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NRSG 110: Med Surg 2 > [Exam 1] Chapter 28: Management of Patients with Structural, Infections, and Inflammatory Cardiac Disorders (Page 791-801, 809-817) > Flashcards

[Exam 1] Chapter 28: Management of Patients with Structural, Infections, and Inflammatory Cardiac Disorders (Page 791-801, 809-817) Flashcards

1
Q

What separates the atria from the ventricles?

A

Atrioventricular valves, and include the tricuspid valve and mitral valve

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2
Q

What does the tricuspid valve separate?

A

Right atrium from right ventricle

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3
Q

What does the mitral valve separate?

A

Separates the left atrium from the left ventricle

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4
Q

Tricuspid valve has how many leaflets

A

Three

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5
Q

Mitral valve has how many leaflets?

A

Two

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6
Q

Both the mitral and tricuspid valve have what?

A

Chordae tendineae that anchor valve leaflets to papillary muscles of the ventricles

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7
Q

What is located between the ventricles and their correspond arteries?

A

Semilunar valves; this includes pulmonic and aortic valve

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8
Q

Where does the pulmonic valve lie?

A

Between the right ventricle and the pulmonary artery

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9
Q

Where does the aortic valve lie?

A

Between the left ventricle and the aorta

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10
Q

What is regurgitation?

A

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

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11
Q

What is Stenosis?

A

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

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12
Q

The mitral valve may also have what?

A

Prolapse

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13
Q

What is valve prolapse?

A

The stretching of an atrioventricular valve leaflet into the atrium during diastole

Chordea Tendinae gets tight so it doesn’t close properly after that. Will see decrease in cardiac output.

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14
Q

What is mitrl valve prolapse?

A

Deformity that usually produces no symptoms.

Cause may be an inherited connective tissue disorder resulting in enlargement of one or both of the mitral valve leaflets

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15
Q

Pathophysiology of mitral valve prolapse

A

Portion of one or both mitral valve leaflets balloons back into the atrium during systole.

Blood then regurgitates from the left ventricle back into the left atrium

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16
Q

Mitral Valve Prolapse: Signs and Symptoms?

A

Most never have symptoms. Few have fatigue, shortness of breath, lightheadness, dizziness, palpitations, chest pain, or anxiety

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17
Q

Mitral Valve Prolapse: Often the first and only sign of mitral valve prolapse is

A

an extra heart sound, referred to as a mitral click. Systolic click is early sign that its ballooning into the left atrium.

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18
Q

Mitral Valve Prolapse: If dysrhythmias are documented and cause symptoms, patients is advised to

A

eliminate caffeine and alcohol from teh diet and to stop the use of tobacco products

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19
Q

Mitral Valve Prolapse: Chest pain that does not respond to nitrates may response to

A

Calcium channel blockers or beta-blockers

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20
Q

Mitral Valve Prolapse: Patients with severe mitral regurgitation and symptomatic heart failure may require

A

mitral valve repair or replacement

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21
Q

Mitral Valve Prolapse: Patients with mitral valve prolapse may be at risk for

A

infective endocarditis from bacteria entered blood stream and adhering to abnormal valve structures.

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22
Q

Mitral Regurgitation: What is this?

A

Involves blood flowing back from the left ventricle into the left atrium during systole

Often edges of valve leaflets do not close completely during systole because leaflets and chordae tendineae have thickened and fibrosed.

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23
Q

Mitral Regurgitation: Most common causes in developed countries are

A

degenerative changes in mitral valve and ischemia of the left ventricle

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24
Q

Mitral Regurgitation: Other conditions that lead to this include

A

Myxomatous Changes, which enlarge and stretch the left atrium and ventricle, causing leaflets and chordae tendineae to stretch or rupture.

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25
Q

Mitral Regurgitation: May result from

A

problems with one or more leaflets, chordae tendineae, annulus, or papillary muscles

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26
Q

Mitral Regurgitation: REgardless of the cause, what always happens?

A

blood regurgitates into the atrium during systole

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27
Q

Mitral Regurgitation: What happens to the lungs with this backward flow?

A

Lungs become congested, eventually added extra strain to the right ventricle.

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28
Q

Mitral Regurgitation: What evantually happens as the atrium continues to expand?

A

The volume overload causes ventricular hypertrophy. The ventricle dilates and systolic heart failure develops

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29
Q

Mitral Regurgitation: Clinical Manifestations?

A

Asymptomatic, but acute mitral regurgitation usually manifests as severe congestive heart fialure.

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30
Q

Mitral Regurgitation: Most common symptoms?

A

dyspnea, fatigue, and weakness.

Palpitations, shortness of breath on exertion, and cough also occur

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31
Q

Mitral Regurgitation: How do you find this?

