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New Mix > Cardiac - inflammation > Flashcards

Cardiac - inflammation Flashcards

1
Q

Endocardium

A

Inner most layer of the heart
Includes the heart valves

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2
Q

Myocardium

A

Thickest layer of the heart
Middle layer

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3
Q

Pericardium

A

Outer most layer of the heart and consists of two layers

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4
Q

What is ineffective endocarditis?

A

Infection of the innermost later of the heart (endocardium) and includes the heart valves

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5
Q

What is the pathology of endocarditis?

A
  1. Caused by blood turbulence in the heart which allows bacterial, fungal or viral organisms to infect valves or other endothelial surfaces
  2. Inflammation leads to vegetation formation as microbe stick to endothelial surfaces
  3. Infection spreads and damages the heart valves and supporting structure like the myocardium
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6
Q

What occurs when the heart valves are damaged?

A

Effects electrical conduction, leads to dysrhythmias and heart blocks

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7
Q

If endocarditis spreads to the myocardium what can happen?

A

heart failure

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8
Q

Vegetation on heart can cause…

A

It can cause an emboli in the blood stream because they are fragile and break off

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9
Q

The three categories of risk factors for endocarditis include?

A
  1. Cardiac
  2. Non-cardiac
  3. Procedural
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10
Q

Cardiac risk factors include? (6)

A
  1. Prior endocarditis
  2. Prosthetic heart valve
  3. valvular disease
  4. Rheumatic heart disease
  5. Congenital heart defects
  6. Pacemakers
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11
Q

How do cardiac issue put the patient at more risk for endocarditis?

A

Makes the heart more susceptible to pathogens
Basic procedure hold an additional risk due to this

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12
Q

Non-cardiac risk factors include?

A
  1. Hospital acquired infections
  2. IV drug abuse
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13
Q

Procedural risk factors include?

A
  1. Intravascular devices
  2. Dental work
  3. Tonsillectomy
  4. Wound infections
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14
Q

What is recommended for those at high risk for endocarditis when underling a procedure?

A

prophylaxic antibiotics

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15
Q

Why is endocarditis hard to diagnose?

A

the s/s are non-specific and they don’t occur in all cases

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16
Q

What are the clinical manifestations of endocarditis? (8)

A
  1. Fever
  2. New heart murmur or worsening heart murmur
  3. Flu-like symptoms
  4. AV heart block
  5. Vascular manifestations due to microembolization of vegetation
  6. Heart failure often r/t LS valve dysfunction (s/s look like LSHF)
  7. Decrease CO –> decreased UO, SOB
  8. Further damage to valves
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17
Q

Vascular manifestation: Oslers nodes

A

blotchy red patches on hands from endocarditis - mainly on fingers

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18
Q

Vascular manifestation: Janeway’s lesions

A

Small round bruise like dots on bottom of feet

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19
Q

Is left-sided embolization common? what valves does it affect?

A

Yes it is common
Affects the aortic and mitral valves so enters arterial circulation and s/s are based on where the blood goes

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20
Q

Spleen left embolization s/s

A
  1. Sharp LUQ pain
  2. Splenomegaly
  3. Abdominal rigidity
  4. Local tenderness
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21
Q

Kidney left embolization s/s

A
  1. Flank pain
  2. Hematuria
  3. Renal failure
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22
Q

Limbs left embolization s/s

A
  1. Ischemia
  2. Limb infarction
  3. Gangrene
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23
Q

Brain left embolization s/s

A
  1. Hemiplegia
  2. Ataxia
  3. Aphasia
  4. Visual changes
  5. Altered LOC
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24
Q

Is right side embolization common?

A

No

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25
Q

Lungs right embolization s/s

A

PE:
1. Dyspnea
2. Chest pain
3. Hemoptyosis
4. Respiratory arrest

26
Q

What is endocarditis caused by?

A

systemic bacterium

27
Q

How do you diagnose endocarditis?

A
  1. Patient history and physical
  2. Blood cultures
  3. Echocardiogram
  4. Chest X-ray
  5. ECG
  6. Cardiac Catheterization
28
Q

Endocarditis: history and physical

A

invasive procedures in the last 6 months

29
Q

Endocarditis: blood cultures

A

90% are positive
Indicates systemic bacterium

30
Q

Endocarditis: Echocardiogram

A

visual vegetation on heart valve

31
Q

Endocarditis: ECG

A

first or second degree block

32
Q

When are antibiotics not effective for endocarditis?

