Endocarditis is an inflammation of the inner layer of the heart. It is usually caused by bacteria, fungi, or viruses entering the bloodstream through invasive procedures like dental work or surgery. The microbes accumulate on the heart valves, forming vegetations that can damage the valves over time. Symptoms may include fever, fatigue, loss of appetite, and heart murmurs. Diagnosis involves blood cultures, echocardiography, and other tests. Treatment requires antibiotics and sometimes valve replacement surgery. Complications can include heart failure, embolism, and stroke if left untreated.
Heart failure (HF) is a common cardiovascular condition with increasing incidence and prevalence. Unlike western countries where heart failure is predominantly a disease of elderly, in India it affects younger age group. Heart failure is a chronic condition in which the heart cannot pump enough blood and oxygen to support other organs in your body.
Angina also known as angina pectoris is a medical condition characterized by chest pain usually left sided due to inadequate blood supply (ischemia) to the heart muscles due to obstruction (like presence of blood clot), narrowing or contraction (vasospasm) of the supplying coronary arteries.
Heart failure (HF) is a common cardiovascular condition with increasing incidence and prevalence. Unlike western countries where heart failure is predominantly a disease of elderly, in India it affects younger age group. Heart failure is a chronic condition in which the heart cannot pump enough blood and oxygen to support other organs in your body.
Angina also known as angina pectoris is a medical condition characterized by chest pain usually left sided due to inadequate blood supply (ischemia) to the heart muscles due to obstruction (like presence of blood clot), narrowing or contraction (vasospasm) of the supplying coronary arteries.
Rheumatic heart disease is a condition in which the heart valves have been permanently damaged by rheumatic fever. The heart valve damage may start shortly after untreated or under-treated streptococcal infection such as strep throat or scarlet fever.
Cardiomyopathy, or heart muscle disease, is a type of progressive heart disease in which the heart is abnormally enlarged, thickened, and/or stiffened. As a result, the heart muscle's ability to pump blood is less efficient, often causing heart failure and the backup of blood into the lungs or rest of the body. The disease can also cause abnormal heart rhythms.
Chronic obstructive pulmonary disorders COPD is a [preventable and treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual clients.
It is characterized by airflow limitation that is not completely reversible.
Rheumatic heart disease is a condition in which the heart valves have been permanently damaged by rheumatic fever. The heart valve damage may start shortly after untreated or under-treated streptococcal infection such as strep throat or scarlet fever.
Cardiomyopathy, or heart muscle disease, is a type of progressive heart disease in which the heart is abnormally enlarged, thickened, and/or stiffened. As a result, the heart muscle's ability to pump blood is less efficient, often causing heart failure and the backup of blood into the lungs or rest of the body. The disease can also cause abnormal heart rhythms.
Chronic obstructive pulmonary disorders COPD is a [preventable and treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual clients.
It is characterized by airflow limitation that is not completely reversible.
Infective endocarditis is an infection of the valves and endothelial surface of the heart. Endocarditis usually develops in people with cardiac structural defects (eg, valve disorders).
shock is the state of insufficient blood flow to the tissues of the body .it contains introduction, definition, stages of shock, types of shock, diagnostic evaluation, prognosis ,prevention, care for each stage.
Running Head Homework 2 Homework 2 Homework 2.docxwlynn1
Running Head: Homework 2
Homework 2
Homework 2
Care plan for MI
NUR3125
Fall 2017
This patient is presenting to the emergency with symptoms that indicate a Myocardial Infarction. The patient, who is a 48-year-old man, is stating a 3-day history of sub sternal chest pain that is radiating to his back. The symptoms started up while he was mowing his lawn. He stated the pain has eased up over time. He also reported mild trouble with breathing and some nausea but no vomiting. He exercises daily, but does report that he eats a lot of fast food. His last total cholesterol was 232 mg/dL. He also has a 15-year history of tobacco use and family history of myocardial infarction (MI), specifically his father had an MI at age 54 and his grandfather at age 58. His current blood pressure is elevated at 158/98 and heartrate of 102 bpm, his respiratory rate is currently high at 26 breaths/min and noted mild use of accessory muscles upon examination. Lungs are noted to have slight inspiratory crackles at both lung bases. Jugular venous distention is noted at less than 2cm bilaterally. His lab work reveals an elevated Troponin at 2.9 ng/ml, elevated Creatinine phosphokinase at 141 units/L, and an elevated CK-MB/CK isoenzyme at 2%. Elevated troponin indicates damage to the heart muscle, and the elevated Creatinine phosphokinase and CK-MB/CK isoenzyme along with all these other symptoms and labs indicate a heart attack. ECG is done and shows ST elevation and T wave inversion, also noted with premature ventricular contractions. The lab values and ST elevation point to a Myocardial Infarction and Transmural ischemia that will require immediate attention.
I have chosen three NANDA nursing diagnoses for this patient, with the first one being the priority. The three I choose are:
· Decreased Cardiac Output related to altered heart rate and ischemia as evidenced by ECG showing an ST elevation, elevated Troponin, and patient stating he has had chest pain for three days.
· Acute Pain related to tissue damage in the myocardium from inadequate blood supply as evidenced by elevated troponin labs and patient reporting chest pain that radiates to back for three days.
· Ineffective Health Maintenance related to deficient knowledge about self-care and treatment as evidenced by patient stating he eats fast food often and has had elevated blood pressure and cholesterol at past appointments, and patient admitting to smoking ½ pack of cigarettes daily despite family history of MI.
Care Plan Diagnosis #1 Myocardial Infarction
NANDA Diagnosis 1: Decreased Cardiac Output related to altered heart rate and ischemia as evidenced by ECG showing an ST elevation, elevated Troponin, and patient stating he has had chest pain for three days.
