Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS3313 Adult Health > Chapter 24 Management of Patients w/Structural, Infectious, & Inflammatory Cardiac Disorders > Flashcards

Chapter 24 Management of Patients w/Structural, Infectious, & Inflammatory Cardiac Disorders Flashcards

1
Q

Functions of the Heart

A

Pumping
-Pumping oxygenated blood to the other body parts
- Pump hormones and other vital substances to different parts of the body

Receiving deoxygenated blood and carrying metabolic waste products from the body

Maintain BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Heart Failure (HF)

A

A clinical syndrome resulting from structural or functional cardiac disorders that impair the ability of a ventricle to fill or eject blood
-The heart is unable to pump enough blood to meet the body’s metabolic demands or needs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Heart Failure Risk Factors

A

Cigarette smoking, obesity, poorly managed diabetes,
and metabolic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The onset of HF is typically a …

A

…morbid consequence of another disease
- CAD, HTN, cardiomyopathy, valvular disorders, and renal dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the primary cause of heart failure?

A

Atherosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pathophysiology of HF

A

Significant myocardial dysfunction occurs before the patient experiences signs/symptoms of HF such as SOB, edema, or fatigue.
- Ischemic Heart Disease
- Hyperthyroidism
- MI
- Valve disease
- Alcohol, cocaine use
- HTN
-> Leads to decreased CO, decreased systemic BP, and decreased kidney perfusion

As HF develops the body compensates to cope with the HF and are responsible for the signs/symptoms.
-Baroreceptor activation
->Stimulation of vasomotor regulatory centers in medulla
-> SNS activation
-> Increased secretion of epinephrine & norepinephrine
- RAAS system activation
* Increased aldosterone secretion
-> Na+ & water reabsorption
Both lead to vasoconstriction
- Increased afterload
- Increased BP & HR

The most common type of HF is systolic HF, also HF w/reduced Ejection Fracture (EF).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

LT Sided Heart Failure

A

Occurs when the LV, the heart’s main pumping power source is gradually weakened
- The heart is unable to pump
O2-rich blood from the lungs to heart’s LT atrium, into the LV and on through the body and the heart must work harder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Clinical Manifestations of LT-sided HF

A

Pulmonary Congestion
-Dyspnea & cough
-Crackles & decreased O2 sat
-S3 gallop & orthopnea
-Paraoxysmal nocturnal dyspnea (PND)

Decreased Tissue Perfusion
- Decreased CO
- Decreased EF
- Decreased SV
- Increased Catecholamines (impedes perfusion over time)

Progressive Symptoms
- Decreased GI perfusion
- Decreased brain perfusion (lightheadedness, confusion, restlessness, & anxiety)
- Pale, ashen, cool, & clammy skin
- Tachycardia, palpitations, fatigue, nocturia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

S3 Sound

A

Early diastolic sound

Low pitched

Suggest poor systolic function and/or volume overload

Occurs when mitral valve opens & blood enters overfilled ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Paraoxysmal Nocturnal Dyspnea

A

Shortness of breath that occurs suddenly during sleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

RT-Sided Heart Failure

A

Inability of the RT ventricle to fill or eject sufficient blood into pulmonary circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pathophysiology of RT-sided HF

A

Increased venous pressure leads to JVD and ↑ capillary hydrostatic pressure throughout the venous system → systemic clinical manifestations.
* Right-sided failure can occur as a result of left-sided failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical Manifestations of RT-sided HF

A

Jugular vein distension (JVD) - From increased venous pressure

Dependent edema of the lower extremities

Hepatomegaly: Results from enlargement of the liver from venous
engorgement

Ascites due to fluid in the peritoneal cavity

Loss of appetite from nausea & pain

Generalized weakness: Decreased CO & impaired circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Ascites

A

Accumulation of serous fluid in the peritoneal cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Acute Decompensated Heart Failure (ADHF) Early Clinical Manifestations

