Inflammatory and Structural Heart Disorders Flashcards
1
Q
Infection of the inner layer of the heart that usually affects the cardiac valves
A
Infective Endocarditis (IE)
2
Q
Pathophysiology of IE?
A
when blood turbulence within heart allows causative agent to infect previously damaged valves or other endothelial surfaces
3
Q
Most common causative agents of IE?
A
- staphylococcus aureus
- streptococcus viridans
4
Q
Fibrin and platelets adhere to the valve surface forming a lesion called?
A
Vegetations
5
Q
Risk Factors of IE (cardiac conditions)?
A
- Prior endocarditis
- Prosthetic valves
- Valve disease
- Cardiac lesions
- Congenital heart disease
- Pacemakers
- Marfan’s syndrome
- Cardiomyopathy
6
Q
Risk Factors for IE (Noncardiac)?
A
- increasing age
- Hospital-acquired bacteremia
- dental procedures
- IV drug abuse
7
Q
Risk Factors of IE (Procedure-Associated)?
A
- Intravascular devices
- Dental procedures
- Respiratory procedures
- GI and GU procedures
8
Q
Clinical manifestations of IE?
A
- Murmur in most patients (new or changed)
- Heart failure in up to 80% with aortic valve endocarditis
- other manifestations secondary to embolism
- Low grade fever (90%)
- Chills
- Weakness
- malaise
- fatigue
- Anorexia
- Vascular Manifestations
- embolism-organ infarction
9
Q
Major diagnostic criteria needed for IE confirmation? (need 2 for definitive diagnosis)
A
- Positive blood cultures (2 drawn 30 min apart)
- New or changed murmur
- Echocardiogram shows intra-cardiac mass or vegetation
10
Q
Diagnostic tests for IE?
A
- CXR and ECG can provide more information on extent of disease
- WBC (seriousness of infection)
- Estimated Sedimentation Rate (ESR)
- C-Reactive Protein (CRP)
- Coronary Catheterization/Angiogram (not 1st choice) to see damage of valve
11
Q
Medication Interventions for IE?
A
- Antibiotic administration
- Monitor antibiotic serum levels (e.g., peak and trough)
- Subsequent blood cultures
- Monitor renal function
- Fungal and prosthetic valve endocarditis
- Respond poorly to antibiotics
- May need valve replacement
- Prophylactic Treatment
- Antibiotics before dental or invasive procedures
12
Q
Nursing Interventions for IE?
A
- Increase activity slowly
- TEDS
- C&DB
- Observe for complications or worsening disease
- Teach
- Risk reduction
- Avoid sick people
- Good nutrition
- Good oral hygiene
- Notify HCP prior to invasive procedures
13
Q
Complications of IE?
A
- Dysrhythmias
- Valve dysfunction
- Heart failure
- Sepsis
14
Q
Most common valves affected by Valvular Heart Disease?
A
Mitral and Aortic
15
Q
Cardiac Functional alterations seen in Valvular Heart Disease?
A
- Stenosis (narrowing)
- Regurgitation (backward flow)
16
Q
The below are characteristic of?
- Valve orifice is restricted.
- Forward blood flow is impeded.
- A pressure gradient is created across open valve.
A
Stenosis
17
Q
What is an incomplete closure of valve leaflets that results in backward flow of blood?
A
Regurgitation
18
Q
Most common cause of Mitral Valve Stenosis?
A
Rheumatic heart disease
19
Q
Manifestations of Mitral Valve Stenosis?
A
- Exertional Dyspnea-reduced lung compliance
- Fatigue and palpations (A-fib)
- Murmur
20
Q
Causes of Mitral Valve Regurgitation?
A
- MI
- Rheumatic heart disease
- Mitral valve prolapse
21
Q
Manifestations of
Acute Mitral Valve Regurgitation?
A
- New systolic murmur
- Pulmonary Edema
22
Q
Manifestations of Chronic Mitral Valve Regurgitation?:
A
- may be asymptomatic for years
- Weak, fatigued
- Dyspnea
- palpitations
- Audible S3 sound
- murmur
23
Q
Complications of Mitral Valve Prolapse?
A
- Mitral valve regurgitation
- Infective endocarditis
- Sudden death
- Cerebral ischemia
24
Q
Manifestations of Mitral Valve Prolapse?
A
- Most patients asymptomatic for life
25
Causes of Aortic Valve Stenosis in children?
Congenital defect
26
Causes of Aortic Valve Stenosis in adults?
rheumatic fever
27
Causes of Aortic Valve regurgitation?
- Rheumatic heart disease
- congenital heart defects
- syphyllis
28
```
The nurse is caring for a patient with aortic stenosis. For what should the nurse assess the patient?
A) Systolic murmur
B) Pericardial friction rub
C) Diminished or absent S4
D) Low-pitched diastolic murmur
```
Ans: A
29
Diagnostics for Valvular Heart Disease?
