Cardio - valves, infection, surgery Flashcards
myocarditis - also called - AND are men or women most at risk? (mei likes men)
Inflammatory cardiomyopathy, men most at risk.
myocarditis - what is the most frequent virus that causes it? (Mei has herpes) - what symptoms will you have?
most frequent virus. toxins also can cause it. if virus causes it, then you’ll have a fever.
most common cause of dilated cardiomyopathy/myocarditis (mei has covid)
(mei and brad appeared after Lupe had a transplant)
Lupus (SLE), hypersensitivity reactions, transplant rejection
COVID 19 and other viruses including influenza
S & S of cardiomyopathy/myocarditis (mei has symptoms in her PECCS)
Palpitations, SOB, chest pain, edema, CHF.
treatment of cardiomyopathy/myocarditis (Mei can sometimes solve her own problems)
Identify and treat cause, manage symptoms. sometimes resolves on its own. Can even do heart transplant if it’s bad.
nursing care cardiomyopathy - how to assess it, and assess for what? (monitor brad)
Cardiac monitor, assess for CHF
myocarditis patho (mei has direct damage, then secondary)
myocardium is damaged directly, then immune response causes secondary damage. usually entire myocaridum is affected.
myocarditis - what labs are used to diagnose it?
check inflammatory stuff - c-reactive protein, BNP, proteins, troponins
myocarditis complications (Mei is an athlete)
cardiomyopathy and dsyrrhymias that lead to death (usually the cause in young athletes)
myocarditis - should be on constant (my telemetry)
telemetry
myocarditis - lung assessement (the usual)
check for crackles and edema. jugular vein distention, weight gain, urine output. kidney function.
myocarditis - activities?
restrict activities
endocarditis
Inflammation/infection of the inside of the heart (inner most layer)
endocarditis - patho (Tjan has veggies and leaves)
Infection forms vegetations/thrombi inside the heart that break off from the valve leaflet; emboli disseminate
endocarditis - Destruction of valves, walls, chordae tendinae cause (Tjan loses his vents in Co)
loss of function and impaired ventricular filling (decreased CO)
endocarditis - Back up of blood causes
lung congestion
endocarditis - causes (think of the case study) (rheumy causes the end)
age,
Rheumatic heart disease, history of previous endocarditis
Prosthetic valve
IVDU
Contaminated invasive devices
Hemodialysis
Immunosuppression
Dental caries or gum disease
endocarditis - IV drug users usually have what side heart failure?
right-sided
endocarditis risk factors
hemodialysis, anyone with tons of IVs, biopsies
endocarditis patho (Tjan is turbulent)
turbulent blood flow usually affects heart valves, platelets and fibrin deposit on injury, the vegetations form and cause more damage.
endocarditis - clinical manifestions - what about a murmur? (think case study)
red pads of fingers and toes, painless spots on soles of feet (janyway) splinters under nails (blood clots) usually a new heart murmur, and HF, night sweats, weight loss. fever, confusion.
endocarditis - how to diagnose (tjan gets 2 blood tests and an ECG)
blood tests from 2 different sites. echo cardiogram, CBC
endocarditis treatment
IV antibiotics, usually 4 - 6 weeks or longer. repeat blood cultures until they test negative.
endocarditis - nursing care - monitor for what?
Monitor for organ failure, emboli (vegetatian breaks off 50% of the time), serial blood cultures, progressive exercise, education and rehabilitation
endocarditis - assessment (lungs, heart, etc) (tjan gets the same assessment)
check for crackles and edema. jugular vein distention, weight gain, urine output, decreased cap refill
pericarditis - acute or chronic?
can be acute or chronic.
causes of chronic pericarditis (C. Perry has uremia, TB, radiation, trauma and cancer)
TB, radiation exposure, trauma, uremia, metastatic cancer
causes of acute pericarditis (C. cute Perry also has TB, radiation, trauma and cancer)
trauma, viral infections (flu), uremia, post cardiac surgery, MI, raditation, neoplasms (tumors),
pericarditis - most common symptom (Peri is mostly causing me pain bc he rubs me the wrong way)
90% pleuritic chest pain. also will hear classic friction rub with pericarditis.
how to tell when pleuritic chest pain is an MI or pericarditis? (Peri feels better when he sits up)
with pericarditis, pain will be relieved with patient sits up (fowlers)
how to diagnose pericarditis (peri’s diagonosis is elevated) (the usual)
echo, ECG, chest xray, EKG - st elevation most common
pericarditis - lung exam? (Peri surprisingly has clear lungs) nothing is backing up in the lungs - think
lungs will be clear
pericarditisis treatment (peri’s treatment depends on the cause)
Depends on cause
pericarditisis complications (peri can be complicated and effusive)
effusion
pericarditis - monitor ECG for what?
Assess & monitor VS, RRED, WBC, cardiac rhythm & ST segment for elevation
pericarditis - heart sounds (peri is muffled)
muffled from fluid
cardiac tamponade (tampon for peri)
blood or fluid have leaked into pericardial sac.
causes of cardiac tamponade (micro peri is the cause of tampons)
MVA (microvascular angina?), RV biopsy, pericarditis
cardiac tamponade - cardiac output and what about pressure? (the tampons are low in Co, but the pressure has increased)
decreased CO, increased CVP (central venous pressure)
nursing considerations for cardiac tamponade - drainage? and check what? (check tampon for drainage with jugular)
monitor mediastinal CT drain (if chest was cracked open to remove fluid in peri). drainage should gradually get less. check JVD w/ normal lung sounds.
Obstructive Shock - what direction of blood flow is obstructed? (There’s an obstruction going forward)
Decreased outflow of blood from the heart or great vessels = low or no cardiac output
NO FORWARD FLOW OF BLOOD
Obstructive Shock treatment
relieve obstruction or pt will die
causes of obstructive shock (shocked by the TPP)
PE, tension pneumothorax, pericardial tamponade
Obstructive Shock - signs (I’m shocked you have no pulse)
decreased bp, pulsus paradoxus (bp decreases with inhalation), narrowing pulse pressure
cardiac surgery - invasive or no?
minimally invasive
complications of cardiac surgery - preload and afterload? Co?
ineffective CO, reduced preload, increased afterload, increased preload
complications of cardiac surgery - is angina normal? Peri? (surgery on gyna is not normal)
infection, pain management (sternotomy hurts), angina (this is a bad sign), neurological dysfunction, pericardial tamponade
nursing assessment - cardiac surgery - BP issues?
Hypotension
Hypertension
Bleeding
cardiac valve disease - more in men or women? (the valves have equal rights)
equal in men and women.
valve disease causes (val is caused by the CCIR cure)
infection, rheumatic fever caused by strep, congential, calcific atherosclerosis.
valve disease types
stenosis
prolapse
valve disease - most common (art is popular valve)
aortic stenosis. least is tricuspid and pulmonic valve (right side less pressure)
first sign of valve disease (val has a murmur)
murmur
valve disease s & s - breathing?
SOB, dyspnea, orthopnea
causes of cardiac valve dysfunction (valves can stop working inside, outside, or it’s mechanical)
inside - heart muscle valves
outside - pericardium
mechanical - faulty valves
valves most likely to be stenotic (2 of them)
aortic and mitral
valves most likely for regurgitation (just one)
mitral
cardiac valve - signs of right-sided HF - liver signs?
the tricuspid, and you’ll get signs of right sided heart failure. (Edema of abdomen, feet and ankles
Fatigue
Weakness
Decreased u/o
Jaundice
Ascites)