A

1) Increase in RR

2) Decrease in PaO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Acute Decompensated Heart Failure (ADHF) Later Clinical Manifestations

A

1) Interstitial edema

2) Tachypnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Acute Decompensated Heart Failure (ADHF) Further Progression Clinical Manifestations

A

1) Alveolar edema

2) Resp Acidemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Nursing Process for Heart Failure

A

Assessment – effective of therapy, self-care strategies, explore emotional status

Health History – focus on the signs/symptoms of HF, ask about # of pillows used for sleeping (compensation for orthopnea), edema, abdominal symptoms, AMS, ADLs, and understanding of HF

Physical Examination
 LOC (↓ O2 to the brain)
 Respirations and lungs fields are auscultated to detect crackles and wheezes
 Evaluate BP for hypotension or hypertension
 Auscultated heart for S3 heart sound which is an early sign of ↑ blood volume in the ventricles
 Document HR and rhythm; patient may be placed on continuous ECG if hospitalized
 Assess JVD with the patient sitting at at 45-degree angle (distended > 4cm above sternal angle → Right HF
 Assess pulses, skin, lower legs for edema, abdomen for hepatomegaly, monitor I/O’s, and daily weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Planning & Goals for the Patient w/ HF

A

Promote activity and reduce fatigue

Relieve fluid overload symptoms

Decrease anxiety or increase the patient’s ability to manage anxiety

Encourage the patient to verbalize his or her ability to make decisions and influence outcomes

Educate the patient and family about management of the therapeutic regimen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Diagnostic Testing for Heart Failure

A

Echocardiogram- determines ejection fraction (EF) and confirms dx of HF. An expected EF is 55%-65% of the
ventricular volume. EF is a measure of ventricular contractility

CXR

12-lead ECG

Serum electrolytes & CBC

BUN & Creatinine

Liver function tests

BNP test (Brain natriuretic peptide)- key indicator of HF; high levels are signs of high cardiac filling pressure and
aids in diagnosis and management of HF.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which test is the key indicator for heart failure?

A

BNP test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Normal BNP Level

A

Less than 100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What does a high BNP level indicate?

A

A high BNP level indicates high cardiac filling pressure & the presence of HF
-The higher the BNP, the worse the HF gets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Select Medications for the Patient w/HF

A

Diuretics: ↓ fluid volume overload; observe for electrolyte abnormalities ↑ K+ (spironolactone), ↓ Na, ↓ BP

ACE inhibitors: ↓ BP, ↓ afterload; observe for cough and worsening renal function, ↓ BP, ↑ K+ (critical in the Tx for
CHF

Beta Blockers: dilates blood vessels, ↓ afterload, and improves exercise capacity; observe for ↓ HR, dizziness, fatigue, and symptomatic ↓ BP

Digitalis: Improves cardiac contractility; observe for ↓ HR and digitalis toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Adjunct Therapies for Heart Failure

A

Nutritional Therapy: Low Na+2 diet (no more than 2 g/day) to prevent fluid overload
-Omega-3 supplements are recommended to reduce fatal CV events

Supplemental Oxygen: Oxygen therapy may become necessary as HF progresses based on degree congestion and hypoxia
- Some patients require supplemental oxygen during periods of activity

Management of Sleep Disorders: Sleep apnea is common in HF patients
- Continuous positive airway pressure (CPAP) is suggested to reduce apneic episodes and improve sleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Nursing Process for HF: Health History

A

Focus on the signs/symptoms of HF

Ask about # of pillows used for sleeping
-Assess for paraoxysmal nocturnal Dyspnea

Edema

Abdominal symptoms

AMS

ADLs

Understanding of HF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Nursing Process for HF: Physical Examination

A

LOC (↓ O2 to the brain)

Respirations and lungs fields are auscultated to detect crackles and wheezes

Evaluate BP for hypotension or HTN

Auscultated heart for S3 heart sound which is an early sign of ↑ blood volume in the ventricles

