CHAPTER 1 Cardiovascular System^29
NURSING INTERVENTION
- Place patient in a semi-Fowler’s position for comfort, which eases respira-
tory effort. - Record intake and output of fluids.
- Monitor vital signs to assess for increased respiratory rate, arrythmias.
- Monitor electrocardiogram to look for changes from previous tracing.
- Explain to the patient: fluids restriction may be necessary as heart failure is
a concurrent disease with dilated cardiomyopathy.- Record daily weight and call physician if weight increases 3 lbs (1.4 kg).
- No smoking or drinking alcohol.
- No straining during bowel movements.
- Increase exercise.
Endocarditis
WHAT WENT WRONG?
Microorganisms, usually bacteria, enter the blood stream and attach to the inner
lining of the heart (endocardium) and heart valves, resulting in inflammation.
Ulceration and necrosis occur when microorganisms cover the heart valves. This
usually occurs in patients with rheumatic heart disease or degenerative heart dis-
ease; those with recent instrumentation (IV, GU, and respiratory procedures) or
dental procedures; and IV drug users.
PROGNOSIS
The prognosis depends on both the organism (as some are more virulent than others)
and the degree of damage to the heart. Myocarditis may recur.
HALLMARK SIGNS AND SYMPTOMS
- Chills/fever—due to infectious process.
- Petecchiae on the palate, beneath the fingernails, osler nodes (painful, dis-
colored, raised areas on fingers and feet), Janeway lesions (painful lesions on
palms and soles).
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