CARDIOVASCULAR SYSTEM ( CVS )
Explain/Define Rheumatic fever
Rheumatic fever is an autoimmune collagen disease usually caused by a hypersensitivity reaction to group A, B-hemolytic streptococcal (GABHs) infection.
In rheumatic fever, inflammatory lesions of connective tissues and endothelial tissues occur. It usually affects the heart, joints, blood vessels, and other connective tissues.
Mainly the cardiac valve (mainly the mitral valve) is affected. These diseases are mainly seen in children aged 5 to 15 years.
Rheumatic fever is commonly seen due to genetic conditions, environmental factors, unhygienic living conditions, poor dietary intake.
Explain the Etiology/cause of the Rheumatic fever.
Due to group A B-hemolytic streptococcal infection (GABHS),
Due to the immune response,
Due to genetic factors,
Due to environmental factors
Due to repeated infections,
Due to genetic predisposition,
Due to family history,
Due to unhygienic conditions,
Due to poor dietary intake,
Due to increased immunological response.
Explain the Clinical manifestation/ sign and symptoms of the Rheumatic fever.
fever,
joint pain,
Cardiac symptoms such as,
carditis,
heart murmur,
Chest pain.
To see skin races,
Subcutaneous nodule formation,
Chorea (involuntary, rapid movement),
feel tired,
Abdominal pain,
one head,
tachycardia,
malays,
swatting,
Skin rashes,
epistaxis,
anemia,
weight loss,
weakness,
Sotness of breath,
Swelling of the lymph nodes,
Abdominal pain.
Explain the Diagnostic evaluation of the Rheumatic fever.
History taking and physical examination,
laboratory test,
throat culture,
Antistatoplysin O(ASO) titer,
C-reactive protein (CRP),
Erythrocyte Sedimentation Rate (ESR) test,
Electrocardiogram (ECG),
echocardiogram,
Joint Criteria,
Artificial Subcutaneous Nodule Test,
chest x-ray,
blood test,
WBC count test.
Explain the medical management of the Rheumatic fever.
Advise the child to take proper bed rest. Advise the child to take bed rest for at least six to eight weeks.
Advise the child to have a completely nutritious food intake, which should contain adequate amount of protein, vitamins, and adequate amount of micronutrients. And giving advice to the child to avoid spicy food.
Provide proper antibiotic medication to the child.
Ex:= Penicillin.
Provide nonsteroidal anti-inflammatory drug (NSAID) to relieve child’s fever, joint pain and inflammation.
Ex:= Naproxen,
Ibuprofen.
Provide corticosteroid medication to treat the child’s inflammatory condition.
Provide B-blocker and angiotensin converting enzyme inhibitor medicine to relieve the child’s cardiac symptoms.
Providing anticoagulant medicine to prevent blood clots in the child.
If the child has any epileptic condition then provide antiepileptic medication.
Ex := Sodium valporate.
Provide analgesic meditation to relieve the child’s pain level.
Ex:= Acetaminophen.
Monitoring the child properly and continuously.
Explain the Nursing management of the Rheumatic fever.
Provide continuous bedrest to the child.
Continuously monitoring the child’s body temperature.
Provide adequate nutritious and bland diet to the child.
Obtaining all adequate information from the child’s parents.
Get all the child’s laboratory tests done.
Getting information about the child’s sleep pattern.
Giving complete bed rest to the child.
To check the child’s vital signs like temperature, pulse, respiration, blood pressure etc.
To check the child’s heart sound.
Giving prescribed medicine to the child.
Listening to the child’s breathing rate and looking for any abnormalities.
Changing the position of the child every two hours.
Tell the child to do deep breathing exercises every 1 to 2 hours.
Feed the child in small amounts and often.
If the child needs oxygen, give him oxygen.
To check the intake output of the child.
Daily weight check of child.
If necessary, give supplements to the child.
Monitor the child for any complications.
