Help with patho and nursing diagnosis of a patient

akulahawkRN, ADN, RN, EMT-P · Dec 4, 2011

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 (and what's the difference between the two- is it pathophysiologically significant?)

I think you've got the answer buried in your post, actually. Which of all those above diagnoses cause/can cause weakness (think impaired function) of the heart? What issues might a weak heart cause?

maanggohs · Dec 4, 2011

I'm thinking the MRSA bacteria caused the endocarditis. But I don't know if he has coronary artery disease and congestive heart failure before or after the endocarditis.

it would be endocarditis. Could CAD be cause by damaged to the artery by MRSA? CHF could be a complication of the endocarditis.

To answer your question: I feel like every cardio disease he has is a cause for heart weakness!

akulahawkRN, ADN, RN, EMT-P · Dec 5, 2011

I'm thinking the MRSA bacteria caused the endocarditis. But I don't know if he has coronary artery disease and congestive heart failure before or after the endocarditis.
it would be endocarditis. Could CAD be cause by damaged to the artery by MRSA? CHF could be a complication of the endocarditis.
To answer your question: I feel like every cardio disease he has is a cause for heart weakness!

To me, it sounds like the MRSA caused the endocarditis/valve dysfunction. If the valves aren't working correctly does blood flow well through the heart? If some of the myocardium is dead or has been replaced with scar tissue, will it pump efficiently?

CHF can be a complication of many of the other diagnoses you'd listed...

maanggohs · Dec 5, 2011

I came to the conclusion that the MRSA caused endocarditis --> valve dysfunction --> CHF, CAD --> cardiac debility even after surgery.

Esme12, ASN, BSN, RN · Dec 5, 2011

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 (and what's the difference between the two- is it pathophysiologically significant?)

i came to the conclusion that the mrsa caused endocarditis --> valve dysfunction --> chf, cad --> cardiac debility even after surgery.

or......this was one very sick young man.....

did he have htn that lead to the cad the caused the acute mi (probably of the anterior wall involving the lad "the widow maker") http://en.wikipedia.org/wiki/myocardial_infarction anterior wall, common in young men. that caused a massive heart attack (http://en.wikipedia.org/wiki/myocardial_infarction) that affected the mitral valve (mitral reguritation and possible valve replacement) (http://en.wikipedia.org/wiki/mitral_regurgitation) and because the papillary muscle on the heart was affected/ruptured that caused the onset of ventricular tachycardia (a common arrythmis in anterior wall mi's) (http://www.brown.edu/courses/bio_281-cardio/cardio/handout4.htm) and subsequent cardiac arrest. this alone could have lead to his renal failure (http://en.wikipedia.org/wiki/renal_failure) and the weakened heart muscle caused by this massive heart attack that causes the chf(http://en.wikipedia.org/wiki/heart_failure).

http://texasheart.org/hic/topics/proced/vsurg.cfm

which lead to the patient being placed on life support and multiple iv lines, multilumens, pa lines, arterial lines and and heart assisted theray/iabp and foley(http://en.wikipedia.org/wiki/myocardial_infarction) that lead to the acquired infection of mrsa that caused his sepsis (http://en.wikipedia.org/wiki/sepsis)and and subsequent endocarditis and valvular damage ai...... aortic insufficiency (http://en.wikipedia.org/wiki/aortic_insufficiency) that may have required a valve replacement.(http://www.ncbi.nlm.nih.gov/pubmedhealth/pmh0001231/), and tricuspid stenosis (http://en.wikipedia.org/wiki/tricuspid_valve_stenosis) that lead to the valvuloplasty. the sepsis may have required the use of massive amounts of drugs to support his blood pressure which in turn could have damaged his kidney's as well as the multisystem organ failure that accompanies a massive insult to the body caused by the cardiac arrest, mi,and sepsis. (http://en.wikipedia.org/wiki/multiple_organ_dysfunction_syndrome)

the dvt is (http://en.wikipedia.org/wiki/deep_vein_thrombosis) probably a result of prolonged bedrest (or the placement of some lines) and the cause of the right leg swelling and the prolonged bleeding that is caused by the use of the blood thinner given to treat the blood clot and/or the valve. people with mechanical valves must be anticoagulated to prevent clots fom forming on the valve causing dvt's or strokes. the anemia can be caused by prolonged illness/nutrition as well as the surgeries performed and blood loss from the procedures.

valvuloplasty is the repair of a stenotic valve using a balloon catheter inside the valve. the balloon is placed into the valve that has become stiff from calcium buildup. the balloon is then inflated in an effort to increase the opening size of the valve and improving blood flow (http://en.wikipedia.org/wiki/heart_valve_repair).