NOC (Nursing Outcome Classification) Label: Tissue Perfusion
Expected Client Outcomes:
1. Patient will demonstrate adequate cardiac output evidenced by blood pressure, heart rate, and heart rhythm within normal pa.
5. Introduction
The heart is a vital organ that pumps blood and it has three layers
which are endocardium, myocardium and pericadium.
6. definition
• Endocarditis is an inflammation of the inner layer of
the heart, the endocardium. it usually involves the
valves and other structures like the intraventricular
and septum.
7. etiology
Fungus e.g. candida, aspagellus
Gram negative organisms e.g. pseudomonas
Bacterias e.g. staphylococci
Acute rheumatic fever which cause enlarged and
tender lymph nodes, damages the valves
Congenital heart disease
8. Risk factors
Previous heart damage
Dental procedures which lead into the introduction of
bacterias
Heart surgery
Intubations
Procedures involving gastrol intestinal and genitourinaly
tracts e.g.
barium, enemas, sigmoidoscopy, catheterisation and
cytoscopy
Reproductive conditions like delivery of new
babies, abortions and pelvic inflammatory disease
9. pathophysiology
Usually in this case the bacterias or any other causing agents
enter the blood stream through invasive procedures like dental
procedures, surgery , urinary catherisation.
Then they accumulate on the valves of the heart or
endocardium
Finally they form vegetations or crusters
These vegetation they lead into damage heart valves by
perforating and deforming the valves leaflets
This at the end leads to tearing which means there is poor flow
of blood and lead into accumulation of blood in chambers of the
heart hence endocarditis
10. Clinical manifestations
Loss of vision
Ischemia
Fever
Shortness of breath
Shock
Finger clubbing
Myocardial infarction
Weight loss
Malaise
Chills
Night sweats
Chest and abdominal pain
anorexia
11. Diagnostic evaluation
Blood culture; helps in testing the presence of microorganisms
Urinalysis to see microscopic hematuria.
Doppler echocardiography assist in the diagnosis by
demonstrating a muscle on the valve.
Computerized tomography rule out heart damage
Review bun and creatinine levels to evaluate renal function
Review endocardiography finding if available for valvuler and
ventricular function and presence of vegetation
Review white blood cell count to evaluate course if infection
12. Nursing assessment
It includes history taking like;
– Subjective data:
– past medical history: patient asked of signs of the
disease and the onset of the disease and review
with patient history of risk factors like cardiac
failure, shock
– Medication history: has the pt ever taken any
medication, what happened afterwards
– Family history:asked of any case at home of the
similar conditions
13. – Social history: social behaviours that can trigger
the problem
– Surgical history: if ever operated on
– Objective data: assess for temperature
elevations, heart mummer, evidence of cough ,
peripheral edema and embolism, alscultate for
heart sound, monitor arterial blood gas, rapid
purse rate,dyspnea, restlessness and
manifestation of heart failure
14. Nursing diagnoses
Infective breathing pattern related to inflammation of
heart muscle as evidenced by use of accessory
muscle, dyspnea.
Impaired gaseous exchange related to fluid
accumulation in the lungs as evidenced by shortness
of breath
Decreased cardiac output related to valvular
dysfunction as evidenced by poor tissue perfusion
Imbalanced nutrition less than body requirement
related to anorexia as evidenced by loss of weight.
15. Altered thermoregulation related to infection as
evidenced by increased body temperature (fever).
impaired physical mobility related to fatigue
Ineffective tissue perfusion related to embolisation
Anxiety related to hypoxia or life threatening situation
as evidenced by patient verbalization
Altered comfort pain related to use of accessory
muscle as evidenced by patient verbalization
16. Nursing management
Position the patient at semi fowlers position to help in infective
breathing through providing enough room for lung expansion as
abdominal contents goes down
Administer oxygen therapy 4-6 l/min to help pt in breathing
effectively through supplementing oxygen
Monitor arterial blood gas , carbon dioxide, oxygen saturation
hourly and document to monitor signs of respiratory acidosis
Encourage and provide small frequent meals reach in proteins
helping in repairing worn-out tissues
Monitor vital signs , heart and lung sound, level of consciousness
to evaluate how effectively the organs like the heart and the lungs
are working
17. Schedule nursing activities to allow rest
Encourage and assist pt to cough and deep breath to promote
chest expansion
provide tepid sponging to reduce raised body temperature by
evaporation and conduction
Encourage patient on exercises in order to improve patients
mobility through making the body physically fit
Make yourself available to the patient and nurse with love and
respond well to his/her questions to array pain and anxiety
Educate the patient on disease process to make pt cope up
with therapy and the condition
18. Medical management
if the patient is having poor intake of oxygen administer oxygen
therapy 4-6 l/m in helping the patient get supplemented with
enough oxygen
Administer antibiotic treatment like ampicillin + flucloxacilin
+gentamicin
Administer pcm 1g tds p.o as analgesic that help in relieving
pain
Administer inotropic drugs like digoxin that help in increasing
contractility of the heart
The patient can also be administered with morphine which help
to decrease anxiety
20. In conclusion
Endocarditis as explained above it is the inflammation of
endocardium and it brings a lot complications
Therefore:
21. references
PAUL ONEILL (2012), MASTER MEDICINE. SECOND
EDITION
LINTON (2007). INTRO. TO MEDI-SURGE NURSING,4TH
EDITION
•S. Lewis, M. Heitkemper, S. Dirksen, P. Obrien and L.
Bucher (2007) Medical Surgical Nursing; Assessment and
Management of Clinical problems (7th edition)St
Louisi, Mosby.