Document HR and rhythm; patient may be placed on continuous ECG if hospitalized

Assess JVD with the patient sitting at at 45-degree angle (distended > 4cm above sternal angle → Right HF

Assess pulses, skin, lower legs for edema, abdomen for hepatomegaly, monitor I/O’s, and daily weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Nursing Interventions for the Patient w/ HF: Promote Activity Tolerance

A

Bed rest for acute exacerbations

Encourage regular physical activity;
build up to about 30 minutes daily

Exercise training

Pacing of activities; wait 2 hours after
eating for physical activity

Avoid activities in extreme hot, cold, or
humid weather

Modify activities to conserve energy

Positioning; elevation of the head of bed to facilitate breathing and rest, support of arms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Nursing Interventions for the Patient w/ HF: Manage Fluid Volume

A

Assess for symptoms of fluid overload

Daily weight

I&O

Diuretic therapy; timing of meds

Fluid intake; fluid restriction

Maintenance of sodium restriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Treatment of Acute Decompensated HF: Reduce Volume Overload

A

Diuretics (Furosemide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Treatment of Acute Decompensated HF: Improve Ventricular Function

A

Vasodilators (IV Nitroprusside, NTG), continuous monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Treatment of Acute Decompensated HF: Increase the force of Myocardial Contraction

A

IV inotropes (Milrinone, Dobutamine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Pulmonary Edema

A

Pathologic accumulation of fluid in the interstitial spaces & alveoli of the lungs causing severe respiratory distress
- This situation demands EMERGENT action to prevent O2 and perfusion
from becoming critical!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Pathophysiology of Pulmonary Edema

A

It’s triggered when the LV fail and blood backs up quickly into the pulmonary circulation causing edema; PE can also develop slowly when caused by noncardiac disorders such as kidney injury

The LV can’t handle the fluid overload → ↑ pulmonary pressure which forces fluid into the capillaries, interstitial spaces, and alveoli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Pulmonary Edema Clinical Manifestations

A

Anxious, pale, cyanotic

Cool and clammy skin

Dyspnea

Orthopnea

Tachypnea

Use of accessory muscles

Incessant coughing w/ frothy, blood-tinged sputum

Crackles and wheezes

Tachycardia

Hypotension or HTN

Abnormal S3 or S4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Medical Management of Pulmonary Edema

A

Easier to prevent than to treat

Early recognition: monitor lung sounds and for signs of decreased activity tolerance and increased fluid retention

Minimize exertion and stress

Oxygen; nonrebreather

Medications

-Diuretics (furosemide)

-Vasodilators(nitroglycerin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Nursing Management of Pulmonary Edema

A

Positioning the patient to promote circulation

-Positioned upright w/ legs dangling

Providing psychological support

Reassure patient and provide anticipatory care

Monitoring medications

-I&O

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Which classification of meds play a pivotal role in the management of HF caused by systolic dysfunction?

A) ACE inhibitors
B) Beta-Blockers
C) Diuretics
D) Digitalis

A

A) ACE inhibitors

39
Q

Which of the following is NOT an appropriate recommendation for an exercise program for the
patient with HF?

A) Follow the exercise period with a cool-down
activity
B) High-intensity training will provide the most
benefit
C) Wait 2 hours after eating a meal before
performing the physical activity
D) Begin with low-impact activities such as walking

A

B) High-intensity training

40
Q

Cardiomyopathy

A

The heart can’t efficiently pump blood to the rest of the body due to a series of progressive events that culminates in impaired cardiac output

41
Q

What is major electrolyte involved with
cardiomyopathy?

