help with patho- heart and renal

[maanggohs]

I have a 40 something male patient who's main complaint is cardio debility, anemia and risk of bleeding. What does cardio debility even mean. I searched in my books and online and all I came up with online was weakness related to impaired function.

He had MRSA in his bloodstream that resulted in mitral and triscupid regurgitation and aortic insufficiency so that means endocarditis? And he was diagnosied for endocarditis, congestive heart failure, cardiac arrest, MI, coronary artery disease, hypertension, DVT, renal failure, ventricular trachycardia, esophageal reflux.

He denies pain, shortness of breath, palpitation, nausea, vomiting or abdominal pain. has chills/feels cold. Sometimes slightly increased resp. rate. Abnormal lab values related to renal disease. He's on the borderline of fever. got regular heart rate and rhythm but with murmur. And right leg edema. He's learning to walk again with therapy. He's got really fluctuating lab values.

So if his main complaint is cardio debility, and he has so many things wrong with him, where do I even begin to start describing his pathophysiology?

He got some valve replacement and some valvuloplasty.

[Bob_N_VA]

Lots of pts have interrelated disease processes going and they show up as a laundry list of problems that can be confusing at first. In this case, the fact that he has renal failure or insufficiency is not surprising since the kidney is very susceptible to hypertension and infection. I cant say I've ever heard the term "cardiac debility" but looking at the issues he is purported to have : (endocarditis, congestive heart failure, cardiac arrest, MI, coronary artery disease, hypertension) I would say he has serious cardiac issues that will manifest themselves throughout the body.

So if you are working on a concept map, probably starting with his past history, things that may have caused him to have heart problems earlier on such as alcohol or smoking or diet. Relate those to the renal issues which will then also relate to other symptoms as edema. Go into the lab values and look to see which ones help to justify your conclusions about his disease process. If you are stuck, email the clinical instructor. They should be able to help you course correct your map if you havent nailed down the basics. Good Luck.

[nurseprnRN, BSN, RN]

how'd he get the mrsa positive blood cultures that gave him the endocarditis that trashed his valves? iv drug user? or...?

poor guy. he's certainly had a lousy year so far. i'll bet he's going to need cardiac rehab, so you can look at that-- why would he need it, what would he be working on, why, how would you tell he was doing well/worse? if it possible that "cardio debility" is referring to deconditioning since he's been so sick and has had such an unhappy myocardium?

i used to tell my students they had to learn cardiac physiology because every living person they cared for had a heart (if they don't, they're dead and we don't have to work on them anymore). see what you can figure out about cardiac physiology. start with normal blood flow pathways, then look at what goes wrong when this valve, or this one, or that one, or more of them are either too tight, too loose, or both, or particles of garbage/ vegetations go shooting off from the valve. then think about what else in the body gets annoyed about this, and what happens next.

[Music in My Heart]

So if his main complaint is cardio debility, and he has so many things wrong with him, where do I even begin to start describing his pathophysiology?

Start with the basics and, at least initially, ignore all of the other stuff. Then, if the assignment calls for it, expand.

Cardiac debility... as you found, debility means weakness (in fact, the Spanish word for weak is debil)... cardiac weakness... what does a weak muscle mean? It's not contracting strongly enough to accomplish its task... what do we call the condition when the heart isn't able to pump well enough? Heart failure.

Focus on the pathophysiology of heart failure and you'll see that the rest of what you mentioned ties in one way or another... From where does his heart failure originate? Probably from the sepsis and endocarditis. Why?

How does heart failure contribute to renal failure? How does it contribute to thrombosis?

[Music in My Heart]

I have a 40 something male patient who's main complaint is cardio debility, anemia and risk of bleeding.

BTW, is his *complaint* really debility, anemia, and risk of bleeding? Those sound more like diagnoses. His complaints are what he says (for example, "I'm always tired, my legs are swelling, these sores won't heal, my gums are bleeding, I get terrible nosebleeds...") Along the same lines as signs versus symptoms.