Ch 36 Valve Disorders (Exam 2) Flashcards
Stenosis (2)
- constriction or narrowing of the valve opening
- results from rheumatic heart disease
S/S of aortic stenosis (3)
- exertional dyspnea main s/s
- loud first heart sound and a low-pitched murmur
- hoarseness/hemoptysis (enlarged LA and pushes against vocal cords)
Regurgitation
incomplete closure of the valve leaflets, resulting in the backward flow of blood
What part of the heart regulates movement of mitral leaflets?
Chordae tendineae
Regurgitation results from?
- ischemic papillary muscle dysfunction
- infective endocarditis (d/t vegetation)
S/S of aortic regurgitation (4)
- thready peripheral pulses
- cool, clammy extremities
- new systolic murmur
- pulmonary edema: crackles on auscultation, SOB, low O2 sat
What is infective endocarditis? Cause of IE?
- infection of the endocardial surface of the heart that affects the heart valves
- staphyloccocus aureus
3 stages of infective endocarditis?
- bacteremia
- adhesion
- vegetation
What is vegetation?
adheres to the valve surface of the endocardium and can embolize to various organs and extremities, causing ischemia and infarction
Clinical manifestations of infective endocarditis? (3)
- hemorrhages and petechiae (formation of lesions on toes and fingers)
- Roth spots: bleeding spots on the eyes
- Osler’s: painful, small spots on tips of fingers/toes
- Janeway’s: not painful
Dx studies for infective endocarditis? (4)
- patient history: past dental procedures, OB/GYN procedures
- echocardiograms: vegetations
- (+) blood cultures
- elevated WBC
Prophylactic treatment for infective endocarditis?
antibiotics given at the dentist to reduce risk of infective endocarditis
Surgical intervention for infective endocarditis?
early valve replacement followed by prolonged (6 weeks or longer) drug therapy for patients with a fungal infection
Nursing considerations for infective endocarditis (2)
- recognize s/s of complications of infective endocarditis (stroke, pulmonary edema, HF)
- fever (early sign that drug therapy is ineffective)
2 types of valve replacement
mechanical (artificial) and biologic (tissue)
Mechanical valve replacement
more durable, lasts longer, risk for thromboembolism, requires long-term anticoagulation
Biologic valve replacement (3)
- bovine, porcine, and human
- no anticoagulation required
- less durable
Cause of rheumatic fever
2-3 weeks post-streptococcal pharyngitis (unresolved strep throat)
Major criteria manifestations of rheumatic fever (4)
- carditis: murmurs of the mitral or aortic regurgitation (mitral stenosis)
- monoarthritis or polyarthritis
- Sydenham’s chorea
- erythema marginatum lesions
Minor criteria manifestations of rheumatic fever (3)
- fever
- polyarthalgia
- lab findings of increased erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
Treatment goal of rheumatic fever (5)
- control and treat infection w antibiotics
- relieve joint pain
- treat fever with antipyretics
- rest
- steroids
Treat pharyngitis with ______
antibiotics (penicillin), requires strict adherence to full course of antibiotic therapy to avoid recurrence
What is pericarditis? Causes of pericarditis? 2 syndromes of pericarditis are?
- inflammation of the pericardium sac with fluid accumulation
- idiopathic or caused by viral/bacterial infection (tuberculosis)
- acute pericarditis and Dressler syndrome
What is acute pericarditis vs Dressler syndrome?
- acute pericarditis: first 48-72 hours after an MI
- Dressler syndrome: 4-6 weeks after an MI