A

Systolic murmur is a high-pitched blowing sound at the apex that may radiate to the left axilla.

Echocardiography is used to diagnose and m onitor the progression of mitral regurgitation

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32
Q

Mitral Regurgitation: Medical Management

A

Same as for HF

Benefit from afterload reduction by treatment with ACE inhibitors or angtiotensin receptor blockers.

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33
Q

Mitral Regurgitation: Medical management, what happens once symptoms of heart failure develop?

A

Patient needs to restrict their activity level to minimize symptoms.

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34
Q

Mitral Stenosis: What is this?

A

Obstruction of blood flowing from the left atrium into the left ventricle.

Often caused by rheumatic endocarditis, which progresively thickens mitral valve leaflets and chordae tendineae

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35
Q

Mitral Stenosis: Evantually, the mitral valve orifice

A

narrows and progressively obstructs blood flow into the ventricle

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36
Q

Mitral Stenosis: Pathophysiology: Normal width vs in here?

A

Normally as wide as three fingers. Here, its the width of a pencil

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37
Q

Mitral Stenosis: Pathophysiology: LEft ventricle has difficulty

A

moving blood into the ventricle because of increased resistance by the narrowed orifice

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38
Q

Mitral Stenosis: Pathophysiology: Poor left ventricular filling can cause

A

decreased cardiac output.

Increased blood volume in left atrium causes it to dilate and hypertrophy.

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39
Q

Mitral Stenosis: Pathophysiology: With excessive strain in the left ventricle..

A

the right ventricle hypertorphies, eventually dilates, and fails

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40
Q

Mitral Stenosis: Pathophysiology: What is the first symptom?

A

Often is dyspnea on exertion (DOE) as a result of pulmonary venous hypertension . Symptoms usually develop after the valve opening is reduced by one third to one half its usual size

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41
Q

Mitral Stenosis: Pathophysiology: An enlarged left atrium may create

A

pressure on the left bronchial tree, resulting in a dry cough or wheezing .

May expectorate blood, or experience palpitations, orthopnea , dyspnea and repeated respiratory infecctions

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42
Q

Mitral Stenosis: Pathophysiology: How to determine this?

A

Pulse is weak and irregular in presence of atrial fibrillation. Low pitched , rumbling diastolic murmur is ehard at the apex

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43
Q

Mitral Stenosis: Pathophysiology: Echocardiography is used to diagnose and quantify

A

the severity of mitral stenosis.

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44
Q

Mitral Stenosis: Pathophysiology: ECG , exercise testing, and cardiac catherization with angiography may be used to help

A

determine the severity of mitral stenosis

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45
Q

Mitral Stenosis: Prevention

A

Minimize risk and treatment for bacterial infections.

Prevent of acute rheumatic fever depends on effective antibiotic treatment of group A streptococcal infection

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46
Q

Mitral Stenosis: Medical Management . patients with mitral stenosis may benefit from

A

anticoagulants to decrease the risk of developing atrial thrombus and may require treatment for angina.

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47
Q

Mitral Stenosis: Medical management, if atrial fibrillation develops..

A

cardioversion is attempted to restore normal sinus rhythm

In unsuccessful, the ventricular rate is contorlled with beta-blockers, digoxin, or calcium channel blockers

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48
Q

Mitral Stenosis: Patients are advised to avoid

A

strenous activites, competitive sports, pregnancy , all of which increase heart rate

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49
Q

Aortic Regurgitation: What is this?

A

The flow of blood back into the left ventricle form the aorta during diastole. May be cause dby inflammatory lesions that deform aortic valve leaflets or dilation of the aorta , preventing complete closure of the aortic valve

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50
Q

Aortic Regurgitation: Valvular defect may also result from

A

inefective or rheumatic endocarditis, congenital abnormalities, diseases such as syphilis.

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51
Q

Aortic Regurgitation: Pathophysiology

A

Blood from aorta reutnrs to left ventricle during diastole, in addition to blood normally delivered by the left atrium

Left ventricle dilates in attempt to accommodate.

Systolic blood pressure increases as well to compensate

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52
Q

Aortic Regurgitation: Clinical Manifestions

A

Develops without symptoms

Some aware of foreful heartbeat especially in head or neck.

Marked arterial pulsations visible on carotid may be present as result of increase dforce

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53
Q

Aortic Regurgitation: Signs and symptoms of progressive left ventricular failure include

A

breathing difficulties

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54
Q

Aortic Regurgitation: What will this sound like when assessed?

A

A high-pitched diasstolic murmur is heard at the third or fourth intercostal space

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55
Q

Aortic Regurgitation: How is the pulse pressure here?

