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N160 exam 3 > Endocarditis & Iron deficiency Anemia > Flashcards

Endocarditis & Iron deficiency Anemia Flashcards

1
Q

an inflammation of the endocardium (inner lining of the heart) from a pathogen that has damaged endocardial tissue

A

endocarditis

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2
Q

What are the types of inflammatory diseases of the heart?

A 
 Infective Endocarditis (endocardium)
 Rheumatic Endocarditis
◦A unique form of Infective Endocarditis
 Myocarditis (myocardium)
 Pericarditis (pericardium)
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3
Q

How can infective endocarditis be classified?

A

as an acute or subacute infection

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4
Q

How is acute infective endocarditis caused? Which organism is involved?

A
  • Caused by a new infection

* Organism - frequently staphylococci

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5
Q

How is subacute infective endocarditis caused? Which organism is involved?

A
  • Occurs in an already defective heart valve

* Organism – often streptococci or E.coli

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6
Q

What is infective endocarditis?

A

 Microbial infection of the endocardium

 Deformity or injury of endocardium

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7
Q

What can occur as a result of infective endocarditis?

A

 Results in clot formation on endocardium

 Infective organisms invade clot &; form lesion

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8
Q

What do the lesions (vegatations) form and become as a result of the infective organisms invading and forming a clot?

A

thromboemboli

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9
Q

What are some examples of infective organisms?: (usually bacteria)

A 
◦ Staphylococci, Enterococci or Pneumococci, Streptococci
◦ E.coli
◦ Rickettsia
◦ Fungi – Candida, Aspergillus
◦ Chlamydiae
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10
Q

What can cause the progression of infective endocarditis?

A 
◦ Tears in endocardium
◦ Deformities of valve leaflets
◦ Dehiscence of prosthetic valves
◦ Deformity of the chordae tendineae
◦ Abscesses
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11
Q

What do the signs & symptoms of endocarditis develop due to?

A

 Toxic effect of the infection
 Destruction of the heart valves
 Embolization of fragments of vegetative growths

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12
Q

What are the signs & symptoms of endocarditis?

A 
*fever and new heart murmur 
 Petechiae- skin small pinpoint hemorrhages
 Splinter hemorrhages of nails
◦ Black lines or red streaks on nails
 Roth Spots
 Janeway Lesions
 Osler’s Nodes
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13
Q

What are roth spots?

A

◦ White spots seen on retina

◦ Round or oval

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14
Q

What are janeway lesions?

A

◦ Painless, hemorrhagic lesions

◦ Palms, soles, nose, ear

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15
Q

what are osler’s nodes?

A

◦ Small painful nodules
◦ Tender, red lesions, white centers
◦ On fingers & toes

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16
Q

What are the risk factors for endocarditis?

A 
 Frequent introduction of pathogens
 Valvular heart disease-Valve replacement or repair
 IV drug abuse
 Indwelling IV catheters-esp if IV tip lies near heart
 Recent dental work
 Compromised immune system
 Previous endocarditis
 Recent body piercing or tatooing
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17
Q

What are the labs and diagnostics done for endocarditis?

A

 Inflammatory process:
 Echocardiogram
 Kidney damage
◦ Anemia - low hemoglobin
 Infection:
◦ Positive blood culture-definitive diagnosis
◦ ASO Titer (Antistreptplysion O titer)
 Blood test to measure antibodies produced by
the groups A-Streptococcus bacteria
 A-strep can cause Bacterial Endocarditis

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18
Q

The inflammatory process involves what labs?

A

◦ WBC count, ESR are elevated

19
Q

What does the endocardiogram lab test for?

A

◦ Identify diseased valves
◦ Vegetations-lesions on valves
◦ Ventricular hypertrophy
◦ Heart failure

20
Q

What are the interventions for endocarditis?

A 
 Prevention = best plan
 AHA guidelines for high-risk patient
◦ Prophylactic antibiotics before invasive
procedures
◦ Such as-invasive dental, GI & GU procedure
 Strict aseptic technique
◦ Health care procedures
◦ Invasive lines
◦ Invasive procedures
 Proper hand washing Long-term IV antibiotics
◦ May need long-term IV catheter
◦ Central line or PICC
Monitor labs
◦ Monitor therapeutic antibiotic levels
◦ Effectiveness of medication (temp, WBC)
Discharge referrals –follow up care
Patient education
◦ Home with IV therapy
◦ Home anticoagulant therapy
Monitor for worsening of condition
Monitor for emboli
21
Q

What are the surgical interventions for endocarditis?

A 
Defective valves:
 Surgical debridement
 Surgical repair
 Value replacement
◦ Damaged valve replaced with mechanical
(prosthetic) or biological valve (bovine,
porcine, cadaver)
*Valvuloplasty
*Annuloplasty
*Chordoplasty
22
Q

What is valvuloplasty?

A

 Balloon-tipped catheter inserted via peripheral
vessel into heart
 Balloon inflated in valve to increase valve diameter
 Then balloon removed

23
Q

What is an annuloplasty?

A

 Sternal incision made remove stenotic tissue at valve
 “O” ring is placed in valve leaflets
 Prevents regurgitation

24
Q

What is chordoplasty?

