Disorders of cardiac Oxygenation and perfusion: Infective Endocarditis, AAA, Valvular disease, TAVR, Cardiac Arrest Flashcards
1
Q
Infective endocarditis
A
- Microbial infection on the endothelial surface of the heart
- Rare, high mortality (14-22% die in hospital, 40% die within one year)
- Develops mainly in older pts or those with prosthetic heart valves or devices
2
Q
Staphylococcal endocarditis
A
- Infection of the valves in the right side of the heart (Tricuspid and pulmonic)
- More common in IV drug users
3
Q
Hospital acquired Infective endocarditis
A
- Occurs mainly in debilitated pts
- Long term indwelling cath
- Pts receiving dialysis or prolonged IV antibiotics
4
Q
Pericardium
A
- Outermost layer of the heart
- 2 thin fibrous layers that contain fluid to protect the heart from friction
5
Q
Myocardium
A
- Middle muscular layer of the heart
6
Q
Endocardium
A
Innermost layer of the heart, comes into contact with the blood
7
Q
Infective endocarditis (IE) Patho
A
- Injury to the endocardium leads to the formation of a clot, Bacteria such as staph or strep invade the clot
- Plt, fibrin, microorganisms cluster as vegetations on the endocardium
- Vegetations may embolize to other vessels in the body
- As the clot on the endocardium continues to expand the infecting organism is covered by a new clot, concealing it from the body’s defenses (Making a lot of chemotherapy kinda useless)
- Infection may erode through the endocardium into underlying structures, causing tears, abscesses and deformities
8
Q
Vegetations
A
- Similar to biofilm, its an aggregation of bacteria or some other micro organism
- Resistant to treatment due to how effectively it is anchored to the tissue
- Able to break off from the main cluster to colonize somewhere else in the body
9
Q
Manifestations of IE
A
- S+S develop from toxic effects of the infection, destruction of heart valves and embolization of pieces of vegetation
- Primary presenting S+S are Fever and heart murmur ~85% of patients, and if the murmur gets worse so is the pt
- Clusters of petechiae may be seen as well
- Small painful nodes (Osler nodes) may be seen in the pads of fingers and toes
- Roth spots may be seen as well
- Splinter hemorrhages
- Embolization, leading to stroke
- Heart failure due to valve deformity
With the presence of emboli, every area of the body has a presentation
10
Q
Roth spots
A
- Clinical manifestation of IE
- Hemorrhages with pale centers caused by emboli
- Can be seen in the Eye
11
Q
Osler nodes
A
Small painful nodules seen in the pads of fingers and toes
12
Q
Splinter hemorrhages
A
Clinical manifestation of IE
* Red-brown lines and streaks seen under the proximal half of nails
13
Q
HF indications: IE
A
- Indicates poor prognosis with meds alone and needs surgery
- HF is the most frequent complication and may result from valve deformity from the vegetation
14
Q
Embolic stroke
A
- 22-50% of pt with IE have embolization
- 65% if emboli target the CNS
15
Q
Risk factors for IE
A
- Prosthetic cardiac valves or prosthetic material
- Implanted cardiac devices (Pacemaker, ICD)
- History of bacterial endocarditis (Even without HD)
- Congenital heart disease patients (Repaired or unrepaired)
- IV drug abuse
- Body piercing (Especially oral, nasal, nipple)
- Hemodialysis pts
Essentially anything foreign to the body
16
Q
Diagnositic testing IE
A
- Microorganism found in two seperate blood cultures. And vegetation is found in imaging of heart (Echocardiogram and transesophageal echo)
- 2 sets of blood cultures, from different venipuncture sites over 24 hours, must be drawn 2 hours apart before antibiotics can be started
- Negative blood cultures don’t rule out IE (can embolize any time)
- You may see elevated white blood cell counts, elevated ESR and C-reactive proteins
17
Q
Med mgmt IE
A
- Treatment is focused on eradication of invaded organisms through the use of appropriate antibiotics
- Antibiotics are given for 2-6 weeks in high enough doses to ensure eradication of dormant bacteria with dense vegetations
- Blood levels of antibiotics are drawn to ensure high enough levels, and repeat blood cultures are done
- After antibiotics are given the patient should begin to feel better, less fatigued
18
Q
Surg mgmt of IE
A
- May be needed if pt develops
1. HF or an intracardiac abscess
2. Recurrent systemic embolizations
3. If antibiotics do not clear infection - Surgery includes, valve repair, debridement of abscess and fistula closure
- Most pts with prosthetic valve IE require a new valve replacement
19
Q
Nursing mgmt of IE
A
- Vitals: Making note of fevers
- Admin antibiotics and education of pt
- Timing of antibiotics to ensure high enough levels
- Good infection control practices for RN and pt (Handwashing and all that)
- Monitor for S+S systemic embolization
- Patient care is directed to mgmt of infection, monitor invasive lines and wounds for S+S infection
- Education is provided regarding activity, meds and S+S infection
- Pts with IE are at high risk for another episode of IE
20
Q
S+S systemic embolization: IE
A
- Neuro changes
- CP
- Dyspnea
- Weakness
- Pain
21
Q
Aneurysm
A
- Local sac or dilatation found in a weak point in the wall of an artery
- Classified by shape or form
- Most common or saccular and fusiform
22
Q
Saccular aneurysm
A
- Projects from one side of the vessel
23
Q
Fusiform aneurysm
A
Dilatation of the entire artery
24
Q
Abdominal aortic aneurysm (AAA)
A
- Aneurysm of the descending aorta
- Most common cause is atherosclerosis
25
Q
Who is most affected by AAA
A
- Men are 2-6 times more likely than women to be affected
- White people more than black people
- Most prevalent in people under 65
26
Q
Most common location AAA
A
Infrarenal, below the renal arteries
27
Q
Patho AAA
A
- Dmg to the media layer of the vessel
- May be caused by congenital weakness, trauma, or disease
- Once it develops it tends to enlarge
28
Q
Risk factors AAA
A
- Genetic predisposition
- Nicotine use
- HTN (1/2 of pts have HTN)
29
Q
Clinical manifestations: AAA
A
- 40% of people have symptoms, can feel heartbeat in abdomen when lying
- Most important indication of AAA is a pulsatile mass in the middle and upper abdomen
- If Aaa is associated with thrombus, a major vessel may be occluded or smaller distal occlusions may result from emboli
- Know signs of impending rupture
30
Q
Signs of impending rupture AAA
A
- Severe lower back pain
- Abdominal pain (Middle or lower abdomen, left of midline)
- Falling BP (BP going down= less blood in the system)
- Decreased blood count (Bleeding internally means less blood flow to go around)
31
Q
Rupture into peritoneal cavity AAA
A
- Rapidly fatal
- Contained peritoneal rupture leads to hematoma formation in
1. Scrotum
2. Perineum
3. Flank
4. Penis
32
Q
AAA diagnostic testing
A
- Ultrasound or CTA to determine size, length and location
- If its small, ultrasounds are given Q 6 mo until the size increases to the point where surgery is warranted, some stay stable over years
- Most AAA occur in 60-90, rupture is likely with HTN and aneurysms greater than 6 cm wide
33
Q
AAA risk factors for rupture
A
- > 6cm
- HTN
34
Q
When is a patient considered for surgery: AAA
A
If the older pt is a surgical risk, the aneurysm is not repaired until its 5.5 cm wide
35
Q
Med mgmt: AAA
A
- Antihypertensive agents
- Diuretics
- BB
- Ace inhibitors
- ARBS
- Calcium channel blockers
