controlling the symptoms• Nitrates • Calcium-channel blockers• Beta-blockers• For heart failure, it is treated as it
would be for any other heart with heart failure
MITRAL REGURGITATION
MITRAL REGURGITATION
• Systolic murmur• Dyspnea• Fatigue• Palpitations• Shortness of breath on exertion• Cough due to pulmonary congestion
MITRAL STENOSIS
MITRAL STENOSIS
• Dyspnea on exertion = 1st symptom• Progressive fatigue• Hemoptysis• Repeated respiratoty infections
MITRAL STENOSIS
Colleen C. Flores, RN
• Antibiotic prophylaxis• Anticoagulants• Valvuloplasty• Percutaneous transluminal
valvuloplasty• Mitral valve replacement
AORTIC REGURGITATION
AORTIC REGURGITATION
• Asymptomatic• Clients may be aware of forceful heartbeats (head &
neck)– Visible or palpable on carotid or temporal arteries
• Exertional dyspnea followed by fatigue• Diastolic murmur • Widened pulse pressure• Water-hammer pulse• Breathing difficulties (Progressive signs and symptoms)
AORTIC STENOSIS
AORTIC STENOSIS
• Asymptomatic• Exertional dyspnea• Dizziness and syncope• Rough systolic murmur
Surgical Management
• Valvuloplasty
Surgical Management
• Valvuloplasty
Surgical Management
• Valve Repair and Replacement:
Surgical Management• Valve Repair and Replacement:
NURSING MANAGEMENT
• Education on diagnosis (it may be hereditary), symptoms that may develop
• Need for prophylactic antibiotics before any invasive procedure
• Diet :
DISTURBANCES IN OXYGEN TRANSPORT MECHANISM
Infectious Disorders
Rheumatic Heart Disease
Rheumatic Heart DiseaseStrep Throat S/Sx
• sudden onset of sore throat
• pain on swallowing• fever, usually 101–104°F• headache• red throat/tonsils• abdominal pain, nausea
and vomiting may also occur, especially in children
Rheumatic Fever S/Sx• fever• painful, tender, red swollen
joints• pain in one joint that
migrates to another one• heart palpitations• chest pain, SOB• skin rashes• fatigue• small, painless nodules under
the skin
Rheumatic Heart Disease
• Best defense = prevent rheumatic fever from occurring
• Treat strep throat with penicillin or other antibiotics
• People with history of rheumatic fever are more susceptible to recurrent attacks and heart damage.
Infective Endocarditis (Bacterial Endocarditis)
Colleen C. Flores, RN
• Manifestations:– Remittent fever (high or low) accompanied by chills*– Malaise, fatigue, anorexia, weight loss – Headache & musculoskeletal complaints (arthralgia)– Murmurs– Petichiae (conjunctiva), splinter hemorrhages (dark red
lines) under the nails, Painful finger or toe tip (Osler’s node – pea-sized nodules)
• Dx: blood culture – at least 6 (taken during chills or at height of fever), ECG, CBC
• Tx: antimicrobials – depend on organism involved (Penicillin & Streptomycin commonly used)– IV 4-6wks– Prosthetic heart valves may need to be replaced
Splinter Hemorrhages
Osler’s nodes
Roth’s Spots
Myocarditis
Pericarditis
Manifestations & Management:1. Acute: chest pain exacerbated with respirations– Pericardial friction rub (classic sign)– MGT: tx of underlying cause, NSAID (ASA), morphine, provide
reassurance on temporary nature of disease2. Cardiac tamponade: narrow pulse pressure– Tachycardia (compensatory) → shock & death– Hypotension, jugular vein distention, cyanosis, muffled heart
sounds, paradoxic pulse– MGT: pericardiocentesis; prompt intervention needed to
prevent shock & death3. Constrictive: RV failure & ↓cardiac output– Fatigue on exertion, dyspnea, low pulse pressure, distended
neck veins, delayed capillary refill time– leg edema, ascites– MGT: digitalis, diuretics, Na+ restriction; pericardiectomy
Colleen C. Flores, RN
DISTURBANCES IN OXYGEN TRANSPORT MECHANISM
Vascular and
Peripheral Disorders
Colleen C. Flores, RN
Vascular System
Aortic Aneurysm
Clinical ManifestationThoracic Aortic Aneurism May be asymptomatic
Pain is usually constant and boring (when patient is supine)Dyspnea, brassy cough, hoarseness of voice
Abdominal Aortic Aneurism (AAA)
Feels that heart is beating in the abdomen while lying downMay feel abdominal mass or abdominal throbbing
Dissecting Aneurism of the Aorta
Sudden severe and persistent pain described as tearing or ripping in the anterior chest or back and extends to the shoulders, epigastric area or abdomen
Buerger’s Disease
Raynaud’s Disease
Raynaud’s Disease
Management
Veins Cause/s Clinical Manifestations
Superficial (Thrombo-phlebitis)- Saphenous- Median cephalic & basilic
Varicose veins, IVs injections, Buerger’s, cancer, blood dyscrasias
Tender, indurated, visible, & palpable vein; ovoid nodules in skin
Deep Vein (DVT)- Femoral, iliac, tibial, popliteal
Immobility, CHF, cancer, blood dyscrasias, fracture, dislocation, obesity, oral contraceptives
(+)Homan’s sign, tenderness, warmth, superficial venous distention, cyanosis (severe occlusion)
Pharmacological Management
• Anti-coagulants - prevents clot formation–Heparin (Liquaemin) –Warfarin (Coumadin
• Thrombolytics = Streptokinase - dissolves clot
Surgical Management
Venous Thrombectomy
Umbrella Procedure
Nursing Management
• Superficial thrombophlebitis – local measures (i.e. warm pack, extremity elevation); sometimes anti-inflammatory meds are required
• DVT – CBR until local signs of inflammation subsides; after 7-15days = ambulate with elastic stockings
Colleen C. Flores, RN