A

Considerably widened in patients with aortic regurgitation

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56
Q

Aortic Regurgitation: Whats a characteristic sign of this?

A

The water hammer pulse in whihc the pulse strikes a palpating finger with a quick, sharp stroke and then suddently collapses

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57
Q

Aortic Regurgitation: Diagnosis can be confirmed by

A

echocardiography, cardiac MRI, and cardiac catherization

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58
Q

Aortic Regurgitation: Prevention

A

Prevention of aortic regurgitation is based on treatment for bacterial infection. Strategries are aimed at preventing acute and recurrent rheumatic feverr.

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59
Q

Aortic Regurgitation: Medical Management : Patient with decreased left ventricular function is advised to

A

avoid physical exertion competitive sports and isometric exercise.

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60
Q

Aortic Regurgitation: Patients with aortic regurgitation and also hypertension should be treated with

A

dihydropyridine calcium channel blockers or ACE inhibitors

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61
Q

Aortic Regurgitation: Symptomatic patients should be isntructed to restrict

A

sodium intake and avoid volume overload

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62
Q

Aortic Regurgitation: Treatment of choice is

A

aortic valve replacement or valvuloplasty, prefably performed before left ventricular fialure occurs.

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63
Q

Aortic Regurgitation: Surgery recommended for any patient who is

A

symptomatic

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64
Q

Aortic Stenosis: What is this?

A

Narrowing of the orifice between the left ventricle and aorta. As adult, often result of degerative calcifications

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65
Q

Aortic Stenosis: Calcifications may be caused by

A

proliferative and inflammatory changes that occur in response to years of normal mechanical stres, similar to changes in atherosclerotic artieral disease

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66
Q

Aortic Stenosis: Rheumatic Endocarditis may cause

A

adhesions or fusion of the commissures and valve ring, stiffening of the cusps and calcific nodules on the cusps

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67
Q

Aortic Stenosis: Patho: How long for this to occur?

A

Several years to several decades

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68
Q

Aortic Stenosis: Patho: Left ventricle overcomes obstruction to emptying by

A

contracting more slowly but with more power than normal, forcibly squeezing blood through the smaller orifice

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69
Q

Aortic Stenosis: Patho: Obstruction to left ventricular outflow increases

A

pressure on the left ventricle, so the wall hypertrophies

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70
Q

Aortic Stenosis: Clnical Manifesttions: How does this appear in most people?

A

Aymptomatic

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71
Q

Aortic Stenosis: Clnical Manifesttions: When symptoms develop, patients usually first have

A

exertional dyspnea, caused by increased pulmonary venous pressure due to left ventricular failure

Orthopnea, PND, and Pulmonary edema also may occur

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72
Q

Aortic Stenosis: Clinical Manifestations: Most common symptom?

A

Angina Pectoris resulting from increased oxygen demand of the hypertrophied left ventricle with decreased blood supply

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73
Q

Aortic Stenosis: Assessment and Diagnostic Findings: What might a physical examination show?

A

Loud, harsh systolic murmur that may be heard over the aortic area and radiate to the carotid arteries

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74
Q

Aortic Stenosis: Assessment and Diagnostic Findings: What diagnostic tools can be used?

A

Echocardiography, Cardiac MRI, and CT Scanning used to diagnose and monitor the progression.

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75
Q

Aortic Stenosis: Assessment and Diagnostic Findings: Evidence of left ventricular hypertrophy may be seen on a

A

12-lead ECG and an echocardiogram

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76
Q

Aortic Stenosis: Prevention:

A

Focused on controlling risk factors for proliferative and inflammatory responses, namely through treating diabetes, hypertension and elevated triglycerides

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77
Q

Aortic Stenosis: Medical Management: What is prescribed to treat?

A

Medications

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78
Q

Aortic Stenosis: Medical Management: DEfinitive treatment for aortic stenosis is

A

surgical replacement of the aortic valve

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79
Q

Aortic Stenosis: Medical Management: Patients who are not surgical candiates may beenfit from

A

one or two balloon percutaneous valvuloplasty procedures with or without transcatheter aortic valve implantation

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80
Q

Nursing Management: Valvular Heart Disorders: Patient education of

A

sleeping with HOB elevated while having rest periods

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81
Q

Nursing Management: Valvular Heart Disorders: You want to monitor for

A

VS Trends

Heart Failure, Dysrhythmias, Other Symptoms

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82
Q

Nursing Management: Valvular Heart Disorders: What do you do with medication?

A

Collaborate with pt to develop a medication schedule

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83
Q

Nursing Management: Valvular Heart Disorders: Why are daily weights done?

A

To monitor for weight gain.

