Download Week 10 Activity INUR3306

Inflammatory Heart Disease
Rheumatic Fever/ Rheumatic
Heart Disease
Endocarditis
Myocarditis
Pericarditis
Pathophysiology
Characterized by
nonsuppurative
inflammatory lesions of
the joints, heart,
subcutaneous tissue,
and central nervous
system. Rheumatic
fever follows
pharyngeal infection
with rheumatogenic
group A streptococci.
Damaged valves and
endocardium
contribute to the
development of
infective endocarditis.
Specifically, the
damaged part of a
heart valve forms a
local blood clot, a
condition known as
non-bacterial
thrombotic
endocarditis (NBTE).
Inflammation and
muscle damage, a heart
affected with
myocarditis is unable to
respond to the increase
in volume.
acutely inflamed and
has an infiltration of
polymorph nuclear
(PMN) leukocytes and
pericardial
vascularization
Sign and Symptoms
Fever, painful joints,
itchy rash
Nursing Care
While corticosteroids are
often used, evidence to
support this is poor.
Salicylates are useful for
pain.
Fever, heart murmur,
weight loss, and
coughing
Surgical debridement of
infected material and
replacement of the valve
with a mechanical or
bioprosthetic artificial
heart valve is necessary in
certain situations
Fever, rash, diarrhea,
joint pains, and easily
becoming tired.
Decreased cardiac output
related to a reduced
mechanical function of the
heart muscle or valvular
dysfunction
Fever higher than 38°C,
subacute onset, large
pericardial effusion,
cardiac tamponade, lack
of response to NSAIDs
Assess the patient’s
cardiovascular status
frequently, watching for
signs of cardiac
tamponade.
Valvular Heart Disease
Mitral Stenosis
Mitral Regurgitation
Mitral Valve Prolapse
Aortic Stenosis
Aortic Regurgitation
Tricuspid Stenosis
Pathophysiology
The normal mitral valve
orifice area is
approximately 4-6 cm2.
As the orifice size
decreases, the pressure
gradient across the
mitral valve increases
to maintain adequate
flow.
The regurgitant volume
causes a volume
overload and a pressure
overload of the left
atrium and the left
ventricle. The increased
pressures in the left
side of the heart may
inhibit drainage of
blood from the lungs
via the pulmonary veins
and lead to pulmonary
congestion.
Heart problem in which
the valve that separates
the upper and lower
chambers of the left
side of the heart does
not close properly.
Narrowing of orifice
between LV & aorta.
Valve flaps fail to
completely seal the
aortic orifice during
diastole & thus permit
back flow of blood from
aorta into LV.
Narrowing of tricuspid
valve orifice due to
commissural fusion &
fibrosis.
Sign and symptoms
Heart failure,
Palpitations, Chest
pain, Hemoptysis
Nursing Care
Watch closely for signs of
pulmonary dysfunction
caused by pulmonary
hypertension, tissue
ischemia caused by emboli,
and adverse reactions to
drug therapy.
1.Shortness of breath,
2.Weakness or
dizziness,
3.Wheezing and heavy
coughing,
4.Physical exertion,
5. chest pain,
6.Fever,
7.Rapid weight gain,
8. Swelling of the
ankles, feet or
abdomen.
Assess lung sounds and
determine any occurrence of
Paroxysmal Nocturnal
Dyspnea (PND) or
orthopnea.
Chest pain, Dizziness,
Fatigue, Panic attacks,
Shortness of breath.
Altered tissue perfusion
related to narrowing of the
coronary artery associated
with atherosclerosis or
thrombosis
Heart failure, loss of
consciousness, or
chest pain, swelling of
the legs.
Dyspnea on exertion,
Orthopnea,
Paroxysmal nocturnal
dyspnea,
Palpitations, Angina
pectoris, Cyanosis
A fluttering discomfort
in the neck, fatigue,
cold skin, and right
upper quadrant
abdominal discomfort.
Activity intolerance related
to imbalance between
oxygen supply and demand
Activity intolerance related
to imbalance between
oxygen supply and demand
The resultant tricuspid
regurgitation from
percutaneous treatment is
better tolerated than
insufficiency occurring
during mitral valvuloplasty
Tricuspid Regurgitation
Allows regurgitation of
blood from RV into the
RA during systole.
Pulmonic Stenosis
Resistance to blood
flow causes right
ventricular
hypertrophy. A patent
ductus arteriosus
partially compensates
for the obstruction by
shunting blood from
the left ventricle to the
aorta then back to the
pulmonary artery and
back into the lungs.
The reasons for changes
in stiffness of the right
ventricle's walls are not
well understood, but
such stiffness is thought
to increase with
hypertrophy of the
ventricle.
Pulmonic Regurgitation
Cardiomyopathy
Characterized by
ventricular chamber
enlargement and
systolic dysfunction
with greater left
ventricular (LV) cavity
size with little or no wall
hypertrophy.
Hypertrophy can be
judged as the ratio of LV
mass to cavity size; this
ratio is decreased in
persons with dilated
cardiomyopathies.
Fatigue, Declining
exercise capacity,
Swelling, Abnormal
heart rhythms, Pulsing
in your neck, An
enlarged liver,
Shortness of breath
with activity.
Heart murmur,
Shortness of breath,
especially during
exertion, Chest pain,
Loss of consciousness,
Fatigue.
Assess lung sounds and
determine any occurrence of
Paroxysmal Nocturnal
Dyspnea (PND) or
orthopnea.
Fatigue, Shortness of
breath, especially
during exertion, Chest
pain, Palpitations,
Enlarged liver, Fainting
with exercise,Exercise
intolerance.
Assess manually peripheral
pulses (with weak rate,
rhythm indicated low
cardiac output).
Breathlessness with
exertion or even at rest,
Swelling of the legs,
ankles and feet,
Bloating of the
abdomen due to fluid
buildup, Cough while
lying down, Fatigue,
Irregular heartbeats
that feel rapid,
pounding or fluttering,
Chest pain, Dizziness,
lightheadedness and
fainting.
Decreased cardiac output
related to reduced
myocardial contractility
Percutaneous balloon
valvuloplasty and is done
when a resting peak
gradient is seen to be
>60mm Hg or a mean
>40mm Hg is observed.