A

Fungal and prothetic valve endocarditis so they are often candidates for early valve replacement

33
Q

Treatment of endocarditis

A
  1. Antibiotics: IV at hospital, continued antibiotics at home
  2. Valve replacement
34
Q

Nursing care endocarditis

A
  1. Assessment
  2. Goal - return to normal heart function
  3. Education
  4. Monitor for fever
  5. Maintain perfusion, body temperature, and increase activity intolerance
35
Q

What should you include in the assessment for a patient with endocarditis?

A

Tells us how the treatment is working
1. Pain
2. Activity intolerance
3. Listen to heart to see if worsening murmur
4. Look for skin abnormalities

36
Q

What education should be included or a patient with endocarditis?

A
  1. Prevention - those at high risk
  2. Oral hygiene
  3. Prophylactic therapies
  4. S/S of complications like PE, Stokes, HF
37
Q

What is acute pericarditis?

A

Inflammation of the pericardial sac

38
Q

How many layers is the pericardium composed of and what are they?

A
  1. Visceral/epicardium: covers the heart
  2. Parietal/pericardium: sac that contains the heart
39
Q

What is the cause of pericarditis?

A
  1. infectious process like bacteria, fungal or viral
  2. non-infectious injury
  3. Hypersensitive/autoimmune response like a rheumatic fever
40
Q

What is the pathology of pericarditis?

A

Inflammatory process that increases pericardial vascularity and leads to fibrin deposits on the pericardial sac

41
Q

How many hours after an MI are you at an increased risk for acute pericarditis?

A

48-72 hours after

42
Q

Clinical manifestations of pericarditis are?

A
  1. Progressive, sharp chest pain
  2. Dyspnea d/t pain with inspiration
  3. Pericardial friction rub
43
Q

What makes the chest pain r/t pericarditis worse?

A

respiration and laying supin
Can radiate to back or shoulder

44
Q

What is the chest pain r/t pericarditis relieved by?

A

sitting up and leaning forward

45
Q

What does a pericardial friction rub sound like and where is it best heard?

A
  1. High pitched grating sound
  2. Best osculated over the lower left sternal border of the chest while patient is leaning forward
46
Q

What are the complications of pericarditis?

A
  1. Pericardial effusion
  2. Cardiac tamponade
47
Q

What is a pericardial effusion?

A

fluid in the pericardium - between the visceral and parietal layers
can compress nearby structures like that lungs or phrenic nerve

48
Q

What can a pericardial effusion lead to?

A

cardiac tamponade

49
Q

What is a cardiac tamponade?

A
  1. Develops as a pericardial effusion that increased in volume –> compression of the heart –> decreased CO
  2. Patient begins to report chest pain and appears anxious/ confused and experiences Becks triad
50
Q

What is Becks triad and what is it associated with?

A

Hypotension, distended neck veins and muffled heart sounds
Associated with cardiac tamponade

51
Q

Diagnostics for pericarditis is?

A
  1. ECG
  2. Echocardiogram
  3. Doppler imaging
  4. CT/MRI
  5. Chest x ray
  6. Elevated troponin
52
Q

What does an ECG look like with pericarditis?

A

Widespread ST elevations

53
Q

What does an echocardiogram show you with pericarditis?

A

most helpful to determine the presences or pericardial effusion or cardiac tamponade

54
Q

What does a CT/MRI show you with pericarditis?

A

view of the pericardial space

55
Q

What does a chest x ray show for pericarditis?

A

enlarged heart d/t pericardial effusion

56
Q

What does an elevated troponin tell you with pericarditis?

A

indicates myocardial damage

57
Q

What is the treatment for pericarditis?

A
  1. Identify and treat the underlying problem
  2. Antibiotics for infectious processes
  3. NSAIDS for pain and inflammation
  4. Corticosteroids for inflammation
  5. Pericardiocentesis
  6. Pericardial window
58
Q

What is a pericardiocentesis procedure?

A

long needle inserted into pericardial space to remove fluids and relieve cardiac pressure
life saving procedure that is a definitive treatment for cardiac tamponade

59
Q

Nursing care for a patient with pericarditis looks like

A
  1. Manage pain and anxiety
  2. Best rest - provide overbid table for patient to lean on for support
  3. HOB over 45 degrees
  4. Education - explain why the pain and all procedures to decrease anxiety
  5. Monitor for decreased CO and cardiac tamponade
60
Q

What do you do if you suspect a cardiac tamponade?

A

notify the provider immediately

61
Q

Is pain a priority for care for pericarditis

A

priority consideration
PQRSTU is essential

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