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84
Q

Nursing Management: Valvular Heart Disorders: 2.2 lbs of weight gain is equal to how many L’s?

A

1 L

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85
Q

Surgical Management: Valve REpair and Replacement Procedure: What is Valvuloplasty?

A

Repair, rather than replacement of a cardiac valve

They do not require continuous anticoagulation

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86
Q

Surgical Management: Valve REpair and Replacement Procedure: What is a Commissurotomy?

A

Repair that is made to commissures between the leaflets to the annulus to the valve by annuloplasty to leaflets or to chordae

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87
Q

Surgical Management: Valve REpair and Replacement Procedure: What is performed at the conclusion to evaluate teh effectiveness of the proceudre?

A

Transesophageal Echocardiogram (TEE)

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88
Q

Valve Repair and Replacement Procedure - Commissurotomy: This is the most common

A

valvuloplasty procedure

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89
Q

Valve Repair and Replacement Procedure - Commissurotomy: Each valve has

A

leaflets; the site where the leaflets meet is called the commissure

90
Q

Valve Repair and Replacement Procedure - Closed Commissurotomy: They do not require

A

Cardiopulmonary bypass. Valve is not directly visualized

91
Q

Valve Repair and Replacement Procedure - Closed Commissurotomy: This is more commonly performed in

A

developing nations

92
Q

Valve Repair and Replacement Procedure - Closed Commissurotomy: Performed where?

A

Surgical technique performed in the operating room with the patient under general anesthesia

93
Q

Valve Repair and Replacement Procedure - Closed Commissurotomy: This is the preferred technique for patients with

A

congenital mitral stenosis, severe calcified mitral stenosis, left atrial thrombosis or those with tricuspid regurgitation

94
Q

Valve Repair and Replacement Procedure - Closed Commissurotomy: Simple explanation of procedure

A

Midsternal incision is made, a small hole is cut into the heart and a dilator is used to open the commissure

95
Q

Valve Repair and Replacement Procedure - Closed Commissurotomy: Percutaneous balloon valvuloplasty is the technique most commonly performed in the united states as a bridge to

A

surgical valve replacement or transfermoral aortic valve replacement for closed commissurotomy.

96
Q

Valve Repair and Replacement Procedure - Closed Commissurotomy: Balloon valvuloplasty is beneficial for

A

mitral valve stenosis in younger patients and for patients with complex medical conditions that place them at high risk

97
Q

Valve Repair and Replacement Procedure - Closed Commissurotomy: Procedure contraindicated for

A

patients with left atrial or ventricular thrombus, serve aortic root dilation, significant mitral valve regurgitation

98
Q

Valve Repair and Replacement Procedure - Closed Commissurotomy: Where is balloon valvulloplasty performed?

A

Cardiac catherization lab

99
Q

Valve Repair and Replacement Procedure - Closed Commissurotomy: Medication before balloon valvuplasty?

A

Receive light or moderate sedation or a local anesthetic

100
Q

Valve Repair and Replacement Procedure - Closed Commissurotomy: What does mitral balloon valvuloplasty involve?

A

Advancing one or two catheters into the right atrium, through the atrial septum in to the left atrium, across the mitral valve, and into the left ventricle

Guidewire placed through each catheter.

101
Q

Valve Repair and Replacement Procedure - Closed Commissurotomy: Mitral Balloon Valvuloplasty three sections?

A
  1. First expands in the ventricle to help position the catheter the valve
  2. Balloon expands above the valve, holding catheter across the valve
  3. Middle section of the balloon expands in the valve orifice opening the commissures
102
Q

Valve Repair and Replacement Procedure - Closed Commissurotomy: Mitral Balloon Valvuloplasty do not completely occlude the

A

valve, thereby permitting some forward flow of blood during the inflation period.

103
Q

Valve Repair and Replacement Procedure - Closed Commissurotomy: All patients have some degree of what after the procedure?

A

Mitral regurgitation

104
Q

Valve Repair and Replacement Procedure - Closed Commissurotomy: Other possible complications after procedure include

A

bleeding from teh catheter insertion sites, emboli resulting in strokes, and left-to-right atrial shunts

105
Q

Valve Repair and Replacement Procedure - Closed Commissurotomy: Aortic balloon valvuloplasty is performed most commonly by introducing

A

a catheter through the aorta , across the aortic valve, and into the left ventricle .

106
Q

Valve Repair and Replacement Procedure - Closed Commissurotomy: How does Aortic Balloon Valvuloplasty work?

A

Balloons infated for 15-60 seconds and inflation is repeated several times.

107
Q

Valve Repair and Replacement Procedure - Closed Commissurotomy: Possible complications from aortic balloon valvuloplasty include

A

aortic regurgitation, emboli, ventricular perforation, and rupture of the aortic valve annulus.

