Alterations in Oxygenation

1
Alterations in Oxygenation

• Endocarditis, Pericarditis
• Rheumatic Heart Disease
• Valvular Heart Disease

2
Infective Endocarditis

• Inflammation of the endocardium
• S/S
• fever
• myalgia, arthralgia
• chills
• weakness
• malaise
• heart murmurs, heart failure

3

• Diagnosis
• Blood clutures
• WBS
• Sed Rate - 30mm/hr
• Medical Management
• Antibiotics
• Valve replacement

4
Nursing Care/Diagnosis

• Altered comfort Fever
• Decreased Cardiac Output
• Activity Intolerance
• Anxiety
• Altered Health Maintenance
• Altered Nutrition
• Emboli

5
Rheumatic Heart Disease

• Beta-hemolytic Strep
• S/S
• carditis
• polyarthritis
• chorea
• erythema marginatum
• subcutaneous nodules
• Minor - fever, lab findings,throat culture,wbc

6
Management

• Medical
• abtibiotics
• salicylates and steroids
• bedrest
• Nursing - similar to endocarditis
• Risk for injury R/T chorea
• Ineffective management of TX regimen
• Decreased Cardiac Output

7
Patient Teaching

• Disease process
• prophylactic antibiotic
• decrease exposure to strep infections
• good nutrition, hygiene
• adequate rest
• poss. of valve disease - S/S
• PREVENTION

8
Valvular Disease

• Mitral Stenosis
• S/S
• dyspnea
• palpitations
• loud/accentuated S1
• opening snap
• low-pitched, rumbling diastolic murmur

9

• Mitral Regurgitation
• Acute - pulmonary edema
• Chronic - heart failure
• Mitral Valve Prolapse
• murmur
• clicks
• arrhythmias
• occasionally CP

10

• Aortic Stenosis
• poor prognosis
• HF, syncope, angina
• prominent S4, murmur
• Aortic Regurgitation
• exertional dyspnea
• orthopnea
• PND

11
Medical Management

• Prophylactic ATB therapy
• Digitalis, diuretics
• sodium restriction
• anticoagulant therapy
• anti-dysrhythmic therapy
• oral nitrates, B-blockers
• surgical repair-valve replacement

12
Nursing Care

• Prevention
• DX/TX strep infections
• prophylactic ATB therapy
• understand S/S and report
• Care
• provide adequate rest periods
• discourage smoking
• assist with ADL
• Administer ATB

13
Nursing Diagnosis

• Activity Intolerance
• Ineffective management of Tx regimen
• Sleep pattern disturbance
• Pain
• Hypervolemia
• Decreased cardiac output
• Emboli

14
Pericarditis

• S/S
• chest pain, worse with cough,inpiration
• dyspnea
• precordial friction rub
• Complications
• pericardial effusion
• cardiac tamponade

15
Management

• Medical
• ATB
• Steroids
• NSAIDS
• Pericariocentesis
• Nursing
• pain control
• bedrest
• decrease anxiety

16
Chronic Pericarditis

• S/S
• HF - dyspnea, edema, anorexia, fatigue, JVD
• Management
• Pericardiectomy

17
Peripheral Vascular Disease

• Arterial Occlusion
• S/S
• abrupt onset
• 6 Ps
• Treatment
• Anticoagulant tx
• ambolectomy/thrombectomy
• direct infusion - fibrinolytic

18
Chronic Arterial Occlusive Diseasse

• S/S
• intermittent claudication
• ischemic pain _at_ rest
• numbness, tingling
• peripheral neuropathy
• pallor, blanching with elevation pain
• skin - shiny, taut, hairless, poor pulses

19
Complications

• Infection
• necrosis
• ulcers over bony prominences - toes, feet
• Diagnosis
• Doppler ultrasound
• Angiography

20
Management

• Interventions
• stop smoking
• decrease weight
• control of lipid levels
• mange HTN
• slow, progressive activity
• inspection/care of feet
• care of ulcers

21
Surgical Treatment

• PTA
• intravascular stents
• arterial bypass graft
• Nsg Care
• bedrest
• circulatory assessment - CSM checks
• monitor for complications-report to MD
• Heels off bed, OOB 2nd-3d day