Give the child food that is low in salt, low in fat and low in calories.
Tell the child not to put salt on the food.
Ask the child to do their daily routine activities in small increments.
Tell the child to take some rest during the activity.
Providing psychological support to the child.
Ask the child to describe his feelings.
Asking the child to undergo mind diversional therapy.
Explain all the procedures for the disease and its treatment to the child and his family members.
Providing proper knowledge for child’s diet and follow-up.
Congestive cardiac failure (CCF) is also called congestive heart failure (CHF). Inadequate cardiac output In congestive cardiac failure, the heart cannot work (pump) properly due to accumulation of fluid around the lungs and thickening of the muscular layer of the heart. Therefore, the amount of cardiac output imparted by the heart cannot be produced in the body.
Therefore, the blood cannot be transported in an adequate amount throughout the body, so the required amount of blood does not reach all the parts of the body, so oxygen and nutrition are also not available to the cells, tissues and organs. This alters the function of the heart.
Explain the Etiology/cause of the congestive cardiac failure.
Congestive cardiac failure is mainly caused by any abnormality of the heart muscle such as
Myocardial infection,
Hypertension,
Valvular heart disease,
cardiomyopathy,
Dysrhythmias.
Due to chronic lung disease.
hemorrhage,
anemia,
anesthesia,
surgery,
Physical or emotional stress,
Due to congenital heart defect,
Due to cardiomyopathy,
due to infection,
Due to genetic disorder,
Due to rheumatic heart disease,
Due to Kawasaki disorder,
Due to metabolic disorders,
hyper lipidemia,
coronary artery disorder,
Because of family history
Explain the clinical manifestation/sign and symptoms of the congestive cardiac failure.
Breathing difficulties,
dyspnea,
feel tired,
weakness,
Poor growth and development,
fluid retention,
cyanosis,
Increase in heart rate,
Cough,
feeding difficulties,
Liver enlargement,
swatting,
nocturia,
sleeplessness,
becoming restless,
Elevated blood pressure,
in Ade,
weight gain,
upper abdominal pain,
Distended jugular vein
Abnormal fluid accumulation in the body,
anorexia,
nozia,
Cardiomegaly.
Explain the Diagnostic evaluation of the Congestive cardiac failure
History taking and physical examination,
electrocardiogram,
ECG,
Chest X-ray,
Cardiac Catheterization
Radionuclide ventriculogram.
Explain the medical management of the congestive cardiac failure.
Giving the child a diuretic medicine such as frusemide.
Providing angiotensin converting enzyme inhibitor medicine to the child.
Providing the child with a digitalis group medication such as digoxin.
This medicine increases the contractility of the heart and helps the heart to beat more forcefully.
Giving the child beta blocker group drugs like atenolol, metoprolol, these drugs reduce the workload of the myocardial layer and prevent fetal dysrhythmias.
Administering aldosterone antagonist drugs reduces sodium retention, thus activation of the sympathetic nervous system and cardiac remodeling.
Provide proper ion supplementation to treat the child’s anemic condition.
Provide proper antibiotic medicine to the child.
Administer vasodilator therapy.
Explain the surgical management of the congestive cardiac failure.
Coronary Angioplasty,
Coronary Artery Bypass Surgery,
implantable cardiac fibrillators,
Intra Aotic Balloon Pump,
Left Ventricle Assist Device,
Heart transplantation
Cardiac Resynchronize Transplantation Therapy.
Explain the complications of the congestive cardiac failure.
heart failure,
Cardiac dysrhythmias,
myocardial failure,
renal failure,
pneumonia,
Pulmonary embolism.
Explain the nursing management of the congestive cardiac failure.
Obtaining all adequate information from the child’s parents.
Get all the child’s laboratory tests done.
Getting information about the child’s sleep pattern.
Giving complete bed rest to the child.
To check the child’s vital signs like temperature, pulse, respiration, blood pressure etc.
