NCM 112 Lesson # 3

Topic: Inflammatory Disorders Date:09/08/2022

INFLAMMATORY

DISORDERS
Pericardium
 double-walled sac that surrounds the of the
heart
Visceral pericardium (Epicardium)
 Covers the heart
 Composed of single layer serosal investment
Parietal pericardium
 Lines the cavity
 Composed of two layers: a serosal lining and a
fibrous sack.
Pericardial fluid
 fluid in between the inner wall of the
pericardium and the heart
 Cushions and protects your heart from outside
forces.
 Normal: 10-50 mL of pericardial fluid.
INFECTIOUS BACTERIAL MICROORGANISMS
 These microorganisms affect the pericardium and the pericardial fluid leading to DRYING UP
 1. GABHS (Group A Beta haemolytic streptococcus)
o Causative agent for SORE THROAT  RHEUMATIC FEVER  RHEUMATIC
HEART DISEASE  ENDOCARDITIS  ACUTE GLOMERULONEPHRITIS
2. Staphylococcus Aureus
3. HITA (Haemophilus Influenzae Type A)
4. Streptococcus Pneumoniae
o Causative agent for PNEUMONIA
INFLAMMATORY DISORDERS
I. PERICARDITIS
 Inflammation of the pericardium thereby
causing friction due to rubbing of the
heart
 Causes heart murmurs

II. PERICARDIAL EFFUSION/

CARDIAC TAMPONADE
 Heart is drowning in its own blood
 Extra fluid builds up putting pressure on the
heart and preventing from pumping well
 Manifestation is through BECK’s TRIAD
1. QUIET HEART SOUNDS/ MUFFLED
HEART SOUNDS/ DISTANT HEART
SOUNDS
2. JUGULAR VEIN DISTENTION (JVD)
3. HYPOTENSION
 Treatment can be done by giving DIURETICS
and ASPIRATING FLUID
 o PERICARDIOCENTESIS – a doctor inserts a needle through the chest wall, tissue, and
around the heart. A catheter will be inserted to drain excess fluid.

III. MYOCARDITIS

 Inflammation of the heart muscle (myocardium) reducing its ability to pump blood.
 Similar to Coronary
Artery Disease (CAD)
 CausesChest pain, shortness of breath, and rapid or irregular heart
rhythms (arrhythmias).

IV. ENDOCARDITIS
 Life-threatening inflammation of the inner lining of
the heart’s chambers and valves.
o especially BICUSPID/MITRAL,
AORTIC, and PULMONIC
VALVE
 The lining is called the
endocardium/endometrium.
 Causes RHEUMATIC HEART
DISEASE and RHEUMATIC
FEVER
 Treatment is done by giving
BROADSPECTRUM
ANTIBIOTICS and preventing
SORETHROAT
o The key to prevention is by gargling
SALINE WATER
ASSOCIATED VALVE DISORDERS:
a. MITRAL PROLAPSE – floppy flaps that opens on its own
b. MITRAL STENOSIS –narrowed valved requiring stronger pump causing strain and reducing
blood flow
c. MITRAL REGURGITATION – fluids goes back because it is not closed properly/
completely
d. AORTIC STENOSIS
e. AORTIC REGURGITATION
f. PULMONIC STENOSIS

Both Aortic Stenosis and Regurgitation cause

LEFT SIDED HEART FAILURE
 Replacement of valve
 Administer Blood Thinners
(ANTICOAGULANTS) since
they are prone to blood clots.
Pulmonic Stenosis cause RIGHT SIDED
HEART FAILURE

V. CONGESTIVE HEART FAILURE

 Due to the infection of ENDOCARDIUM
 Occurs when the heart muscle doesn’t pump blood as well as it should  blood often backs up and fluid
can build up in lungs
o Low cardiac output and circulation
o Poor oxygenation
 Most common cause of congestive heart failure is CORONARY ARTERY DISEASE
(CAD)
 Most affected area is the LEFT VENTRICLE
o Most thick and problematic since
it is responsible for
SYSTEMIC
CIRCULATION
1. Left ventricle fills with blood
increasing in pressure
2. Mitral valve opens
3. Blood goes back to the Left
Atrium
4. Travels through the pulmonary
vein to the lungs
5. Increase intrapulmonary
pressure
 6. Fills right ventricle increasing in pressure
7. Opens tricuspid valve
8. Blood goes back to the Right Atrium
9. Travels to the lower extremities and upper extremities
10. Goes back to the organs

A. Left sided heart failure (L = LUNGS AFFECTED)

 WOF: Lung changes (Shortness of breath, DOB, abnormal sounds)
B. Right sided heart failure (R= REST OF THE BODY)
 WOF: Hepatosplenomegaly, Cardiomegaly, ANASARCA (generalized edema)

DIURETICS DOC for Heart failure: DIGOXIN

- make you pass more urine and help relieve
ankle swelling and breathlessness caused
by heart failure
I. THIAZIDE
- Reduce fluid accumulation in the body by
decreasing urinary excretion of calcium
Example: Diuril (Chlorothiazide)
II. LOOP DIURECTICS
- Blocks the absorption of salt and water
from the filtered fluid in the kidney
tubules  increase in urine output
(DIURESIS)
Example: Furosemide Lasix
(Potassium wasting), Spironolactone
(Potassium Sparring)
 LASIX = Long acting Six hours; give banana since it is potassium wasting
2 Qualities:
1. NEGATIVE CHRONOTROPIC – heart
beat becomes slower
2. POSITIVE INOTROPIC – heart beat
becomes stronger
 Monitor APICAL PULSE on 5th ICS at PMI
(Point of Maximal Impulse) <60 bpm
 Monitor client’s POTASSIUM LEVEL for
DIGITALIS TOXICITY:
1. HALOS AROUND LIGHTS
2. SINGLE COLOR VISION (no halo)
 Yellow or green
 Antidote: DIGIBIND (DIGOXIN IMMUNE
FAB)