108
Q

Valve Repair and Replacement Procedure - Closed Commissurotomy: Aortic valve procedure is not as effective as

A

mitral valve procedure

109
Q

Valve Repair and Replacement Procedure - Open Commissurotomy: Performed with direct

A

visualization of the valve

110
Q

Valve Repair and Replacement Procedure - Open Commissurotomy: How is the procedure performed?

A

Patient under anesthesia

Midsternal or left thoracic incision made

Cardiopulmonary bypass initiated and incision is made into heart

Valve exposed and scalpel or finger used to open commissures

111
Q

Valve Repair and Replacement Procedure - Open Commissurotomy: Added advantage of visualizing valve is that

A

thrombus and calcification may be identified and removed

112
Q

Valve Repair and Replacement Procedure - Annuloplassty: What is this a repair of?

A

The valve annulas (junction of valve leaflets and muscular heart wall).

113
Q

Valve Repair and Replacement Procedure - Annuloplassty: What is required for this?

A

General anesthesia and cardiopulmonary bypass are required for most annuloplasties

114
Q

Valve Repair and Replacement Procedure - Annuloplassty: This procedure narrows

A

the diameter of the valve’s orifice adn is a useful treatment for valvular regurgitation

115
Q

Valve Repair and Replacement Procedure - Annuloplassty: What are the two annuloplasty techniques?

A

One technique uses an annuloplasty ring which may be preshaped or flesxible . Leaflets sutured to a ring, creating an annulus of the desired size

Second technique is tight then annulus involves folding elongated tissue over into itself in leaflets or tacking leaflets to the atrium

116
Q

Valve REpair and Replacement Procedure - Leaflet Repair: What is this?

A

Repair for elongated, ballooning, or other excess tissue leaflets is removal of the extra tissue

117
Q

Valve REpair and Replacement Procedure - Leaflet Repair: Elonged tissue may be tucked and

A

sutured. Wedge of tissue may be cut from middle and gap sutured closed.

118
Q

Valve REpair and Replacement Procedure - Chordoplasty: What is this

A

Repair of chordae tendineae . Mitral valve is most often invoved with chordoplasty

119
Q

Valve REpair and Replacement Procedure - Chordoplasty: Tricuspid valve seldom requires chordoplasty because

A

tricuspid valve disease is often a result of mitral or aortic valve disease or left ventricular dysfunction

120
Q

Valve Replacement: What is used for most valve replacements?

A

General anesthesia and cardiopulmonary bypass

121
Q

Valve Replacement: Mitral and aortic valve replacements may be performed with

A

minimally invasive technique that do not involve cutting through length of sternum .

Instead 2-4 inch incision made on lower half of sternum

122
Q

Valve Replacement: What happens after valve is visualized?

A

Leaflets of the aortic or pulmonic valve are removed. Some or all of mitral valve structures left in place .

Sutures palced around the annulus and then through the valve prosthesis . Replacement valve slide down the suture into position and tied.

123
Q

Valve Replacement: What is TAVI?

A

Minimally invasive aortic valve replacement procedure, may be performed in a catherization laboratory

124
Q

Valve Replacement: TAVI indicated for patients with

A

aortic stenosis who are not cadinates for surgical valve replacement or have high risk

125
Q

Valve Replacement: How does TAVI performed?

A

Pt under general anesthesia, balloon valvuloplasty is performed. Then tisssue replacement valve attached to a catheter is inserted, positioned at aortic valve, and implanted.

126
Q

Valve Replacement: TAVI is beneficial for patients with

A

severe symptomatic mitral regurgitation who have high surgical risk. Crreates mechanical bridge between two leaflets.

127
Q

Valve Replacement: Mechannical Valves: What are these?

A

Are of bileaflet ,, tilting-disc or ball-and-cage design and are thought to be more durable than tissue prosthetic valves. Often use in younger patients and those with kidney injury.

Do not deteriorate or become infected

128
Q

Valve Replacement: Significant complications of mechanical valves include

A

thromboemboli and long-term use of required anticoagulants

129
Q

Valve Replacement: What are the three types of tissue valves?

A

Bioprostheses, homografts, and autografts .

Less likely to generate thromboemboli and long-term anticoagulation not required.

130
Q

Tissue Valves: What are Bioprosthses?

A

Tissue valves used for aortic, mitral, and tricuspid valve replacement. Patients od not need long-term anticoagulation therapy.

131
Q

Tissue Valves: Bioprosthesis used for women of what age?

A

Childbearing because potential complications of long-term anticoagulation associated with menses, placental transfer to a fetus.