To check the child’s heart sound.
Look at the child’s nails, skin, face, tongue to see if there is any pallor.
Giving prescribed medicine to the child.
Giving the child a fowler position.
Listen to child’s lung sounds.
Listening to the child’s breathing rate and looking for any abnormalities.
Changing the position of the child every two hours.
Tell the child to do deep breathing exercises every 1 to 2 hours.
Feed the child in small amounts and often.
If the child needs oxygen, give him oxygen.
Giving diuretic medicine to the child.
To check the intake output of the child.
Daily weight check of child.
If necessary, give potassium as a supplement to the child.
Monitor the child for any swallowing.
Give the child food that is low in salt, low in fat and low in calories.
Tell the child not to put salt on the food.
Ask the child to do their daily routine activities in small increments.
Tell the child to take some rest during the activity.
Providing psychological support to the child.
Ask the child to describe his feelings.
Asking the child to undergo mind diversional therapy.
Explain all the procedures for the disease and its treatment to the child and his family members.
Providing proper knowledge for child’s diet and follow-up.
Infective endocarditis means infection and inflammation in the innermost layer of the heart, myometrium, is called infective endocarditis. Infective endocarditis sometimes also involves the valves of the heart (mainly the mitral valve). It is usually caused by bacterial, viral and fungal infections.
If infective endocarditis involves the myocardium of the heart and other vital organs such as the brain and kidneys, it is considered a medical emergency.
Explain the Etiology / cause of Infective Endocarditis
Due to bacteria,
due to virus,
Due to fungal infection,
Due to Streptococcus viridans,
Staphylococcus aureus,
E coli,
Pseudomonas aeruginosa,
HACEK Organism (Haemophilus, Actinobacillus, Cardiobacterium, Ecanella, Kingella).
Explain the Clinical manifestation/ Sign and symptoms of Infective Endocarditis.
fever,
feeling cold,
night sweating,
malays,
anorexia,
joint pain,
Splinter haemorrhage (under nail and conjunctiva),
clubbing,
anemia,
hematuria,
GI bleeding,
feel tired,
weakness,
Heart murmur (abnormal heart sound),
Janive lesions (painful, red spots on palms and soles).
Osler’s nodes (painful, tender nodules on finger pads and toes).
Petechiae (small, redish-purple spots on screen and mucus membrane usually caused by bleeding within the skin).
Roth spot (retinal hemorrhage with pale center).
Splenomegaly (enlargement of the spleen).
Abnormal heart sound.
Sotness of breath.
Weight loss.
Explain the Diagnostic evaluation of Infective Endocarditis
History taking and physical examination,
blood culture,
echocardiography,
ECG,
Immunological Investigation,
blood examination,
Urine Examination,
radionuclide test,
Mild to moderate leukocytosis,
Erythrocyte Sedimentation Rate (ESR),
x a,
Ultrasonography.
Explain the Management of Infective Endocarditis
Immediate management status of infective endocarditis.
Provide proper antibiotic medication to the child.
Ex:=
gentamicin,
streptomycin,
cefazolin,
ampicillin,
coxacillin,
amikacin,
Vancomycin.
Provide proper antifungal medication to the child.
Ex:=
Amphotericin-B,
5- Fluorocytosine.
Advise the child to take adequate bed rest.
To provide proper work and comfortable environment to the child.
To provide proper position to the child.
Advising the child to perform daily routine activities in small amounts.
To properly monitor the child’s vital signs.
Properly assess the child’s cardiovascular status and renal function.
Assess the child for any signs and symptoms of drug toxicity.
To carry out proper laboratory investigation of the child.
Advising the parents of the child to maintain proper oral and dental hygiene and general cleanliness of the child.
Maintain proper aseptic technique while handling the child.
Providing prophylaxis antimicrobial agents to the child before and after dental procedures.
Maintain proper aseptic technique during cardiac catheterization and surgery.