A

Sodium

42
Q

Pathophysiology of Cardiomyopathy

A

Decreased SV stimulates the SNS & the RAAS-> Increased systemic vascular resistance & increased Na+ & fluid retention
-> Places an increased workload on the heart

The decrease in CO can be seen on the echocardiogram as a decrease in ejection fraction -> can lead to HF

43
Q

Hypertrophic Cardiomyopathy

A

An autosomal genetic disorder that leads to ↑ heart muscle size and mass
-The heart muscle becomes abnormally
thick
 The thickened muscle impairs the
pumping action of the heart
 Thickness of the heart reduces the size
of the ventricles
 Leads to ventricular hypertrophy &
diastolic failure

44
Q

Dilated Cardiomyopathy

A

The heart muscle begins to dilate,
stretch, and become thin → enlarged
LV
- Most common form of cardiomyopathy
- Impaired contractility causes the
heart to weaken → HF
- Poor blood flow through the ventricle
may → ventricular or atrial thrombi,
which may embolize to other parts
of the body

45
Q

Which type of cardiomyopathy is the most common?

A

Dilated cardiomyopathy

46
Q

Ischemic Cardiomyopathy

A

Term frequently used to describe an enlarged heart caused by CAD
-Usually accompanied by HF

47
Q

Clinical Manifestations of Cardiomyopathy

A

Patients may remain stable and w/out symptoms for many years.

As the disease progress, patients present
with:
 Dyspnea on exertion (DOE)
 Syncope and Fatigue
 Paroxysmal nocturnal dyspnea (PND)
 Cough, Orthopnea, Peripheral edema
 Early satiety, chest pain, palpitations

48
Q

Assessments & Diagnostic Findings Associated w/ Cardiomyopathy

A

History (predisposing factors, family history)

Chest pain

Review of systems: presence of orthopnea,
syncope

Review of diet (Na reduction, vitamin supplements)

Psychosocial history: impact on family, stressors,
depression

Physical assessment: VS, pulse pressure; pulsus
paradoxus; weight gain or loss; PMI; murmurs; S3
or S4; pulmonary auscultation for crackles, JVD,
and edema

49
Q

Nursing Interventions for the Patient with Cardiomyopathy

A

Improve cardiac output and peripheral blood flow
-Rest, positioning (legs down), supplemental O2, medications, low Na diet, avoid dehydration

Increase activity tolerance and improve gas exchange
-Cycle rest and activity, ensure patient recognizes symptoms that indicate the need for rest

Reduce anxiety
-Eradicate or alleviate perceived stressors, educate family about diagnosis, assist with anticipatory grieving

Decrease the sense of powerlessness
-Assist patients in identifying things that have been lost (i.e., ability to play sports), assist patients in identifying amount of control they still have left

Promote home and community-based care
-Educate patients about ways to balance lifestyle and work while accomplishing therapeutic activities
-Assess patient and family and their adjustment to lifestyle changes, educate family about CPR and AEDs, establish trust

50
Q

The nurse is providing education to a client newly diagnosed with cardiomyopathy. Which statement should the nurse use to best describe cardiomyopathy to the client?

A) Cardiomyopathy is another term for high blood pressure.

B) Cardiomyopathy is an abnormal heart rate.

C) Cardiomyopathy causes ineffective pumping of the heart.

D) Cardiomyopathy develops when the kidneys cannot regulate blood
pressure.

A

C) Cardiomyopathy causes ineffective pumping of the heart

Rationale: Cardiomyopathy is a disease process in which the heart is weakened, which interferes with its ability to pump blood through the body. The other statements do not accurately describe cardiomyopathy.

51
Q

Valvular Regurgitation

A

The valve does not close properly, and blood backflows through the valve

52
Q

Valvular Stenosis

A

The valve does not open completely, and blood flow through the valve is reduced

53
Q

Valvular Prolapse

A

The stretching of the valve leaflet into the atrium
during systole

54
Q

Mitral Valve Regurgitation

A

Blood flows from the LV back into the left atrium due to valve not closing properly

55
Q

Clinical Manifestations of Mitral Valve Regurgitation

A

SOB with exertion/SOB lying flat

Fatigue

Reduced ability to exercise

Palpitations

Swelling in legs, abdomen, and neck veins

Chest pain (less common)

