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Care of Adult/Older patients > Inflammatory and Structural Heart Disorders > Flashcards

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)

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2
Q

Pathophysiology of IE?

A

when blood turbulence within heart allows causative agent to infect previously damaged valves or other endothelial surfaces

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3
Q

Most common causative agents of IE?

A
  • staphylococcus aureus

- streptococcus viridans

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4
Q

Fibrin and platelets adhere to the valve surface forming a lesion called?

A

Vegetations

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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
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6
Q

Risk Factors for IE (Noncardiac)?

A
  • increasing age
  • Hospital-acquired bacteremia
  • dental procedures
  • IV drug abuse
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7
Q

Risk Factors of IE (Procedure-Associated)?

A
  • Intravascular devices
  • Dental procedures
  • Respiratory procedures
  • GI and GU procedures
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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
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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
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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
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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
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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
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13
Q

Complications of IE?

A
  • Dysrhythmias
  • Valve dysfunction
  • Heart failure
  • Sepsis
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14
Q

Most common valves affected by Valvular Heart Disease?

A

Mitral and Aortic

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15
Q

Cardiac Functional alterations seen in Valvular Heart Disease?

A
  • Stenosis (narrowing)

- Regurgitation (backward flow)

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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

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17
Q

What is an incomplete closure of valve leaflets that results in backward flow of blood?

A

Regurgitation

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18
Q

Most common cause of Mitral Valve Stenosis?

A

Rheumatic heart disease

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19
Q

Manifestations of Mitral Valve Stenosis?

A
  • Exertional Dyspnea-reduced lung compliance
  • Fatigue and palpations (A-fib)
  • Murmur
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20
Q

Causes of Mitral Valve Regurgitation?

A
  • MI
  • Rheumatic heart disease
  • Mitral valve prolapse
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21
Q

Manifestations of

Acute Mitral Valve Regurgitation?

A
  • New systolic murmur

- Pulmonary Edema

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22
Q

Manifestations of Chronic Mitral Valve Regurgitation?:

A
  • may be asymptomatic for years
  • Weak, fatigued
  • Dyspnea
  • palpitations
  • Audible S3 sound
  • murmur
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23
Q

Complications of Mitral Valve Prolapse?

A
  • Mitral valve regurgitation
  • Infective endocarditis
  • Sudden death
  • Cerebral ischemia
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24
Q

Manifestations of Mitral Valve Prolapse?

A
  • Most patients asymptomatic for life
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25
Q

Causes of Aortic Valve Stenosis in children?

A

Congenital defect

26
Q

Causes of Aortic Valve Stenosis in adults?

A

rheumatic fever

27
Q

Causes of Aortic Valve regurgitation?

A
  • Rheumatic heart disease
  • congenital heart defects
  • syphyllis
28
Q 
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
A

Ans: A

29
Q

Diagnostics for Valvular Heart Disease?

A
  • H&P
  • Echocardiogram
  • ECG
  • Chest X-ray or CT scan
  • Cardiac Cath
  • Labs
30
Q

Why is an echocardiogram done for Valvular Heart Disease?

A

shows the valve structure, function and chamber size

31
Q

Why is an ECG done for Valvular Heart Disease?

A

rhythm and ischemia

32
Q

Why is a CXR or CT scan done for Valvular Heart Disease?

A

to see the size of heart

33
Q

Why is a Cardiac Cath done for Valvular Heart Disease?

A

to measure the pressures in the valve and the size of the valve opening

34
Q

Why is are labs dranw for Valvular Heart Disease?

A

to rule out infection

35
Q

Nursing Cardiovascular Assessment Findings Valvular Heart Disease?

A
  • Abnormal heart sounds
  • Tachycardia
  • Dysrhythmias
  • Hypotension
36
Q

Nursing Respiratory Assessment Findings Valvular Heart Disease?

A
  • Crackles
  • wheezes
  • hoarseness
37
Q

Nursing Gastrointestinal Assessment Findings Valvular Heart Disease?

A
  • Ascites in ABD

- Hepatomegaly

38
Q

Nursing Integumentary Assessment Findings Valvular Heart Disease?

A
  • Diaphoresis
  • Peripheral edema
  • Temperature changes
  • Clubbing
39
Q

Focus of TX for Valvular Heart Disease?

A

Preventing:

  • Exacerbations of heart failure
  • Acute pulmonary edema
  • Thromboembolism
  • Recurrent endocarditis
40
Q

Drug therapy for Valvular Heart Disease?

A
  • Digitalis
  • Diuretics
  • Antiarrhythmics
  • Beta-Blockers
  • Anticoagulants
  • Antibiotics
41
Q

Patient Teaching for Valvular Heart Disease?

A
  • 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
Q

Warfarin (Coumadin) mechanism of action?

A

interferes with the production of vitamin K dependent coagulation components

43
Q

Indications for Warfarin

A

Afib, mechanical valve, DVT, PE

44
Q

Reversal agent(s) for Warfarin?

A

Vit K and fresh frozen plasma (FFP)

45
Q

INR therapeutic range for patient with a mechanical valve?

A

2.5 - 3.5

46
Q

A group of diseases that directly affect the structure and functioning ability of the myocardium?

A

Cardiomyopathy

47
Q

Cause of Primary Cardiomyopathy?

A

unknown etiology

48
Q

Cause of Secondary Cardiomyopathy?

A

Caused by another disease process

49
Q

Most common type of Cardiomyopathy?

A

Dilated Cardiomyopathy

50
Q

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.

A

Dilated Cardiomyopathy

51
Q

Highest prevalence of Dilated Cardiomyopathy in?

A

Middle-aged African Americans and men

52
Q

Most common cause of sudden cardiac death in young people?

A

Hypertrophic Cardiomyopathy

53
Q

Causes of Dilated Cardiomyopathy?

A
  • Cardio toxic agents (OH, cocaine)
  • CAD
  • genetics
  • HTN
  • metabolic disorders
  • muscular dystrophy
  • myocarditis
  • pregnancy
  • valve disease
54
Q

Causes of Hypertrophic Cardiomyopathy?

A
  • Aortic Stenosis
  • genetics
  • HTN
55
Q

Diagnostics for Dilated Cardiomyopathy?

A

Chest Xray, ECG, BNP, Cardiac Cath

56
Q

Diagnostics for Hypertrophic Cardiomyopathy?

A

ECG, ECHO, Cardiac Cath

57
Q

TX of Dilated Cardiomyopathy?

A
  • TX underlying cause
  • Nitrates
  • B-adrenergic blockers
  • Antidysrhythmics
  • ACE inhibitors
  • Diuretics
  • Digoxin
  • Anticoagulants (if indicated)
58
Q

TX of Hypertrophic Cardiomyopathy?

A
  • B-adrenergic blockers
  • Antidysrhythmics
  • ACE inhibitors
  • Diuretics
  • Anticoagulants (if indicated)
59
Q

Patient Teaching for Cardiomyopathy pt?

A
  • 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
Q

Diet for Cardiomyopathy pt?

A

Low Fat, Chol, and Na diet

  • 6-8 glasses of H2O (unless contraindicated)
  • Avoid alcohol, caffeine, OTC meds
61
Q

Patient Teaching for Hypertrophic Cardiomyopathy ?

A
  • 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)

Care of Adult/Older patients (5 decks)

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