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46 Cardiovascular system

prompt intervention and treatment and decreases the risk of heart failure progressing to pulmonary edema. Provide reassurance by teaching the client and his family about this disease and the need for prolonged treatment. Tell them to watch closely for fever, anorexia, and other signs of relapse about 2 weeks after treatment stops. Suggest quiet diver-sionary activities to prevent excessive physical exertion. Having the client and his family involved in care gives them a feeling of control and promotes compliance with long-term therapy. Make sure a susceptible client under-stands the need for prophylactic antibi-otics before, during, and after dental work, childbirth, and genitourinary, GI, or gyneco-logic procedures to prevent further episodes of endocarditis.

Teaching topics Explanation of the disorder and treatment plan Medications and possible adverse effects Recognizing symptoms of endocarditis; notifying the physician immediately if symp-toms occur Need for prophylactic antibiotics before, during, and after dental work, childbirth, and genitourinary, GI, or gynecologic procedures

Heart failure

Heart failure occurs when the heart cant pump enough blood to meet the bodys meta-bolic needs.

Heart failure can occur as left-sided failure or right-sided failure. Left-sided heart failure causes mostly pulmonary symptoms, such as shortness of breath, dyspnea on exertion, and a moist cough.

Right-sided heart failure causes systemic symptoms, such as peripheral edema and swelling, jugular vein distention, and hepatomegaly.

CAUSES Atherosclerosis Cardiac conduction defects (in left-sided failure)

(macrophages), elevated ESR, normocytic normochromic anemia (in 70% to 90% of endocarditis cases), and positive serum rheumatoid factor (in about one-half of all clients with endocarditis after the disease is present for 3 to 6 weeks). Echocardiography may identify valvular damage. ECG may show AF and other arrhythmias that accompany valvular disease. Three or more blood cultures in a 24- to 48-hour period identify the causative organism in up to 90% of clients.

NURSING DIAGNOSES Activity intolerance Decreased cardiac output Risk for injury

TREATMENT Bed rest Maintaining sufficient fluid intake Surgery (in cases of severe valvular damage) to replace defective valve

Drug therapy Antibiotics: based on infective organism Aspirin

INTERVENTIONS AND RATIONALES Before giving antibiotics, obtain a client history of allergies to prevent anaphylaxis. Observe for signs of infiltration and inflam-mation, possible complications of long-term I.V. drug administration, at the venipuncture site. Rotate venous access sites to reduce the risk of these complications. Watch for signs of embolization (hema-turia, pleuritic chest pain, left upper quadrant pain, and paresis), a common occurrence during the first 3 months of treatment. These signs may indicate impending peripheral vascular occlusion or splenic, renal, cerebral, or pulmonary infarction. Monitor the clients renal status (BUN levels, serum creatinine, creatinine clearance, and urine output) to check for signs of renal emboli or evidence of drug toxicity. Observe for signs of heart failure, such as dyspnea, tachypnea, tachycardia, crackles, jugular vein distention, edema, and weight gain. Detecting heart failure early ensures

Antibiotics are a key treatment

for endocarditis. Be sure to administer

antibiotics on time to maintain

consistent antibiotic blood levels.

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