A blowing systolic murmur heard at the apex

  • Confirmed w/ Echocardiography
56
Q

Treatment for Mitral Valve Regurgitation w/ HF

A

ACE Inhibitors, Beta Blockers and Valve Replacement

57
Q

Aortic Regurgitation

A

This is a back flow of blood into the LV from the aorta due to the aortic valve not closing tightly

58
Q

Clinical Manifestations of Aortic Regurgitation

A

SOB with exertion/SOB lying flat

Fatigue

Palpitations

Swelling in legs, abdomen, and neck veins

Chest pain or tightness with exertion

High pitched, blowing diastolic murmur at the 3rd or 4th ICS at the left sternal border

59
Q

Treatment for Aortic Regurgitation

A

ACE Inhibitors & Ca Channel blockers for HTN management, and Aortic Valve replacement or Valvuloplasty

60
Q

How is mitral valve and aortic regurgitation confirmed?

A

ECHOcardiography

61
Q

Nursing Management: Valvular Heart Disorders

A

Educate the patient about the diagnosis and treatment

Teach to report new symptoms or changes to the
provider

Explain that bacterium can easily adhere to a diseased heart valve more readily→ Endocarditis and further damage to the valve

Measure VS and compare results with previous data

Assess heart/lung sounds and peripheral pulses
Assess signs/symptoms of HF, arrhythmias, symptoms of syncope, and chest pain

Educate patient to relieve chest pain (angina) with rest
before taking nitroglycerin

62
Q

Nursing Management of Patients with Valvular Heart Disorders

A

Patient education

Monitor VS trends, heart and lung sounds, peripheral pulses

Monitor for complications
-Heart failure
-Arrhythmias
-Other symptoms: dizziness, syncope,
angina pectoris

Medication schedule: plan and education

Daily weights: monitor for weight gain

Plan activities with rest periods

63
Q

Valvuloplasty

A

Cardiac valve repair

64
Q

Annuloplasty

A

Repair of annulus of heart valve

65
Q

Annulus

A

Junction at which valve leaflets connect to the heart wall

66
Q

Leaflet Repair

A

Repair of cardiac valves movable “flaps” leaflets”

67
Q

Candidates for Valve Replacement

A

Patients w/:
-Valves w/extensive calcification
-Severely fibrotic or fused leaflets, chordae tendineae, or papillary muscles

68
Q

Bioprostheses

A

Valves made from animal tissues (heterograft)
-Used for aortic, mitral, & tricuspid valve replacement

Less risk of thromboembolism

Shorter life than mechanical valves

Long-term anticoagulation is not required
-However, patients with biologic valves and atrial fibrillation must be on long-term anticoagulation

69
Q

Homografts

A

AKA “Allografts”

Obtained from cadaver tissue donations used for aortic & pulmonic valve replacement

Not always available-> highly expensive

Lasts for 10-15 yrs

70
Q

Autografts

A

AKA “Autologous Valves”

Obtained by excising the patient’s own pulmonic valve & a portion of the pulmonary artery for use as the aortic valve

71
Q

Mechanical Valves

A

Last longer than biologic

Higher risk of thromboembolism

Require long-term anticoagulation
 INR values of 2.5-3.5 considered therapeutic

72
Q

The nurse is caring for a client with mitral valve regurgitation. Which of the following is an expected assessment finding for this disorder?