132
Q

Tissue Valves: Bioprostheses are made from

A

pigs but some are from cows or horses

133
Q

Tissue Valves: What are homografts / allografts?

A

Obtained from cadaver tissue donations and are used for aortic and pulmonic valve replacement.

134
Q

Tissue Valves: How long do homografts last for?

A

10-15 years

135
Q

Tissue Valves: What are autografts?

A

Obtained by excising patients own pulmonic valve and portion of pulmonary artery to use an aortic valve

136
Q

Tissue Valves: Autografts and Anticoagulation

A

Unneccessary because its patients own tissue. Alternative for children and those who cannot tolerate anticoagulation

137
Q

Infectious Diseases of the Heart: Infections are named for

A

layer of heart most involved in the infectious process

Endocarditis (Endocardium)
Myocarditis (Myocardium)
Pericarditis (Pericardium)

138
Q

Infectious Diseases of the Heart: What is Rheumatic Endocarditis?

A

Unique infective endocarditis syndrome

139
Q

Infectious Diseases of the Heart: Diagnosis of infection is made primarily on

A

basis of patients symptoms

140
Q

Rheumatic Endocarditis: Acute Rheumatic Fever occurs most often in

A

school-age children

141
Q

Rheumatic Endocarditis: Patients with rheumatic fever may develop

A

rheumatic heart disease as evidenced by a new heart murmur, cardiomeagaly, pericardtis, and heart failure.

142
Q

Rheumatic Endocarditis: Prompt and effective treatment of “Strep” throat with antibiotics can prevent

A

development of rheumatic fever

143
Q

Rheumatic Endocarditis: Signs of Rheumatic Fever?

A

Fever

Chills
Sore Throat

Diffuse redness of throat

Petechiae on the roof

Enlarged and tender lymph nodes

144
Q

Inefective Endocarditis: What is this?

A

Microbial infection of the endothelial surface of the heart

145
Q

Inefective Endocarditis: Usually develops in people with

A

prosthetic heart valves, cardiac devices, or structural cardiac defects

146
Q

Inefective Endocarditis: More comon in

A

older adults who are more likely to have degenerative or calcify valve lesions

147
Q

Inefective Endocarditis: Staphylococcal endocarditis infections of valves in right side of heart are common among

A

IV drug abusers

148
Q

Inefective Endocarditis: HAI Endocarditis occurs most often in

A

patients with debilitating disease or indwelling catheters and in patients who are receiving hemodialysis

149
Q

Inefective Endocarditis: People taking immunosuppressive medications or corticosteroids are more suspectible to

A

fungal endocarditis

150
Q

Inefective Endocarditis: Deformity or injury to the endocardium leads to

A

accumulation of fibrin and platelets on the endocardium .

Infectious ocrangisl invade the clot and endocardial lesions

151
Q

Inefective Endocarditis: Infection most frequently results in

A

platelets, fibrin, blood cells, and microorganisms that cluser as vegetations on the endocardium

152
Q

Inefective Endocarditis: As the clot on the endocardium continues to expand,

A

the infecting organism is covered by new clot and concealed from the bodys normal defenses

May erode through the endocardium causing tears or other deformities.

153
Q

Inefective Endocarditis: Signs develop from

A

toxic effects of the infection, destruction of heart valves, and embolization of fragments of vegetative frowths

154
Q

Inefective Endocarditis: PRimary present symptoms include

A

fever and heart murmur.

FEver may be intermittent or absent. Heart murmur may be absent at first, but develops in almost all patients

155
Q

Inefective Endocarditis: In addition to fever and heart murmur, what else may be found?

A

Clusters of petechiae may be found . Also Nodes and irregular macules as well.

156
Q

Inefective Endocarditis: What may be observed in the eyes?

A

Hemorrhages with pale centers. Petechiae may appear in conjunctiva and mucous membranes

157
Q

Inefective Endocarditis: CNS manifestations include

A

Headache

Temporary or transient cerebral ischemia

Strokes

Embolization may be a present symptom.

HEart Failure, indicates poor prognosis wth medical therapy

158
Q

Inefective Endocarditis: Vague complaints of malaise, anoreia, weight loss, cough and back and joint pain may be mistaken for

A

influenza.Definitive diagnosis made when microorganism is found in two separate blood cultures. Must have two within a 24 hour period in order to administer antimicrobial agents

159
Q

Inefective Endocarditis: What may assist with diagnosing?

A

Echocardiography may assist with diagnosis by demonstrating mass on a valve, prosthetic valve or supporting structures

160
Q

Inefective Endocarditis: How to prevent bacterial endocarditis in high risk patients?

A

Antibiotic prophylaxis is recommended for high-risk patients immediately before and sometimes after dental procedures that involve manipulation of gingival tissue.

