Chapter 37 & 40 Flashcards
Sensitivity response that develops after an upper respiratory tract infection with group A beta-hemolytic streptococci
Rheumatic Carditis (Rheumatic Endocarditis)
Occurs when chronic pericardial inflammation causes a fibrous thickening of the pericardium
Chronic Constrictive Pericarditis
Inflammation or alteration of the pericardium (the membranes sac that encloses the heart)
Acute Pericarditis
- Microbial infection of the endocardium
- Most common infective organism (Streptococcus viridans and Staphylococcus aureus)
- Port of entry (oral cavity, skin rashes lesions abcesses, infection and surgery or invasive procedures
Infective Endocarditis
Fluid accumulation in the pericardial sac
- hypotension
- jugular venous distention, muffled heart sounds, paradoxical pulse
Cardiac Tamponade
Chest pain caused by a temporary imbalance between the coronary arteries ability to supply oxygen and the cardiac muscles demand for oxygen
Angina Pectoris
may begin expectorating frothy, pink-tinged sputum
-sign of life threatening pulmonary edema
HF becomes very severe
changes in potassium levels
- anorexia, fatigue, blurred vision, and changes in mental status
- Nearly any dysrhythmia, but PVCs most common
- Early signs bradycardia and loss of P wave
Digoxin toxicity
Benefits for patients with chronic HF with sinus rhythms and A Fib
- increase contractility
- Reduce HR
- Slowing of conduction through the atrioventricular node
- Inhibition of sympathetic activity while enhancing parasympathetic activity
Digoxin
the aortic valve, leaflets do not close properly during diastole and the annulus (the valve ring that attaches to the leaflets) may be dilated, loose, or deformed
-Asymptomatic for many years
Symptoms
-exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea
Aortic Regurgitation
Patients develop murmur
- HF most common complication, Arterial embolization
- abdominal assessment; rebound tenderness on palpation
- petechiae (pinpoint red spots)
- Positive blood culture is prime diagnostic test
Infective Endocarditis (bacterial endocarditis)
they require antibiotic administration before all invasive procedures and test
Valvular Heart Disease history remind health care providers
Prevent the mitral valve from closing completely during systole
- left atrium and ventricle dilate and hypertrophy
- Symptoms: fatigue ad chronic weakness as a result of reduced cardiac output
- Report anxiety atypical chest pain, and palpitations
Mitral Regurgitation
Usually results from rheumatic carditis, which can cause valve thickening by fibrosis and calcification
-left atrial pressure increases
-left atrium dilates
-pulmonary artery pressure increases
-right ventricle hypertrophies
Pulmonary congestion and right side HF occur first
Mitral Stenosis
occurs because the valvular leaflets enlarge and prolaspe into the left atrium during systole
- Most are asymptomatic.. Report chest pain, palpitations or exercise intolerance
- shape pain localized to left side of heart
- dizziness, syncope, and palpitation may be associated with atrial or ventricular dysrhythmias
Mitral Valve Prolapse (MVP)
Aortic valve orifice narrows and obstructs left ventricular outflow during systole.
-increase resistance to ejection or afterload resulting in ventricular hypertrophy
Aortic Stenosis
from fixed cardiac output: dyspnea, angina, and syncope on exertion
- when CO falls: fatigue, debilitation, peripheral cyanosis
- Narrow pulse pressure
- diamond shaped systolic crescendo- decrescendo murmur noted on auscultation
Aortic Stenosis
Blackouts
Syncope
Occurs when the space between the parietal and visceral layers of the pericardium fills with fluid
Pericardial Effusion
Inability of the heart to work effectively as a pump
-sometimes referred to as pump failure
Heart Failure
Hypertension, coronary artery disease, valvular disease involving the mitral or aortic valve
-decrease tissue perfusion from poor cardiac output and pulmonary congestion from increasing pressure in the pulmonary vessels
Left sided Heart Failure (Ventricular)
- When heart cannot contract forcefully enough during systole to eject adequate amounts of blood into the circulation
- As ejection fraction decrease, tissue perfusion diminishes and blood accumulates in the pulmonary vessels
Systolic Heart Failure (Systolic Ventricular Dysfunction)
Symptoms: inadequate tissue perfusion or pulmonary and systemic congestion
-forward failure because CO is decreasing and fluid backs up into the pulmonary system
Systolic Heart Failure (Systolic Ventricular Dysfunction)
When the left ventricle cannot relax adequately during diastole
-inadequate relaxing or stiffening prevents the ventricles from filling with sufficient blood to ensure an adequate CO
