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Module 1 > Infections of the Heart > Flashcards

Infections of the Heart Flashcards

1
Q

Infections named after the layer of the heart that is affected

A

Endocarditis
-Infective Endocarditis (IE)
-Rheumatic Endocarditis

Myocarditis

Pericarditis

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2
Q
  1. Infective Endocarditis (IE)

Definition:
_______ infection of the endothelial surface of the heart

Its ____, but has a ___ mortality rate

14-22% die during hospital stay

Up to 40% die within 1yr of diagnosis

Endothelial- inner lining of the heart- includes:

A

Microbial (bacterial)

rare
high

valves (likes to affect the valves)

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3
Q

Infective Endocarditis (IE)~Risk Factors

A

Implanted devices (pacemakers),
IV drug users,
branding,
tattoo,
piercings,
Dialysis,
older adults
dental procedures,
IV drug users- Staph infections

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4
Q

Infective endocarditis pathophysiology

Deformity or injury of the endocardium
–Leads to _____ on the endocardium

Infectious organisms: ____, ____, _____ invade the clot
—Cause ____ on the endocardium
—Can ____ through the endocardium

Clot grows & conceals infection
—______ may occur

Onset insidious, _____ complaints

A

clot formation

staphylococci, streptococci, fungi
vegetations
erode

Embolization

vague flu-like

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5
Q

IE
Right sided infections –

A

PE- severe chest pain with inspiration

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6
Q

signs & symptoms of Infective endocarditis:

A

Fever
Heart murmur
Roth spots- in eyes
Osler nodes- painful spots on fingers
Clusters of petechia
Splinter hemorrhages on finger nails
Janeway lesions - not painful spots on feet

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7
Q

More signs & symptoms of IE:

Chest pain
Dyspnea
Tachycardia
Fatigue
Chills
Loss of appetite
_________

A

Unexplained weight loss

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8
Q

Potential complications with IE

most
frequent:

A

Heart failure
–Most frequent complication

Cardiomegaly

AV blocks

Splenomegaly
–Metastatic foci infection develops into splenic abscess

CNS involvement: headache, stroke

Embolization of other organs
–Kidney damage
–Pulmonary embolism

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9
Q

Diagnosis of IE

A

Minimum of two sets of blood cultures
–drawn from different venipunctures sites
–over a 24-hour period
–Must be at least 2 hours apart
—-Negative BC do not definitely rule out IE

Other labs:
-elevated WBC
-anemia
-+ rheumatoid factor
-elevated ESR or CRP

Echocardiogram

Transesophageal echocardiography (TEE)

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10
Q

Prevention of IE:

For high risk patients:

avoidusing:

Our role as nurses
IV catheters & invasive procedures
Finish all antibiotics
What else?

A

Antibiotic prophylaxis
–recommended before and sometimes after dental procedures
–Indicated for patients having manipulation of infected tissue (wound debridement)
–Good oral hygiene + regular professional oral care

Avoid using toothpicks, nail biting, body piercing, tattooing, IUDs

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11
Q

Nursing & Medical Management of IE

Antibiotic therapy (____ usually), or antifungal, or antiviral

Home health

Psychosocial support

Surgical intervention (d/t: HR, recurrent embolization’s, intra-cardiac abscess, meds not working)

Monitor:

Fluids, rest, good hand hygiene, NSAIDS

IV access care (PICC)

A

PCN

temperature, heart and lung sounds

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12
Q

Nursing & Medical Management of IE

Assess:

Pt education:

A

-heart sounds and for worsening of murmurs
-S&S pulmonary infarction & infiltrates
-S&S or organ damage (stroke, MI, HF, glomerulonephritis, splenomegaly)

infection control, antibiotic prophylaxis, high risk patient precautions

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13
Q

Endocarditis~Rheumatic Endocarditis

Rheumatic Fever:
Can lead to mitral valve stenosis or regurgitation
Murmurs
Cardiomegaly
Pericarditis
HF

Most often in ________

S&S:

A

Group A Beta-Hemolytic Strep

School-aged children

sore throat, painful swallowing, fever, petechiae in mouth, swollen tonsils & lymph nodes

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14
Q

Endocarditis~Rheumatic Endocarditis

Risk factors:

Prompt tx with antibiotics can prevent rheumatic fever

________ first line antibiotics

A

malnutrition, overcrowding, poor hygiene, low socioeconomic status

PCN & Amoxicillin

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15
Q

Myocarditis:

-
-

Mortality depends on severity
-Mild (recover completely)
-HF and cardiomegaly
-SCD

A

Inflammatory

-Heart dilation
-Thrombi (on the heart wall, or around the coronary vessels)
-Degeneration of the muscle fibers