A. A High pitched, blowing diastolic murmur
B. A blowing systolic murmur heard at the apex
C. A loud, harsh systolic murmur is heard over
the aortic area
D. A low-pitched, rumbling diastolic murmur

A

B) A blowing systolic murmur heard at the apex

73
Q

Infective Endocarditis

A

Infection of endocardial layer of heart

Endocardial layer continuous with heart valves

Heart valves continuous with endocardium

Valves commonly affected

Vegetations form on valves or endocardial surface
-May become emboli

74
Q

Most Common Cause for Infective Endocarditis

A

Streptococcus viridans and Staph aureus

75
Q

Risk Factors for Endocarditis

A

IV Drug Use

Prosthetic heart valves

Prior endocarditis

Certain heart disorders:
 Cardiomyopathies
 Congenital heart disease
 Acquired valve disease
 Existing cardiac lesions

Implanted Cardiac Devices
 Pacemaker/Cardioverter Defib

Hemodialysis

76
Q

Clinical Manifestations of Infective Endocarditis

A

Onset is usually insidious
Often non-specific
Fever, malaise, weakness, anorexia

Arthralgia, myalgia

Abdominal discomfort

Cutaneous signs
 Splinter hemorrhages: Reddish-brown lines & streaks that may be seen under half of fingernails & toenails

 Osler’s nodes: Small painful nodules

 Roth’s spots: Hemorrhages w/ pale centers caused by emboli (may be observed in fundi of eyes)

 Janeway lesions: Irregular, red or purple, painless flat macules that may be present on palms, fingers, hands, soles, and toes

77
Q

Pathophysiology of Infective Endocarditis

A

1) Clot Formation: Deformity/injury of the endocardium leads to accumulation of fibrin & platelets on the endocardium

2) Infectious organisms invade the clot & endocardial lesion

3) Infection results in platelets, fibrin, blood cells, & microorganisms that clusters as vegetations on the endocardium
-Vegetations may embolize to other vessels throughout the body

4) As the clot on the endocardium continues to expand, the infecting organism is covered by the new clot & concealed from the body’s normal defenses

5) Infection may erode through the endocardium into underlying structures (valve structures) -> causes tears or other deformities of valve leaflets, dehisence of prosthetic valves, deformity of chordae tendineae, or mural abscesses

78
Q

Diagnostic Findings Associated w/ Infective Endocarditis

A

Blood Cultures x2 (aerobic/anaerobic)

Echocardiogram (show vegetation)

Labs: CBC (elevated WBC), Rheumatoid Factor (positive), ESR (elevated), CRP (elevated)

Transesophageal Echo (TEE)-superior in assessing vegetations

79
Q

Prevention of Infective Endocarditis

A

Antibiotic prophylaxis: For those w/previous infective endocarditis, prosthetic heart valves, patients w/ heart transplant & valve regurgitation
- Done before dental procedures

Good Oral hygiene
 Regular dental visits, brushing, flossing, and using plaque removal devices

Increased vigilance required in patients with IV catheters and during invasive procedures
 Nurses must perform meticulous hand hygiene
 All catheters, drains, tubes should be removed when no longer needed

80
Q

Medical Management of Infective Endocarditis

A

Objective of Treatment: Eradicate invading organisms through adequate doses of an appropriate antibiotic

Antibiotic therapy IV for 2 to 6 weeks
 Serum levels of antibiotics and blood
cultures are monitored to gauge
effectiveness of therapy

Patients may require psychosocial support

Confined to home or hospital with
restrictive IV therapy

81
Q

Nursing Management of Infective Endocarditis

A

The nurse monitors the patient’s temperature and administers
antibiotics as prescribed

Ensure planned rest periods and space
activities due to fever→ fatigue

Practice good infection control by nurse, patient, and family members

NSAIDS prescribed for fever and discomfort

Assess heart sounds for new or worsening murmur

Assess all invasive lines and wounds
daily redness, warmth, swelling,
drainage, and tenderness

Educate the patient and family members on activity restrictions,
medications, and signs/symptoms of
infection

82
Q

Pericarditis

A

Inflammation of pericardium, which is the sac enveloping the heart

83
Q

Clinical Manifestations of Pericarditis

A

May be asymptomatic

Chest pain- most characteristic symptom; constant and worsens
with inspiration/relieved by sitting forward