161
Q

Inefective Endocarditis: Poor dental hygiene can lead to

A

bacteremia

162
Q

Inefective Endocarditis: Female patients are advised not ot use

A

IUD devides .

163
Q

Inefective Endocarditis: Antibiotic therapy usully is given for

A

2-6 weeks every 4 hours or continuously by IV infusion

164
Q

Inefective Endocarditis: PN Therapy is given in doses that produce

A

high serum concentration for a significant period to ensure eradication of dormant bacteria

165
Q

Inefective Endocarditis: Patients temperature is monitored at

A

regular intervals because the course of fever is one indication of treatment effectiveness

166
Q

Inefective Endocarditis: Surgical management may be required if

A

the infection does not respond to medication or the patient has prosthetic heart valve endocarditis, mobile vegation, HF, heart block, or develops complications

167
Q

Inefective Endocarditis: Surgical interventions include

A

valve debridement or excision, debridegement of vegations, debridement and closure of an abscess

168
Q

Inefective Endocarditis: Most patients who have prosthetic valve endocarditis require

A

valve replacement

169
Q

Inefective Endocarditis: Nursing Management: Nurse monitors

A

patients temp, may have fever for week.

Administer antibiotic, antifungal, or antiviral meds.

170
Q

Inefective Endocarditis: Nursing Management: Patients need enough fluid to keep their urine

A

light yellow

171
Q

Inefective Endocarditis: Nursing Management: FEver often causes

A

fatigue, rest periods should be planned and activites spaced to get rest.

172
Q

Inefective Endocarditis: Nursing Management: Whae else may be prescribed?

A

NSAIDS as antipyretics or to decrease the discomfort of fever

173
Q

Inefective Endocarditis: Nursing Management: Heart sounds assessed. New or worsening murmur may indicate

A

dehiscence of a prosthetic valve, rupture of an abscess, or injury to valve leaflets or chordae tendinae

174
Q

Inefective Endocarditis: Nursing Management: Patient care direted toward managmeent of infection. Long term IV antimicrovbial therapy often is necessary meaning

A

many patients may have peripherally inserted central catheters orother long-term IV access

175
Q

Myocarditis: What is this?

A

Inflammatory process involving the myocardium that can cause heart dilation, thrombi on the heart wall, infiltration of circulating blood cells and degeneration of muscle fibers

176
Q

Myocarditis: Most patients with mild symptoms recover

A

completely. Some develop cardiomyopathy and heart fialure

177
Q

Myocarditis: Usually results from

A

viral, bacterial, rickettsial, fungal, parastic or spirochental infection. May also be immune related after acute systemic infection like rheumatic fever

178
Q

Myocarditis: MAy develop in patients receiving

A

immunosuppressive therapy or in those with inefectiv endocarditis, chrohns disease, or lupus

179
Q

Myocarditis: May result from an inflammatory reaction to

A

toxins such as pharmacologic agents used in the treatent of other diseases, ethanol, or radiation

180
Q

Myocarditis: Symptoms of acute myocarditis depend on

A

the type of infection, the degree of myocardial damage, and the capacity of the myocardium to recover.

181
Q

Myocarditis: Patients may develop mild-to-moderate symptoms reporting

A

fatigue and dyspnea, syncope, palpitations and occasional discomfort in teh chest and upper abdomen

182
Q

Myocarditis: What is being used for assessment?

A

Cardiac MRI is being used more often as a diagnostic tool because of its noninvasive approach.

With contrast, it can guide clinicians to sites for endocardial biopsies

183
Q

Myocarditis: Patients without any abnroaml heart structures may suddenly develop

A

dysrhythmias or ST-T wave changes

184
Q

Myocarditis: If pt has structural heart abnormalities, clienical assessment may disclose

A

cardiac enlargement, faint heart sounds, pericardial friction rub, a gallop rhythm , or a systolic murmur

185
Q

Myocarditis: Prevention

A

Preventing disease by means of appropriate immunizations and early treatment appears to be important to prevent incidienc of myocarditis

186
Q

Myocarditis: Medical Management: Patient are given specific treatment for underlying cause if it is known and are placed on

A

bed rest to decrease cardiac workload .

Best rest decreases myocardial damage and complications of myocarditis..

187
Q

Myocarditis: Medical Management: For young patients, they should be limited for

A

6 month period or at least until heart size and function return to normal

188
Q

Myocarditis: Medical Management: What should not be used?

A

NSAIDs should not be used for pain and control… ineffective in relieving the inflammatory process in myocarditis and worsens the inflammation

189
Q

Myocarditis: Nursing Management: Assesses for

A

resolution of tachycardia, fever, and other clinical manifestations.