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16
Q

Myocarditis – pathophysiology:

A

Viral (most common)
-Coxsackieviruses A & B
-HIV
-Influenza A

Bacterial, fungal, parasitic (Chagas disease)

Spirochetal
-Lyme disease

Immune related
-After acute systemic infections

Related to autoimmune disorders
-lupus

Inflammatory reaction to toxins
-Pharmacologic agents

17
Q

Myocarditis – pathophysiology

May start in a small area of myocardium and then spread throughout

___ and ___ latent manifestations

A

DCM and HCM

18
Q

Myocarditis – S&S:

______ (resolves on its own)

Mild to moderate
-Fatigue
-Dyspnea
-Syncope
-Chest pain / palpitations / tachycardia
-Upper abdomen discomfort

Most common symptoms are ____

May develop ____ and ___

A

Asymptomatic

flulike

HF and SCD

19
Q

Myocarditis Diagnosis & prevention:

A

Cardiac MRI

Endocardial biopsies

Elevated WBC, CRP, leukocyte count, and ESR

Early treatment and recognition

ECG
-May develop sudden arrhythmias
-ST-T wave changes

Antibiotics (tx underlying cause)

Immunizations (influenza, hepatitis)

20
Q

Myocarditis Diagnosis

Clinical assessment

A

Friction rub
Gallop heart sound
Murmur
Faint heart sounds

21
Q

Myocarditis Nursing & Medical Management

CV assessment for s/sx ____ & _____

Continuous cardiac monitoring

Anti-embolism stockings, passive & active exercises,
anticoagulants

Sensitive to ____ (increased mortality)

do not use _____ for pain control*

Bedrest to decrease cardiac workload and myocardial damage

May require: ACE inhibitors, ARBs, beta blockers, diuretics ~ to reduce heart’s workload

Specific treatment for underlying cause (severe cases: IV meds, VAD, IABP, ECMO) Ventricular assistive device, extra-corporal membrane oxygenation, intra-aortic balloon pump

A

heart failure and dysrhythmias

digoxin

NSAIDs

22
Q

pericarditis

Inflammation of the sac surrounding the heart

Adhesive (constrictive) or by what accumulates in the pericardial sac (serous, purulent, calcific, fibrinous, sanguineous, or malignant

5% ER visits due to chest pain

Acute, chronic, or recurrent

Infectious or noninfectious

can occur after _____ or ______

A

pericardiectomy or 10-2 months after MI

23
Q

Pericarditis

Primary (________)

Secondary to:

Prolonged –

A

idiopathic, viral infection

medical and surgical disorders (lupus, MI, cancer, radiation, and uremia)

thickening and decreased elasticity
-Restricts hearts ability (constrictive)

24
Q

Pericarditis

Potential complications:

A

Pericardial effusion, cardiac tamponade, peripheral edema, hepatic failure

25
Q

Pericarditis causes:

A

Infection
-Viral (enteroviruses, herpes, adenoviruses, parvovirus)
-Bacterial (mycobacterium tuberculosis)
-Fungal (histoplasma, aspergillus, candida)
-Parasitic (tapeworm, toxoplasma)

Autoimmune disorders
-Rheumatic fever, rheumatoid arthritis, sarcoidosis, etc.

Disorders of adjacent structures
-MI, pneumonia, dissecting aneurysm

Metastasis from lung or breast cancer

Chest trauma

Metabolic
-Uremia, anorexia, myxedema

Radiation therapy

26
Q

Pericarditis Clinical Manifestations

A

chest pain
-Usually constant
-worse with deep inspiration and positional

Creaky or scratchy friction rub (main)
-Heard left lower sternal border

Mild fever, increased WBC, ESR, and CRP, anemia

May have nonproductive cough, hiccups

Dyspnea & respiratory splinting

Increased heart rate

s/sx of heart failure

27
Q

Pericarditis Diagnostics

Most often diagnosed by: _______

Echocardiogram (can detect inflammation, pericardial effusion, tamponade, HF)
Echo can also be used to guide in pericardiocentesis

CT can help to determine the size and location of the pericardial effusion, and my be used to guide pericardiocentesis

MRI (detect adhesions, and inflammation)

Video assisted pericardioscope – guided biopsy

12 lead – shows concave ST elevations, depressed PR intervals

A

history, and S&S

28
Q

Treatment of pericarditis

Goals of treatment:

Reduce-

Treat-

Check for complications (cardiac tamponade requires _______; constrictive pericarditis may require surgery)

Rest

A

pain and inflammation (anti-inflammatory & antispasmodic meds)

underlying cause, if it is known (antibiotics)

pericardiocentesis

Module 1 (11 decks)

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