Diastolic Heart Failure (HF with preserved Left Ventricular function)
May be caused by left ventricular failure
- cannot empty completely
- increasing volume and pressure develop in the venous system and peripheral edema results
Right-sided Heart Failure (ventricular)
when CO remains normal or above normal, unlike left and right sided HF
- caused by increasing metabolic needs or hyperkinetic conditions
- not as common
High-output Heart Failure
result of pulmonary problems COPD or pulmonary hypertension
Right-sided HF in the absence of left-side HF is usually
Weakness, fatigue, dizziness, acute confusion, pulmonary congestion, breathlessness, oliguria
- pulse may be tachycardiac (may alternate in strength)
- Respiratory rate typically exceeds 20 breaths/min
- disoriented or confused when HF due to brain hypoxia
- May auscultate crackles and wheezes in lungs
Symptoms of left-sided HF
Increase systemic venous pressure and congestion
- neck vein for distention and measure abdominal girth
- hepatomegaly, hepatojugular reflux and ascites
- dependent edema
- ambulatory patients- ankles and legs
- restricted to bedrest- sacrum
Symptoms of Right-Sided Heart Failure
noninvase diagnostic procedure of choice to visualize the structure and movement of the heart
Echocardiography
Produced and released by ventricles when the patient has fluid overload as a result of HF
B-type Natriuretic Peptide (BNP)
Neurohormones that work to promote vasodilation and diuresis through sodium loss in the renal tubules
Natriuretic Peptides
Enlargement of the myocardium with or without chamber dilation (slightly oxygen deprived)
-Cardiac muscle may hypertrophy more rapidly than collateral circulation can provide adequate blood supply to the muscles
Myocardial Hypertrophy
Causes Na/water retention
Induces vasoconstriction
Increases preload/afterload
Aldosterone inhibitors (spironolactone)
Aldosterone
Reduced blood flow to the kidneys, common in low-output states, results in activation of RAS
-Vasoconstriction becomes more pronounced and aldosterone secretion causes sodium and water retention
Renin-Angiotension System Activation
- increases catecholamines result of tissue hypoxia represents the most immediate compensatory mechanism
- stimulation of the adrenergic receptors causes an increase in HR (beta adrenergic) and BP from vasoconstriction (alpha adrenergic)
- increases HR results in an immediate increase in cardiac output
- Results in arterial vasoconstriction maintaining blood pressure and improving tissue perfusion in low-output states
Stimulation of the sympathetic Nervous System
- observe patient for increased urinary output
- monitor for decreased respiratory distress
- Continue to monitor for improvement
- Think about the possible causes of the patient’s heart failure
- think about your response to the patient
- develop a teaching plan for the patient prevent worsening or recurrent acute episodes of HF
What should you Reflect on Cardiac Problems
- taking VS
- monitoring O2 sat by pulse ox
- performing a complete cardiovascular assessment
- performing a complete respiratory assessment (listen for crackles or wheezes)
- Weighing patient
- Assessing cognition
- Assessing for pain or other symptoms
Should interpret and how to respond to patients experiencing inadequate oxygenation and tissue perfusion as a result of HF (perform/ interpret physical assessment including)
- Report SOB, especially on exertion
- Report of dizziness
- report of weight gain within days
- syncope
- dyspnea on exertion
- report of palpitations
- report of fatigue and weakness
- disorientation or acute confusion (especially in older adults)
- peripheral or abdominal ascites
Might notice if a patient is experiencing inadequate oxygenation and tissue perfusion as a result of HF
subacute or chronic disease of cardiac muscle, and cause may be unknown
- basis of abnormalities in structure and function
- dilated cardiomyopathy
- hypertrophic cardiomyopathy
- restrictive cardiomyopathy
- arrhythmogenic right ventricular cardiomyopathy
Cardiomyopathy
- seeing health care provider immediately or call 911 if patient is not in hospital setting
- Notifying physician/ rapid response team
- raising the head of the bed to a sitting position
- giving O2
- maintaining/ starting IV line
- admin furasemide IV push
- monitoring I and O
- giving ACE inhibitors or ARBs IV or oral
Respond to patient experiencing inadequate oxygenation and tissue perfusion as a result of HF
Observe patient for evidence of improved circulation and oxygenation
- think about what may have caused it
- think about how the nurse may have identified the problem sooner
what should you reflect from hypovolemic shock
