Timby/Smith: Introductory
Medical-Surgical Nursing, 10/e
Chapter 23: Caring for Clients with
Infectious and Inflammatory Disorders of
the Heart and Blood Vessels
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Rheumatic Fever and Rheumatic Carditis
• Systemic inflammatory disease that can follow Strep A
throat infection, which can manifest in cardiac structures
• Cause: Antibodies cross-react against host cardiac tissue
resulting in valvular damage, pancarditis
• Diagnostics: O titer; ESR; C-reactive protein; ECG;
echocardiograph
• Signs/Symptoms: Acute rheumatic fever; Carditis;
Polyarthritis; Rash, subcutaneous nodules; Chorea;
Inability to use skeletal muscles
• Treatment: Drugs: IV antibiotics, ATB therapy, aspirin,
steroids; Surgery; Bed rest
• Nursing Management
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Question
Is the following statement true or false?
Rheumatic carditis is the name of the infection which
manifests in cardiac structures.
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Answer
True.
Rheumatic carditis is the name of the infection which
manifests in cardiac structures after a client has a
rheumatic fever. Rheumatic fever is a systemic
inflammation.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Rheumatic Fever and Rheumatic Carditis
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Infective Endocarditis
• Inflammation of the endocardium (inner layer of
cardiac tissue)
• Cause: Bacteria, fungi
• Diagnostics: Blood culture; transesophageal
echocardiography; ECG
• Signs/Symptoms: Fever; Chills; Muscle aches; Joint
pain; Osler’s nodes; Splinter hemorrhages;
Janeway’s lesions; Roth’s spots; Enlarged spleen;
Petechiae
• Treatment: IV antibiotic; Antibiotic therapy; Bed
rest; Surgery: Valve replacement
• Nursing Management
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Myocarditis
• Inflammation of the myocardium (muscle layer of the
heart)
• Cause: Microbial infection; EtOH, cocaine abuse;
Radiation therapy; Autoimmune disorders
• Diagnostics: WBC count; C-reactive protein test;
Cardiac isoenzyme levels; ECG; Echocardiography;
Radionuclide studies; Myocardial biopsy
• Signs/Symptoms: Chest pain; Low-grade fever;
Tachycardia; Dysrhythmias; Dyspnea, etc.
• Treatment: ATB; Cardiotonic meds; Heart transplant
(severe case)
• Nursing Management
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Cardiomyopathy
• Cause: Chronic condition of structural changes in
cardiac muscle resulting in the inability of the heart
muscle to pump blood efficiently
• Diagnostics: Chest radiography; Echocardiogram;
ECG; Cardiac catheterization; Endomyocardial
biopsy; Radionuclide studies
• Signs/Symptoms: Heart murmur; Forceful heart
contractions
− Dilated: Dyspnea, fatigue, swollen legs,
palpitations, chest pain
− Hypertrophic: Chest pain, syncope, fatigue, short
of breath, acute illness after strenuous exercise
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Question
Is the following statement true or false?
Cardiomyopathy is a chronic cardiac structural
condition resulting in the heart pumping inefficiently.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
True.
Cardiomyopathy is a chronic cardiac structural
condition.
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Cardiomyopathy
• Signs/Symptoms (Cont’d)
− Restrictive: Exertional dyspnea, edema in legs,
ascites, hepatomegaly
• Treatment:
– Medications: Diuretics; Antidysrhythmics; Cardiac
glycosides; Anticoagulants; Antiinflammatories
– Surgery: Ventriculomyomectomy; Artificial
pacemaker; Heart transplant
• Nursing Management
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Cardiomyopathy
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Pericarditis
• Inflammation of the pericardium usually secondary to
cardiac disorders, surgery resulting in cardiac
tamponade; Pulsus paradoxus
• Diagnostics: ECG; Chest radiography; Blood tests;
Echocardiography
• Signs/Symptoms: Fever; Malaise; Dyspnea;
Precordial pain
• Treatment: Rest; Analgesics; Antipyretics; NSAIDs;
Corticosteroids; Pericardiocentesis; Pericardiostomy;
Pericardiectomy
• Nursing Management
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Pericarditis
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Thrombophlebitis
• Inflammation of vein resulting in clot formation
(DVT – lower extremities), pulmonary embolus
(Clot migrating toward pulmonary circulation);
Postphlebitic syndrome; Virchow’s triad
• Diagnostics: Venography; Doppler ultrasound;
Impedance plethysmography
• Signs/Symptoms: Affected extremity discomfort; +
Homans’ sign; Heat; Redness; Edema; Fever;
Malaise; Anorexia
• Treatment: Complete rest of extremity; continuous
warm, wet packs; Anticoagulant therapy; Oral
anticoagulants; Surgery; Filter placement
• Nursing Management
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Thromboangiitis Obliterans (Buerger’s Disease)
• Lower extremity arterial lumen spasms: Restrict
blood flow causing vascular occlusions resulting in
hypoxia, anoxia, ulcerations, gangrene
• Diagnostics: Doppler ultrasound; IPG; Angiography
• Signs/Symptoms: Cold, numb, burning, tingling
feet; Cyanosis; Redness of feet and legs; Mottled
skin; Leg ulcers; Black, gangrenous toes and heels;
Thick nails; Peripheral pulses disappear with activity;
Intermittent claudication
• Treatment: Tobacco restriction; Buerger-Allen
exercises; Analgesics; (Leg ulcers): Moist dressings;
Topical antiseptics; Antibiotic ointments; (Surgery):
Sympathectomy; Wound debridement; Amputation
• Nursing Management
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Question
Is the following statement true or false?
Buerger’s disease can result in amputation of the lower
extremities.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
True.
Buerger’s disease can result in amputation of the lower
extremities. Surgeons only amputate as necessary
and then only as much as needs removed to keep
the client safe.
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End of Presentation
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins