Management of Clients with Cardio-vascular Disorders Infectious Diseases of the Heart Hilal Alrahbi-MSN, RN School of Nursing-UON Hilal Alrahbi-Adult Nurs I

Hilal Alrahbi-Adult Nurs I Heart Layers Hilal Alrahbi-Adult Nurs I

Infectious Diseases of the Heart Rheumatic Endocarditis Infective Endocarditis Myocarditis Pericarditis Hilal Alrahbi-Adult Nurs I

Rheumatic Endocarditis Inflammation of the endocarium occurs as a result of Rheumatic Fever Etiology of Rheumatic Fever: Causes by group A beta-hymolytic streptococcal bacteria Starts as infection in the upper respiratory tract (pharyngitis) Occurs most often in school-aged children Preventable if diagnosed and treated early with antibiotics Other complications: (Rheumatic Hear Disease) Heart mummer Pericarditis Mitral stenosis Mitral regurgitation Cardiomegaly Hilal Alrahbi-Adult Nurs I

Cont. Rheumatic Endocarditis Clinical Manifestations: Present as Rheumatic Fever and Rheumatic Heart Disease: Signs and symptoms of Reumatic Fever: Sore throat (sudden onset) Fever (38.9-40c) Chills Redness of throat with exudates on oropharynx Enlarged and tender of lymph nodes Abdominal pain Acute sinusitis and otitis media Signs and symptoms of RHD: (see “other complications” on previous slide) Hilal Alrahbi-Adult Nurs I

Cont. Rheumatic Endocarditis Assessment and diagnostic findings: Diagnostic studies are not specific, symptoms may take years to develop (e.g. mitral stenosis, or regurgitation) History of sore throat within 5 weeks Assess S&S Throat culture (group A beta-hemolytic streptococci) Blood for erythrocyte sedimentation rate (ESR) ECG (tachycardia, bradycardia, dysrhythias) Hilal Alrahbi-Adult Nurs I

Cont. Rheumatic Endocarditis Medical management: Prevention: Early detection of oropharyneal streptococcal infections Early and adequate treatment of oropharyneal streptococcal infections Medications: Antibiotic penicillin is prescribed when suspected group A streptococcal infections When diagnosis of R.Fever confirmed, prophylactic penicillin intramuscular injections will be given every 3-4 wks for 5 years or until 21 years old Pain killers (valium) + Treat complications + prophylactic antibiotics for invasive procedures Hilal Alrahbi-Adult Nurs I

Cont. Rheumatic Endocarditis Nursing management: Health education about the disease Signs and symptoms Complications Follow scheduled long-term prophylactic antibiotics Monitor pt. for signs and symptoms, complications Hilal Alrahbi-Adult Nurs I

Infective Endocarditis Infection of the endothelial surface of the heart Common in older people Aging process Reduced immunity Common in people with valular diseases Causes by: Streptococci, staphylococci, entrococci, pneumococci Complications: Valves destructions Dysrhythmias () Thrombi formation and embolism Hilal Alrahbi-Adult Nurs I

Cont. Infective Endocarditis Clinical manifestations: Fever Heart murmur Small painful nodules in fingers and toes Hemorrhages (Bleeding) eye fundus, fingernails, toenails tachycaria Splenomegaly Cardiomegaly Hilal Alrahbi-Adult Nurs I

Cont. Infective Endocarditis Diagnostic findings: Assess signs and symptoms Blood culture Two separate sample in one hour apart Negative result does not rule out infective endocaridit Elevated white blood cells (WBC) Elevated erythrocytes sedimentation rate (ESR) Rheumatoid factor may be positive Echocardiography Hilal Alrahbi-Adult Nurs I

Cont. Infective Endocarditis Medical management: Prevention: Prophylactic antibiotics for high risk patients (valvular diseases) when going for the following procedures: Dental procedures Tonsillectomy Bronchoscopy Endoscopy Gall bladder surgery Good dental and oral hygiene Follow universal precautions when dealing with such pt. s Hilal Alrahbi-Adult Nurs I

Cont. Medical management Medications: Antibiotics IV (penicillin) for 2-6 weeks Surgical: Excision of any abscess Closure of any fistula Replacement of valves Hilal Alrahbi-Adult Nurs I

Hilal Alrahbi-Adult Nurs I Nursing Management Monitor of V/S and heart sounds (murmurs) Monitor the pt. for signs of hear failure, pulmonary edema, systemic embolizations Administer medications accordingly Teach pt. and family about prophylactic antibiotics Involve family in the car of pt. Hilal Alrahbi-Adult Nurs I

Hilal Alrahbi-Adult Nurs I Pericarditis Inflammation of the pericardium May occur after MI or pericadectomy (opening of the pericardium) May lead to an accumulation of fluid in the pericardial sac causing pressure on the heart (cardiac temponade) Signs and symptoms: Chest pain (in the scapula) Pain worsen with deep inspiration, lying down or turning Friction rub can be heart at the lower sternum Hilal Alrahbi-Adult Nurs I

Hilal Alrahbi-Adult Nurs I Cont. Pericarditis Assessment and diagnostic findings: Assess signs and symptoms CT MRI Echocardiography ECG Hilal Alrahbi-Adult Nurs I

Hilal Alrahbi-Adult Nurs I Cont. Pericarditis Medical management: Medication: Analgesics and NSAIDs (aspirin, brufen) for pain and inflammation Steroids (prednisone) for inflammation if severe Surgical: Pericaridal window (opening into the chest cavity) Pericadectomy (release pressure from the ventricles ) Hilal Alrahbi-Adult Nurs I

Hilal Alrahbi-Adult Nurs I Cont. Pericarditis Nursing management: Relieve of pain Reassurance Minimize of activity if pain and rub friction persist Monitor for S&S of heart failure Monitor pt. for signs of cardiac temponade Health education about the disease Hilal Alrahbi-Adult Nurs I

Hilal Alrahbi-Adult Nurs I Thanks Questions ?? WE HEAT YOU MR. HILAL Hilal Alrahbi-Adult Nurs I