Nursing 211

N211: Health Differences Across the Lifespan I

1.20 Infective Endocarditis Infective Endocarditis to the heart valves occurs with the growth of vegetative lesions on valve leaflets. These lesions pose a risk for embolization, erosion or perforation of the valve leaflets, or abscesses within adjacent myocardial tissue. Valvular stenosis or regurgitation, most commonly of the mitral valve can occur, depending on the type of damage inflicted by the lesions, and can lead to symptoms of left or right sided heart failure. Nursing Assessment Chills, fatigue, loud murmur, malaise, night sweats, weakness and weight loss. Diagnostics EKG may show atrial fibrillation. Three or more blood cultures identify the causative organism. Nursing Interventions Teach clients about antibiotics, aspirin and maintaining sufficient fluid intake. Interventions include prevention of anaphylaxis (history of drug allergies before implementing antibiotic), watch for signs of embolization (hematuria, pleuritic chest pain, left upper quadrant pain and paresis). Monitor renal status (BUN, creatinine clearance and output), educate patient in need for prophylactic antibiotics before, during and after any invasive procedures (dental work etc.). Monitor hemodynamic status (vital signs, level of consciousness, urinary output). Administer IV antibiotic for 4 to 6 weeks. Teach clients about anticoagulant therapy. Encourage good hygiene. Instruct clients to inform dentist and other health care providers of history. 1.21 Myocarditis Myocarditis is the focal or diffuse inflammation of the cardiac muscle (middle muscular layer). Myocarditis can be acute or chronic and occur at any age. Recovery is usually spontaneous, without residual defects. Signs and symptoms include arrhythmias (S3 and S4 gallops, faint S1), dyspnea, fatigue, fever. Diagnostics EKG shows diffuse ST-segment and T-wave abnormalities, prolonged PR interval and supraventricular arrhythmias. Biopsy confirms the diagnosis. Nursing Interventions

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