- H&P
- Echocardiogram
- ECG
- Chest X-ray or CT scan
- Cardiac Cath
- Labs
30
Why is an echocardiogram done for Valvular Heart Disease?
shows the valve structure, function and chamber size
31
Why is an ECG done for Valvular Heart Disease?
rhythm and ischemia
32
Why is a CXR or CT scan done for Valvular Heart Disease?
to see the size of heart
33
Why is a Cardiac Cath done for Valvular Heart Disease?
to measure the pressures in the valve and the size of the valve opening
34
Why is are labs dranw for Valvular Heart Disease?
to rule out infection
35
Nursing Cardiovascular Assessment Findings Valvular Heart Disease?
- Abnormal heart sounds
- Tachycardia
- Dysrhythmias
- Hypotension
36
Nursing Respiratory Assessment Findings Valvular Heart Disease?
- Crackles
- wheezes
- hoarseness
37
Nursing Gastrointestinal Assessment Findings Valvular Heart Disease?
- Ascites in ABD
| - Hepatomegaly
38
Nursing Integumentary Assessment Findings Valvular Heart Disease?
- Diaphoresis
- Peripheral edema
- Temperature changes
- Clubbing
39
Focus of TX for Valvular Heart Disease?
Preventing:
- Exacerbations of heart failure
- Acute pulmonary edema
- Thromboembolism
- Recurrent endocarditis
40
Drug therapy for Valvular Heart Disease?
- Digitalis
- Diuretics
- Antiarrhythmics
- Beta-Blockers
- Anticoagulants
- Antibiotics
41
Patient Teaching for Valvular Heart Disease?
- Anticoagulant
- Prophylactic antibiotic (invasive or dental procedures)
- Low-sodium diet
- Activity modifications
- Oxygen therapy
- Avoid infectious people
- Avoid stress and fatigue
- Rest
- Hygiene
- Signs and symptoms of infection
- Stress follow-up care
42
Warfarin (Coumadin) mechanism of action?
interferes with the production of vitamin K dependent coagulation components
43
Indications for Warfarin
Afib, mechanical valve, DVT, PE
44
Reversal agent(s) for Warfarin?
Vit K and fresh frozen plasma (FFP)
45
INR therapeutic range for patient with a mechanical valve?
2.5 - 3.5
46
A group of diseases that directly affect the structure and functioning ability of the myocardium?
Cardiomyopathy
47
Cause of Primary Cardiomyopathy?
unknown etiology
48
Cause of Secondary Cardiomyopathy?
Caused by another disease process
49
Most common type of Cardiomyopathy?
Dilated Cardiomyopathy
50
Diffuse inflammation and rapid degeneration of myocardial fibers that results in ventricular dilation, impairment of systolic function, atrial enlargement and stasis of blood in the left ventricle.
Dilated Cardiomyopathy
51
Highest prevalence of Dilated Cardiomyopathy in?
Middle-aged African Americans and men
52
Most common cause of sudden cardiac death in young people?
Hypertrophic Cardiomyopathy
53
Causes of Dilated Cardiomyopathy?
- Cardio toxic agents (OH, cocaine)
- CAD
- genetics
- HTN
- metabolic disorders
- muscular dystrophy
- myocarditis
- pregnancy
- valve disease
54
Causes of Hypertrophic Cardiomyopathy?
- Aortic Stenosis
- genetics
- HTN
55
Diagnostics for Dilated Cardiomyopathy?
Chest Xray, ECG, BNP, Cardiac Cath
56
Diagnostics for Hypertrophic Cardiomyopathy?
ECG, ECHO, Cardiac Cath
57
TX of Dilated Cardiomyopathy?
- TX underlying cause
- Nitrates
- B-adrenergic blockers
- Antidysrhythmics
- ACE inhibitors
- Diuretics
- Digoxin
- Anticoagulants (if indicated)
58
TX of Hypertrophic Cardiomyopathy?
- B-adrenergic blockers
- Antidysrhythmics
- ACE inhibitors
- Diuretics
- Anticoagulants (if indicated)
59
Patient Teaching for Cardiomyopathy pt?
- Medication teaching
- diet
- Maintain reasonable weight
- Avoid alcohol, caffeine, OTC meds
- Balance activity and rest
- Reduce stress
- S/S of HF
- Suggest caregiver learn CPR
- May focus on end of life care or palliative care
60
Diet for Cardiomyopathy pt?
Low Fat, Chol, and Na diet
- 6-8 glasses of H2O (unless contraindicated)
- Avoid alcohol, caffeine, OTC meds
61
Patient Teaching for Hypertrophic Cardiomyopathy ?
- Avoid strenuous activity
- Any activity that causes an increase in systemic vascular resistance is dangerous and should be avoided
- Rest and elevation of the feet to improve venous return
- Avoid vasodilators (ex:nitro)