valve repalcement is exactly what it says.....the damaged valve is replaced with either a mechanical valve or a bio-valve (porcine-pig, and bovine-cow).

http://www.nlm.nih.gov/medlineplus/ency/article/002954.htm

http://en.wikipedia.org/wiki/aortic_valve_replacement

http://en.wikipedia.org/wiki/mitral_valve_replacement

the reasons to choose a mechanical versus bio valve are many, age and tolerance of long term anti-coagulationamong many other factors(http://www.webmd.com/heart-disease/should-i-replace-my-aortic-valve-with-a-mechanical-or-tissue-valve) shorter durability of a tissue valve, which increases the likelihood that you will need another replacement valve, against the drawbacks of taking anticoagulant medicine for the rest of your life or as long as you have a mechanical valve. these medicines can increase the risk of bleeding.

mechanical valves last at least 20 to 30 years in most cases. the greater durability of a mechanical valve makes it less likely that you will have to replace the valve in your lifetime. while mechanical valves can break down, this is very rare.

in spite of chemical treatments to improve durability, tissue valves typically last about 8 to 15 years. they usually fail because of the same calcification process that affected the original valve. tissue valves may also tear or become infected. when tissue valves are used, a second valve replacement may be necessary.

in general, mechanical valves are the preferred choice for children, teens, and adults age 60 and younger, all of whom will likely outlive a tissue valve and need another valve replacement.

tissue valves are most appropriate for people who are less likely to outlive their valves, which includes people who:

are older than 65.
are younger than 60 and have severe lung disease.
have heart failure.
have [color=#3789b9]coronary artery disease.
have kidney disease.
have a life expectancy of less than 10 years.

now after all this....do you understand why the patient is weakened with low activity tolerance? plus the long term bedrest is very debilitating. (http://en.wikipedia.org/wiki/bed_rest) are two.

the heart failure third......

there are many different ways to categorize heart failure, including:

the side of the heart involved (left heart failure versus right heart failure). left heart failure compromises aortic flow to the body and brain. right heart failure compromises pulmonic flow to the lungs. mixed presentations are common, especially when the cardiac septum is involved.
whether the abnormality is due to insufficient [color=#0645ad]contraction ([[systolic dysfunction], to insufficient relaxation of the heart ([color=#0645ad]diastolic dysfunction), or to both.
whether the problem is primarily increased venous back pressure ([color=#0645ad]preload), or failure to supply adequate arterial perfusion ([color=#0645ad]afterload).
whether the abnormality is due to low cardiac output with high [color=#0645ad]systemic vascular resistance or high cardiac output with low vascular resistance (low-output heart failure vs. high-output heart failure).
the degree of functional impairment conferred by the abnormality (as reflected in the [color=#0645ad]new york heart association functional classification [color=#0645ad][9])
the degree of coexisting illness: i.e. heart failure/systemic hypertension, heart failure/pulmonary hypertension, heart failure/diabetes, heart failure/renal failure, etc.

functional classification generally relies on the new york heart association functional classification. the classes (i-iv) are:

class i: no limitation is experienced in any activities; there are no symptoms from ordinary activities.
class ii: slight, mild limitation of activity; the patient is comfortable at rest or with mild exertion.
class iii: marked limitation of any activity; the patient is comfortable only at rest.
class iv: any physical activity brings on discomfort and symptoms occur at rest.

this score documents severity of symptoms, and can be used to assess response to treatment. while its use is widespread, the nyha score is not very reproducible and doesn't reliably predict the walking distance or exercise tolerance on formal testing.[color=#0645ad][10]

in its 2001 guidelines the [color=#0645ad]american college of cardiology/[color=#0645ad]american heart association working group introduced four stages of heart failure:[color=#0645ad][11]

stage a: patients at high risk for developing hf in the future but no functional or structural heart disorder.
stage b: a structural heart disorder but no symptoms at any stage.
stage c: previous or current symptoms of heart failure in the context of an underlying structural heart problem, but managed with medical treatment.
stage d: advanced disease requiring hospital-based support, a heart transplant or [color=#0645ad]palliative care.
http://en.wikipedia.org/wiki/heart_failure

the gerd? well, bedrest or damage to the nerves during openheart... http://en.wikipedia.org/wiki/gastroesophageal_reflux_disease

check this link for the care of a critical heart patient....http://wps.prenhall.com/chet_perrin_criticalcare_1/98/25165/6442471.cw/content/index.html

and cardio-disability?? http://www.freedomdisability.com/social-security-disability-heart-disease-other-cardiovascular-disabilities/

gosh i love sick hearts.....i hope this helps you understand better.....:heartbeat