Pericardial friction rub- most characteristic clinical manifestation

Diffuse ST segment elevation

Mild fever, elevated WBC, ESR, CRP, anemia

Non-productive cough or hiccup/SOB

84
Q

Diagnostic Findings Associated w/ Pericarditis

A

Echocardiogram- detect inflammation

TEE

CT imaging: determine size, shape, and location of effusions

MRI: detect inflammation and adhesions

12-lead ECG: may show ST elevations

85
Q

Medical Management of Pericarditis

A

If CO is impaired-> Pt is placed on bed rest until, fever, chest pain, and friction rub have subsided

Analgesics & NSAIDS: Aspirin, indomethacin, or ibuprofen may be prescribed for pain relief during the acute phase
-Corticosteroids (prednisone) can be used as an alternative when NSAIDS are contraindicated

86
Q

Objective of Medical Management of Pericarditis

A

Objective: Determine the cause, administer therapy for treatment & symptom relief & detect signs & symptoms of cardiac tamponade

87
Q

Key Point of Nursing Management of Pericarditis

A

BE ALERT for signs/symptoms
of cardiac tamponade

88
Q

The nurse identifies that a patient has a characteristic symptom of pericarditis. Which symptom does the
nurse recognize as significant for this diagnosis?

a) Dyspnea

b) Constant chest pain

c) Fatigue lasting more than 1 month

d) Uncontrolled restlessness

A

b) Constant chest pain

89
Q

Myocarditis

A

An inflammatory process involving the middle layer of the heart, the myocardium

Can Cause:
- Heart dilation
- Thrombi on the heart wall (mural thrombi)
- Infiltration of circulating blood cells around the coronary vessels & between muscle fibers
- Degeneration of muscle fibers

90
Q

Pathophysiology of Myocarditis

A

Usually from an infectious source (viral: HIV, influenza A)
- Can also be autoimmune-related (rheumatic fever or autoimmune disease)

May begin in 1 small area then spread to the rest of the myocardium
- Degree of myocardial inflammation & necrosis determines the degree of interstitial collagen & elastin destruction

91
Q

Clinical Manifestations of Myocarditis

A

May be asymptomatic as infection resolves

May develop mild-moderate symptoms & seek medical attention (most are flu-like)
- Fatigue
- Dyspnea
- Syncope
- Palpitations
- Occasional discomfort in the upper abdomen & chest

92
Q

Assessment & Diagnostic Findings Associated w/ Myocarditis

A

May reveal no detectable abnormalities (may go undiagnosed)

Tachycardic & complain of chest pain

Endomyocardial biopsy is the most definitive diagnosis
- Cardiac MRI is used more often since it’s non-invasive

Patients w/out initial heart structure abnormalities may suddenly develop arrhythmias/ ST–T wave changes

If the patient has structural abnormalities (systolic dysfunction):
- Cardiac enlargement
- Faint heart sounds (especially S1)
- Pericardial friction rub
- Gallop rhythm or systolic murmur

Labs:
WBC- elevated
C-reactive protein- elevated
Leukocyte count - elevated
ESR - elevated

93
Q

Medical Management of Myocarditis

A

Given specific treatment if underlying cause is known (ex: antibiotics)

Bed rest to decrease cardiac workload

Activities should be limited for a 6 month period or until heart size & function have returned to normal
- Should be increased slowly
- Notify the clinician immediately of any symptoms w/increasing activity (rapidly beating heart)

DO NOT USE NSAIDS FOR PAIN CONTROL!!!
- Implication of increased cardiac injury & viral replication

94
Q

Nursing Management for Myocarditis

A

Assess for resolution of tachycardia, fever, & other clinical manifestations

Focus on signs & symptoms of HF & arrhythmias

Patients w/arrhythmias are to be put on continuous cardiac monitoring w/ emergent equipment ready

Sensitive to digitalis
Watch for signs of toxicity! Notify provider immediately if these symptoms are observed:
- New onset of arrhythmia
- Headache
- Anorexia
- N/V
- Malaise

NURS3313 Adult Health (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions