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MEDSURG CHAPTER 29

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S/S intermittent claudication (cramps in the legs after exercise), one or both ... Trental may be used to improve intermittent claudication ... – PowerPoint PPT presentation

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Title: MEDSURG CHAPTER 29


1
MED/SURG CHAPTER 29
  • CARING FOR CLIENTS WITH INFECTIOUS INFLAMMATORY
    DISORDERS OF THE HEART BLOOD VESSELS

2
RHEUMATIC FEVER RHEUMATIC CARDITIS
  • Rheumatic Fever - Systemic inflammatory disease
    due to group A strep infection of the throat
  • Rheumatic Carditis- inflammatory cardiac
    manifestations acute or later stages affects
    heart valves, esp mitral valve, endocardium,
    myocardium pericardium fig 29-1
  • S/S most common in children 2-3 wks after a
    strep infection carditis, inflammation in the
    layers of the heart, polyarthritis, rash, SQ
    nodules, chorea which is involuntary grimacing
    adults have more vague symptoms

3
RHEUMATIC FEVER RHEUMATIC CARDITIS
  • Treatment IV antx, PCN drug of choice, bedrest,
    aspirin, steroids
  • Nursing care administer meds, focused cardiac
    assessments education re need for prophalactic
    antx before invasive procedures
  • Box 29-1

4
INFECTIVE ENDOCARDITIS
  • Inflammation of the inner layer of the heart
    tissue
  • Caused by a bacteria or fungi, box 29-2
  • Persons with hx of rheumatic fever are most at
    risk
  • Nursing care client teaching, med adm, lifelong
    susceptibility
  • Acute onset less than 1 week from previously
    healthy
  • Insidious onset slight fever, h/a, malaise,
    fatigue. Later may have purplish, painful
    nodules pads of fingers toes (Oslers nodes),
    black longitudinal lines on the fingernails
    (Splinter hemorrhages), pethechiae
  • Treatment high doses of antx, drg therapy table
    29-1, valve replacement

5
MYOCARDITIS
  • Inflammation of the middle (muscle) layer of the
    heart
  • Caused by viral, bacterial, fungal or parasitic
    infection. Mostly viral cause in the US.
  • S/S General chest discomfort, relieved by
    sitting up, low-grade temp, tachycardia,
    arrhythmias
  • Treat the underlying cause, if bacterial give IV
    antibiotics prevent complications
  • Monitoring CP status, daily wts, vs, I O,
    bedrest

6
CARDIOMYOPATHY
  • Chronic condition
  • Structural changes in heart muscle
  • Table 29-1 types
  • Med/surgical mgmt drug therapy pacemakers
    surgical intervention
  • Nursing mgmt
  • Hx
  • focused physical exam
  • O2 therapy
  • medication teaching

7
PERICARDITIS
  • Inflammation of the pericardium the saclike
    structure that surrounds the heart
  • Can be primary or secondary due to endocarditis,
    myocarditis, chest trauma, MI or cardiac surgery
  • Can have effusion or accumulation of fluid within
    the 2 layers of tissue, fig 29-5

8
PERICARDITIS
  • If effusion occurs can lead to cardiac tamponade
    acute compression of the heart leading to
    impaired filling, fig 29-6
  • Pulsus paradoxus, nsy guidelines 29-1
  • S/S fever, malaise, dyspnea, precordial pain,
    which is pain in the anterior chest over the
    heart, this pain may mimic an MI
  • Treatment r/o MI, rest, analgesics,
    antipyretics, NSAIDS, steroids
  • See nursing process

9
THROMBOPHLEBITIS
  • Inflammation of a vein with clot formation most
    common in the veins deep in the lower
    extremities, DVT
  • Caused by venous stasis, altered blood
    coagulation, trauma to the vein
  • Risks inactivity, reduced cardiac output,
    compression of the veins in pelvis or legs,
    injury, birth control pill use, irritating IV
    drugs
  • S/S pain in the affected extremity Homans
    sign, heat, redness, edema to vein

10
THROMBOPHLEBITIS
  • Dx clinical findings, venous doppler,
    venography
  • Treatment bedrest, anticoagulants, warm, wet
    packs, if large vein affected may have
    thrombectomy
  • Nursing care prevention, exercises for at risk
    pts
  • See nursing process

11
THROMBOANGIITIS OBLITERANS (Buergers dz)
  • Intermittent spasms of arteries associated with
    formation of inflammatory lesions which cause
    restricted blood flow to the extremities, usually
    the legs cause unknown
  • More common in young men, aggravated by smoking
  • S/S intermittent claudication (cramps in the
    legs after exercise), one or both feet cold with
    burning, numbness, tingling of the feet, ulcers
    may development

12
THROMBOANGIITIS OBLITERANS (Buergers dz)
  • Treatment restrict tobacco use, Buerger Allen
    exercises, nsy guidelines 29-2
  • Sympathectomy, interrruption of the sympathetic
    nerve pathway to relieve vasoconstriction may be
    performed
  • Nursing
  • teaching tobacco restriction exercises
  • pain control

13
GENERAL NUTRITIONAL CONSIDERATIONS
  • Anorexia wt loss are common side effects of
    infections increase calories protein prn.
    Encourage small, frequent feedings
  • Encourage weight loss in clients with
    thrombophlebitis

14
General Pharmacological Considerations
  • Most clients with PVD have pain, which may be
    treated with non-narcotic analgesics.
  • Trental may be used to improve intermittent
    claudication
  • Coumadin may be prescribed for those with venous
    thrombosis. Monitoring of PT is very important.
  • Vitamin K is given as an antidote for Coumadin
    OD.
  • Heparin may be given for clients with
    thrombophlebitis
  • Clients receiving anticoagulant therapy must be
    closely monitored for signs of bleeding tendency

15
General Gerontologic Considerations
  • Discourage older adults from using electric
    heating devices due to their decreased
    temperature perception
  • Many older have peripheral vascular insufficiency
    manifested by weak or absent pedal pulses cold,
    clammy feet thickened toenails, shiny skin on
    the lower extremeties
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