Page 150 - Critical Care Nursing Demystified

Chapter 3 CARE OF THE PATIENT WITH CRITICAL CARDIAC AND VASCULAR NEEDS 135

open-heart surgery (OHS) or as a result of an infection or tumor. Pericarditis becomes
a severe problem when fluid builds up, placing outside pressure on the inner struc-
tures like the chambers and valves. (See cardiac tamponade in this section.)
Myocarditis Myocarditis is an infection of the myocardium. When cardiac mus-
cle fibers are damaged, they cannot pump effectively. Like pericarditis, myo-
carditis is commonly seen in infections from viruses, bacteria, and fungi.
Endocarditis Infective endocarditis is an invasion of the inner lining of the heart
and valves by microbes. Staphylococci and streptococci tend to invade the heart
valves depositing fibrin and platelets causing stenosis of these valves. Risk factors
for endocarditis include prosthetic heart valves, IV drug use, and valvular dis-
orders. Endocarditis can lead to systemic embolization; so signs of this should
be part of the nursing assessment (see Table 3–17).
The pathophysiology that all of these conditions have in common is that they
affect the pumping efficiency of the heart and therefore can lead to heart failure.

Hallmark Signs and Symptoms

TABLE 3–17 Inflammatory Disease Signs/Symptoms Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Disease Signs/Symptoms
Pericarditis Pain over the heart worsening with movement or breathing
deeply (pleuritic pain)
Pericardial friction rub heard best over the lower-middle left
sternal border
Mild fever
Signs of dyspnea if heart failure occurs
Myocarditis Flu-like initially
Fatigue
Dyspnea and signs of HF if increases in severity
May develop sudden cardiac death in severe HF
Endocarditis Fever
New onset heart murmurs over valves affected
Osler nodes, which are small, painful nodes over the pads of
the fingers/toes
Conjunctival and mucous membrane petechiae
Splinter hemorrhages (reddish-brown lines) of the fingernails
Janeway lesions (painless, red, irregular macules) on the palms,
fingers, toes, and soles of the feet
Vague feeling of malaise