A

 Surgical repair made-shapes chordate tendinease

to prevent regurgitation

25
Q

What is the goal of care for endocarditis?

A

 Endocarditis can be prevented
◦ Goal of initial treatment is avoiding the
infection
 Goal of care- if the patient does develop endocarditis:
◦ Curing the infection
◦ NO residual damage to heart or valves

26
Q

What are the priority nursing diagnosis for endocarditis?

A

 Activity intolerance
 Cardiac Output, Decreased
 Tissue Perfusion, Decreased
 Knowledge Deficit

27
Q

 Blood loss due to bleeding disorders
 Acute / chronic blood loss
◦ Surgical, traumatic
◦ GI bleed

A

anemia

28
Q

What is hypoproliferative anemia?

A

◦Decreased or defective production of RBCs

29
Q

What are the signs & symptoms of anemia?

A 
Affected by the following issues
 Based on the severity
 Speed at which it developed
 Metabolic needs of the patient
 Presence of other problems
30
Q 
 Most common type of anemia
 Causes: either due to
◦ Blood loss
◦ Hypoproliferative: caused by
Decreased RBC
Defective RBC
A

Iron deficiency anemia

31
Q

What are the signs & symptoms for iron deficiency anemia?

A 
Primary S & S
 Weakness
 Fatigue
 Pallor
 Pica – patients craving ice, starch, dirt
32
Q

What are the signs & symptoms for prolonged iron deficiency?

A
  • Tongue soreness
  • Brittle and ridged nails
  • Ulceration in corner of mouth
33
Q

Physiologic Compensation for IDA

Results in these S & S:

A 
 Tachycardia
 Palpitations
 Dyspnea
 Dizziness
 Development of heart failure
34
Q

What are the risk for IDA (iron deficiency)?

A

 Blood loss
 Dietary deficiency
 Inability to absorb iron
 Pregnancy

35
Q

What are the labs and diagnostics for iron deficiency anemia? Are the labs increased or decreased with this disease?

A

 Ferritin levels (decreased)
 Hemoglobin levels (decreased)
 Serum iron levels (decreased)
 Total Iron Binding Capacity = TIBC (decreased)
 Hematocrit (decreased)
 RBC count (decreased)
 Mean Corpuscular Volume (MCV) (decreased)

36
Q

What are the nursing diagnosis for iron deficiency anemia?

A 
Fatigue R/T :
 Decreased oxygen carrying ability of blood ( Hgb)
Altered nutrition:
 Less than body requirements of iron
Altered tissue perfusion R/T:
  blood volume & H&H
Noncompliance with prescribed therapy
37
Q

What are the nursing interventions for iron deficiency anemia?

A 
Prioritize activities
◦ Balance activity and rest – block care
Healthy diet
◦ Limit alcohol
◦ Dietary supplements
◦ Risks for iron overload
Monitor VS
◦ Pulse oximetry
◦ BP
Promote medication compliance
Monitor for & manage heart failure
Patient education
38
Q

What types of foods are recommended, that are high in iron, for iron deficiency anemia?

A 
 Beans
◦ Black, garbanzo, pinto
 Nuts
 Dried Fruit— prunes, raisins
 Whole grains
 Iron-fortified breads & cereals
 Meats
◦ Especially red meat, beef & organ meats (liver)
 Poultry
 Fish & shellfish
 Egg yolks
 Dark green, leafy vegetables
39
Q

What are the available medications available for iron deficiency?

A

 ferrous fumarate-po
 ferrous gluconate-IV
 iron sucrose-IV
 ferrous sulfate – po (varied amounts of iron)

40
Q

What patient teaching is important for the medication available for iron deficiency?

A 
 Timing with food
 Best absorbed on an empty stomach
 Eat iron rich foods with Vit C
 Need for fiber-iron supp. cause constipation
 Avoid staining of the teeth
 Stool color change - dark
41
Q

What are the parenteral supplements available for iron deficiency anemia?

A

Iron dextran or iron sucrose

42
Q

What are the nursing considerations for the parenteral supplements available for iron deficiency anemia?

A 
 IM dose given via the Z-track
 IV diluted
 May cause a severe allergic reaction
 Delayed reaction (1-2 days later)
◦ Flu-like symptoms may occur
43
Q

What are the medication safety measures for iron deficiency anemia?

A 
 Iron unbound to transferrin is toxic
 Accidental poisoning can occur
 Safety measures:
 Keep medications in a secure place
 Keep meds in original containers
 Keep meds tightly closed
 Use childproof lids
 Do not refer to medications/vitamins
as“candy”
44
Q

How is the care for iron deficiency anemia evaluated?

A

 Show improvement all cited nursing diagnoses
 Maintain normal iron-deficiency related lab values
 Symptoms may start to improve within a few
days of treatment
 Recovery is a slow process
 Cause of the anemia is corrected
 3-6 months for body’s iron stores to replenish
 Cause may never be discovered or may not be correctable - lifetime treatment
 Modifications in plan of care - if the patient is not improving

N160 exam 3 (7 decks)

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