applying O2
- assisting the patient to shock position (head and chest flat or elevated to no more than 30 legs elevated)
- Notifying rapid response team
- Ensuring placement of venous access
- increase IV fluid infusion rate
Respond to hypovolemic shock
-arterial blood gas values; pH lower than 7.35
-elevated serum lactate levels
-hemorrhage
decrease hct and hbg
decrease total RBC and platelets
-dehydration
increase RBC, hct, hbg
increase WBC count
Interpret lab values as a result of hypovolemic shock
- pulse rapid and thready
- pulse pressure narrowed
- respirations rapid and shallow
- O2 sat by pulse ox decreases
- skin cyanosis or pallor (in lighter-skinned patients)
- skin cool and clammy
- cyanosis or pallor of the lips and oral mucous membrane (in patients of any skin color)
- patient is restless or anxious
- Urine output that is less than expected compared with fluid intake
- patient states he or she is thirsty
Might notice if the patient is experiencing inadequate oxygenation and tissue perfusion as a result of hypovolemic shock
when the arteries that supply the myocardium are diseased, the heart cannot pump blood effectively to adequately perfuse vital organs and peripheral tissues
Coronary Artery Disease (CAD)
chest pain caused by a temporary imbalance between the coronary arteries ability to supply oxygen and the cardiac muscles demand for oxygen
Angina Pectoris
chest discomfort that occurs with moderate to prolonged exertion in a pattern that is familiar to the patient
- only slight limitation of activity
- usually associated with a fixed atherosclerotic plaque
- relieved by nitroglycerin or rest
Chronic Stable Angina (CSA)
describe patients who have either unstable angina or an acute myocardial infarction
-atherosclerotic plaque in the coronary artery ruptures resulting in platelet aggregation (“clumping”) thrombus (clot) formation, and vasoconstriction
Acute Coronary Syndrome (ACS)
expandable metal mesh devices that are used to maintain the patient lumen created by angioplasty or atherectomy
Stents
Scar tissue permanently changes the size and shape of the entire left ventricle
- decrease function causing heart failure
- scar tissue doesn’t contract or do conduct electricity causing chronic ventricular dysrhythmias surrounding the infarcted zone
Ventricular Remodeling
- observe patient for decrease report of pain and associated symptoms
- continue to monitor O2
- continue to monitor for dysrhythmias and VS
- think about what could have precipitated this coronary events
- think about how you respond
- develop teaching plan for the patient to help prevent further episodes
What should reflect for coronary artery disease
- calling 911 if patient not at hospital
- ensuring that patient rests
- giving O2
- giving nitroglycerin tablet
- maintaining or starting IV line
- admin morphine sulfate if MI suspected or diagnosed
Respond to a patient experiencing inadequate oxygenation and tissue perfusion as a result of Coronary Artery Disease
- take VS
- monitoring O2 sat
- taking 12-lead ECG
- assessing level of consciousness and cognition
- conducting complete pain assessment
- drawing blood for lab assessment (troponins)
- Ausculating breath sounds for crackles and wheezes
- Auscultating heart for abnormal heart sounds (left sided heart failure)
- assessing for peripheral edema (right sided heart failure)
Perform and interpret physical assessment to patient’s experiencing inadequate oxygenation and tissue perfusion as a result of Coronary Artery Disease
- report of pain (chest, shoulder, arm, jaw, back, abdomen)
- report of persistent indigestion
- dyspnea– diaphoresis
- report of nausea
- vomiting
- anxious behavior
- report of palpitations
- report of fatigue
- disorientation or acute confusion (especially in older adults)
Notice if the patient is experiencing inadequate oxygenation and tissue perfusion as a result of Coronary Artery Disease
Infection of the mediastinum
- fever continuing beyond the first 4 days after CABG
- Instability (bagginess) of the sternum
- Redness, induration, swelling, or drainage from suture sites
- an increased WBC count
Mediastinitis by observing for
- sudden cessation of previously heavy mediastinal drainage
- jugular venous distention but clear lung sounds
- pulses paradoxus (BP more tham 10mmHg higher on expiration than on inspiration)
- An equalizing of PAWP and right atrial pressure
- Cardiovascular collapse
Assess for and report manifestations of Cardiac tamponade immediately, including
- fluid (blood) may accumulate around the heart
- fluid compress the atria and ventricles, preventing them from filling adequately and thus reducing cardiac output
Cardiac tamponade