22
Patient Teaching

• Discourage smoking
• progressive exercise
• teach foot care
• wear clean, all-cotton/wool socks
• comfortable shoes
• Buergers Disease
• Reynauds Phenomena

23
Venous Disorders

• Thrombophlebitis
• Causes
• stasis of venous flow
• damage to vein
• hypercoagulability of blood
• S/S
• leg edema
• wm skin
• temp
• calf tenderness

24
Nursing Care

• Bedrest
• extremity
• wm, moist heat
• oral analgesics
• avoid massaging
• anticoagulant therapy
• Prevention -KEY

25
Pulmonary Embolism

• S/S
• sudden onset dyspnea, tachypnea, tachycardia
• cough, CP, hemoptysis
• DX - lung scan, ABGs
• Medical Management
• O2, ET intubation/mech ventilation
• T,C, DB
• Anticoagulant TX
• Nursing Care - Prevention measures

26
Anemias

• Reduction in
• Number of erythrocytes
• Quantity of HgB
• Volume of Packed RBCs
• Hypoxia
• Causes
• rapid blood loss
• impaired erythrocyt production
• destruction of erythrocytes

27

• S/S
• integument - pallor, sensitivity to cold
• Resp. - SOB, dyspnea with exertion
• Cardiovasc. - palpitations, tachycardia, CP
• GI - anorexia, red tongue, nausea, constipation
• GU - hematuria, menstrual changes
• Neuro - HA, dizziness

28
Iron Deficiency Anemia

• DX - Hgb less than 9, decreased RBCs, serum iron
• Medical Care- ID cause, supplemental iron
• Nursing Care
• Altered Nutrition
• Risk for Ineffective Management

29
B12/Folic Acid Deficiency

• Pernicious Anemia
• failure to absorb B12
• S/S - low Hgb, Hct, RBCs
• Medical Management
• B12 injections, iron supplements, Folic acid
• blood transfusions
• diet - high iron, folic acid
• Nursing - teach
• Monthly B12 injections
• Diet

30
Aplastic Anemia

• Cause - bone marrow failure
• pancytopenia - anemia, leukopenia,
  thrombocytopenia
• S/S
• decreased RBC WBC, platelet
• fatigue, malaise, dyspnea, infection, bleeding
• Management
• blood transfusion, bone marrow transplant
• Nursing - prevent complications

31
Hemolytic Anemia

• Hemolysis of RBCs - drugs, infection, chemicals,
  hyperactive spleen, trauma
• Treatment
• ID/eliminate cause
• O2
• Fluid/electrolyte balance
• splenectomy
• steroids

32
Other anemias

• Secondary
• Hemorrhage
• Sickle Cell
• S/S - acute pain - joints, extremities, abdomen
• Tx O2, analgesics, IV fluids
• NCP - Pain, Knowledge Deficit

33
Polycythemia Vera

• S/S
• blood volume, viscosity, congestion, risk of
  clots
• Treatment
• decrease blood viscosity, volume, bone marrow
• phlebotomy, myelosuppressive therapy, radiation
• Nursing Care
• Altered tissue perfusion

34
Leukemia

• Acute vs Chronic
• S/S
• fatigue, weakness, wt. Loss, bruising, infection
• bleeding - gums, nose, HA, generalized pain
• Diagnosis
• CBC - abnormal, immature leukocytes
• decreased platelet count
• Treatment - chemo, radiation, transplant

35
Nursing Care - Leukemia

• Risk for Sepsis
• Risk for hemorrhage
• Altered Nutrition
• Body Image Disturbance
• Ineffective Coping/Management of Regime

36
Lymphoma

• Hodgkins
• S/S
• enlarged, painless lymph nodes
• fever, night sweats, wt loss
• enlarged liver/spleen
• back pain
• Diagnosis
• lymph node biopsy

37
Lymphoma - Treatment

• Stage the disease - ID appropriate therapy
• splenectomy
• Stage I and II - radiation, chemo
• Stage III and IV - radiation and multi-agent
  chemo
• Nursing Care
• prevent complications of pancytopenia -
  infection, bleeding