Polish up on client care

Calcium channel blockers: nifedipine

(Procardia), verapamil (Calan), diltiazem
(Cardizem)
Low-dose aspirin therapy
Nitrates: nitroglycerin, isosorbide dinitrate
(Isordil)

INTERVENTIONS AND RATIONALES

Obtain an ECG during anginal episodes to
detect evidence of ischemia.
Assess cardiovascular status, vital signs,
and hemodynamic variables to detect evidence
of compromise.
Administer sublingual nitroglycerin and
oxygen for anginal episodes to provide pain
relief.
Monitor intake and output to detect changes
in fluid status.
Monitor laboratory studies. Evaluate
cardiac enzymes to rule out MI. Obtain lipid
panel to determine need for diet changes and
lipid-lowering drugs.
Encourage the client to express anxiety,
fears, or concerns to help him cope with his
illness.

45

circulating bacteria or fungi that flourish and

produce friable verrucous vegetations. Such
vegetations may cover the valve surfaces,
causing ulceration and necrosis; they may
also extend to the chordae tendineae, leading
to their rupture and subsequent valvular
insufficiency.
Untreated endocarditis is usually fatal,
but with proper treatment, about 70% of
clients recover. The prognosis is worst when
endocarditis causes severe valvular damage,
leading to insufficiency and heart failure, or
when it involves a prosthetic valve.

CAUSES
Enterococci
I.V. drug abuse
Mitral valve prolapse
Prosthetic heart valve
Rheumatic heart disease
Streptococci (especially Streptococcus
viridans)
Staphylococci (especially Staphylococcus
aureus)

CONTRIBUTING FACTORS
Teaching topics
Explanation of the disorder and treatment
plan
Medications and possible adverse effects
Limiting activity, alcohol intake, and
dietary fat
Smoking cessation, if appropriate
Taking nitroglycerin for chest pain
Contacting the American Heart
Association

Endocarditis
Endocarditis is an infection of the endocardium, heart valves, or a cardiac prosthesis
resulting from bacterial or fungal invasion.
This invasion produces vegetative growths on
the heart valves, the endocardial lining of a
heart chamber, or the endothelium of a blood
vessel that may embolize to the spleen, kidneys, central nervous system, and lungs. This
disorder may also be called infective endocarditis and bacterial endocarditis.
In endocarditis, fibrin and platelets
aggregate on the valve tissue and engulf

313419NCLEX-RN_Chap03.indd 45

Coarctation of the aorta

Degenerative heart disease
Marfan syndrome
Pulmonary stenosis
Subaortic and valvular aortic stenosis
Tetralogy of Fallot
Ventricular septal defects

ASSESSMENT FINDINGS
Anorexia
Arthralgia
Chills
Fatigue
Intermittent, recurring fever
Loud, regurgitant murmur
Malaise
Night sweats
Signs of cerebral, pulmonary, renal, or
splenic infarction
Valvular insufficiency
Weakness
Weight loss

I never promised
you a rose garden.
Vegetative growths
on my valves lead to
endocarditis.

DIAGNOSTIC TEST RESULTS

Blood test results may include normal
or elevated WBC count, abnormal histiocytes

4/8/2010 7:01:44 PM