A muscular, cramp-type pain in the extremities consistently reproduced with the same degree of exercise or activity and relieved by rest is experienced by patients with peripheral arterial insufficiency. Referred to as intermittent claudication, this pain is caused by the inability of the arterial system to provide adequate blood flow to the tissues in the face of increased demands for nutrients during exercise.Rubor, a reddish blue discoloration of the extremities, may be observed within 20 seconds to 2 minutes after the extremity is dependent. Rubor suggests severe peripheral arterial damage in which vessels that cannot constrict remain dilated. Even with rubor, the extremity begins to turn pale with elevation.
Repair of an ascending aortic aneurysm and aortic valve replacement. (A) Incision into aorticaneurysm. (B) Aortic valve replacement with aortic graft implant to repair ascending aortic aneurysm. (C) Aortic aneurysm trimmed and closed over graft.
ALTERED OXYGENATION: CARDIOVASCULAR
DISTURBANCES IN OXYGENTRANSPORT MECHANISM Structural Cardiac Disorders
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
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)
Rheumatic Heart DiseaseStrep Throat S/Sx Rheumatic Fever S/Sx• sudden onset of sore • fever throat • painful, tender, red swollen joints• pain on swallowing • pain in one joint that• fever, usually 101–104°F migrates to another one• headache • heart palpitations• red throat/tonsils • chest pain, SOB• abdominal pain, nausea • skin rashes and vomiting may also • fatigue occur, especially in • small, painless nodules under children 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.
• 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 Colleen C. Flores, RN
Clinical ManifestationThoracic Aortic Aneurism May be asymptomatic Pain is usually constant and boring (when patient is supine) Dyspnea, brassy cough, hoarseness of voiceAbdominal Aortic Aneurism Feels that heart is beating in the(AAA) abdomen while lying down May feel abdominal mass or abdominal throbbingDissecting Aneurism of the Sudden severe and persistent painAorta described as tearing or ripping in the anterior chest or back and extends to the shoulders, epigastric area or abdomen
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