190
Q

Myocarditis: Nursing Management: CArdiovascular assessment focuses on

A

signs and symptoms of heart failure and dysrhythmias.

191
Q

Myocarditis: Nursing Management: Anti-embolism stocks and passive and active exercises should be used because

A

embolization from venous thrombosis and mural thrombi can occur.

192
Q

Pericarditis: What does this refer to?

A

Inflammation of the pericardium, which is the membranous sac eveloping the heart

193
Q

Pericarditis: May be a

A

primary illness, or it may devvelop during various medical and surgical disorders

194
Q

Pericarditis: May occur how long after acute myocardial infarction?

A

10 days to 2 months

195
Q

Pericarditis: Percarditis may be

A

acute, chronic, or recurring

196
Q

Pericarditis: Classified as either

A

adhesive(constrictive) because of the periocardium becomes attached to each other, serous (serum), purulent (pus) calcific (calcium deposits) or fibrinous (clotting proteins).

197
Q

Pericarditis: Inflammatory process of pericarditis may lead to

A

accumulation of fluid in the pericardial sac and increased pressure on the heart, leading to cardiac tamponade

198
Q

Pericarditis: Prolonged episodes may lead to

A

thickening and decreased elasticity of the pericardium or scarring may fuse the viscerala and perital

199
Q

Pericarditis: Signs, may be

A

aymptomatic

200
Q

Pericarditis: Most characteristic symptom of pericarditis is

A

chest pain, although pain also may be located beneath the clavicle in the neck or scpaula region

201
Q

Pericarditis: Signs: Pain or discomofrt remains fairly

A

constant, but it may worsen with deep inspiration and when lying down or turning

202
Q

Pericarditis: Signs: Most characteristic clinical manifestation of pericarditis is

A

a creaky or scratchy friction rub heard most clearly at the left lower sternal border.

Other signs include Increased WBC, anemia, and eleved ESR.

May have nonproducitve cough

203
Q

Percarditis: Diagnosis most often made i s

A

on the basis of history, signs, and symptoms.

204
Q

Percarditis: Echocardiogram may detect

A

inflammation, pericardial effusion, or tamponade and heart failure.

May be used to guide pericardiocentesis (needle or catheter drainage of the pericardium)

205
Q

Percarditis: TEE useful in diagnosis but

A

may underestimate the extend of pericardial effusions

206
Q

Percarditis: What may be the best diagnostic tool?

A

CT imaging, helps determine size, shape, and location and peripheral effusions and can guide pericardioentesis as well

207
Q

Percarditis: CArdiac MRI may assist with

A

detection of inflammation and adhesions.

208
Q

Percarditis: Occassionaly a video assisted pericardioscop guided biopsy of the pericardium and epicardium is performed to obtain

A

tissue samplesfor culture and microscopic examination

209
Q

Percarditis - Medical Management: Objective of pericarditis management are to

A

determine the cause, administer therapy for treatment and symtom relief, and detect signs and symptoms of cardiac tamponade.

210
Q

Percarditis - Medical Management: When cardiac output is impaired, patient is

A

placed on bed rest until fever, chest pain, and friction rub have subsided.

211
Q

Percarditis - Medical Management: What medications may be prescribed?

A

Analgesic medications and NSAIDS such as aspirin or ibuprofen during acute phase.

Hasten reabsorption of fluid in patients with rheumatic pericarditis.

212
Q

Percarditis - Medical Management: Why is Indomethacin contraindicated?

A

Decreases coronary blood flow

213
Q

Percarditis - Medical Management: Why would Colchicine be prescribed?

A

This or corticosteroids may be prescribed if the pericarditis is severe or if patient does not respond to NSAIDS

214
Q

Percarditis - Medical Management: Pericardiocentesis can be done… what is this?

A

Procedure in which some pericardial fluid is removed, rarely is necessary

Performed if there are signs of heart failure or tamponade

215
Q

Percarditis - Medical Management: Pericardial fluid cultured if

A

bacterial, tubercular, or fungal disease is suspected

216
Q

Percarditis - Medical Management: Pericardial windows may be made, which is?

A

Small opening made in the pericardium, that may be performed to allow continuous drainage into the chest cavity

217
Q

Percarditis - Nursing Management: Patients with acute pericarditis require

A

pain management with analgesics, assistance with positioning, and psychological support

218
Q

Percarditis - Nursing Management: Patients with chest pain benefit from

A

education and reassurance that the pain is not due to a heart attack

219
Q

Percarditis - Nursing Management: Pain may be releived with

A

a forward leaning or sitting position

220
Q

Percarditis - Nursing Management: Relief of pain achieved by

A

rest

NRSG 110: Med Surg 2 (29 decks)

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