Inflammatory Heart Disease

Question 1

Causes of Infective Endocarditis

Answer 1

1. IV drug use; 2. Prosthetic Valves; 3. Invasive Catheters;
2. Aging; 5. Hemodialysis; 6. Cardiac Conditions

Question 2

S/S Infective Endocarditis

Answer 2

Low-grade fever; Flu-like symptoms; Clubbing of fingers;
New or changing heart murmur; splinter hemorrhages; Petechiae;
Osler’s Nodes; Janesway’s Lesions; Roth’s Spots

Question 3

Most common murmur found w/ infective endocarditis

Answer 3

Mitral valve

Question 4

Microembolization of vegetation breakes off and settles in tissues. Seen in finger nails

Answer 4

Splinter hemorrhage’s

Question 5

Microembolization of vegetation in trunk, ankles and feet

Answer 5

Petechiae

Question 6

Painful lesions on finger tips/toes; Inflammatory response

Answer 6

Osler’s Nodes

Question 7

Flat, painless red spots on palms/soles of feet; irregular shaped

Answer 7

Janesway’s Lesions

Question 8

Small, whitish spots on retina seen w/ eye exams

Answer 8

Roth’s Spots

Question 9

Complications of Infective Endocarditis

Answer 9

Heart failure; embolization of vegetation

Question 10

Signs of embolization to spleen

Answer 10

Sharp LUQ pain

Question 11

Decreased UOP, flank pain, increased BUN/Creatinine indicates embolism of vegetation to….

Answer 11

Kidneys

Question 12

SOA, Chest pain, anxiety, decreased o2 saturation is indicative of embolization of vegetation to

Answer 12

Lungs (Pulmonary Embolism)

Question 13

Level of consciousness changes, vision changes suggests embolization of vegetation to

Answer 13

Brain

Question 14

Pain, altered sensation, shiny skin, cool, decreased pulse indicated embolization of vegetation to

Answer 14

Blood vessels (arterial)

Question 15

Diagnostics for Infective endocarditis

Answer 15

Health history; Positive blood cultures; new or changing murmur; vegetation seen on echocardiogram; mild increase in WBCs; Increase in ESR

Question 16

Collaborative Care for Infective Endocarditis

Answer 16

Antibiotics; Blood Cultures; Treat Fever; Valve Replacement

Question 17

Nursing Care for Infective Endocarditis

Answer 17

Throrough H&P;
Antibiotic Administration;
Watch for Complications;
Provide teaching

Question 18

What are some important things to look for with history and physical? (Infective Endocarditis)

Answer 18

Recreational drug use; Cardiac Conditions (Valve replacement); Recent Dental Work?; fever, chills, Petechiae

Question 19

What are some things the nurse should watch out for related to complications with infective endocarditis?

Answer 19

Neuro - Decreased LOC
Renal - hematuria, decreased UOP, flank pain;
Pulmonary - SOA, decreased sats;
Others - LUQ pain, arterial occlusion

Question 20

What are some things the nurse can teach to prevent patient from developing infective endocarditis again?

Answer 20

Stop drugs; clean needles; take antibiotics;

Inform provider before invasive dental procedure or any procedure

Question 21

Nursing diagnoses for Infective Endocarditis

Answer 21

Decreased cardiac output;
Hyperthermia;
Activity Intolerance

Question 22

Causes of pericarditis

Answer 22

Viral/bacterial;
Acute MI;
lupus; cancer/radiation; Drug reactions;
Trauma (pacemaker insertion, central catheter placement)

Question 23

S/S Pericarditis

Answer 23

Chest pain; Dyspnea; Fever; Anxiety; Pericardial Friction Rub

Question 24

Hallmark signs of pericarditis

Answer 24

Pericardial friction rub - scratchy/grating/high-pitched sound

Question 25

What is the difference between MI chest pain and pericardial chest pain?

Answer 25

Chest pain w/ pericarditis is positional; Worsens w/ inspiration or laying flat; Relieved by sitting up and leaning forward

Question 26

Diagnostic Studies for pericarditis

Answer 26

ECG; Echo; CXR; ESR and CRP (inflammatory markers)

Question 27

Collaborative Care Pericarditis

Answer 27

ID and Treat cause; | Treat Pain and Inflammation

Question 28

Complications of Pericarditis

Answer 28

Pericardial Effusion; | Cardiac Tamponade

Question 29

Large collection of fluid that can compress the heart that can compress the heart structures.

Answer 29

Pericardial effusion

Question 30

Where does pericardial effusion typically collect

Answer 30

At apex

Question 31

Sign of chronic/progressive pericardial effusion

Answer 31

Distant heart sounds

Question 32

Pressure in heart leading to inability to pump; result of increasing volume of pericardial effusion

Answer 32

Cardiac tamponade

Question 33

S/S Cardiac Tamponade

Answer 33

``` Beck’s Triad: 1. Hypotension 2. Muffled Heart Sounds 3. JVD Also: increased HR, Narrow pulse pressure, pulses paradoxus ```

Question 34

A decrease in systolic blood pressure greater than 10 mmHg during inspiration signifies...

Answer 34

Pulsus paradoxus

Question 35

Nursing Care for Cardiac Tamponade

Answer 35

Gas Exchange Perfusion Cardiac Function

Question 36

Collaborative care for cardiac tamponade

Answer 36

Pericardiocentesis; Watch for pneumothorax and dysrhythmias; Pericardial window for recurrent tamponade

Question 37

Nursing care for pericarditis

Answer 37

Manage acute pain; Watch for ineffective breathing pattern; watch for complication (cardiac tamponade); provide education

Question 38

What education can nurse provide to someone with pericarditis

Answer 38

Take NSAIDs as scheduled around the clock to reduce inflammation

Question 39

Inflammatory disease in response to group A strep pharyngitis

Answer 39

Rheumatic Fever

Question 40

S/S Rheumatic Fever

Answer 40

Fever; joint pain; erythema marginatum; carditis

Question 41

Red, flat rash on trunk, upper arms and legs, painless

Answer 41

Erythema marginatum

Question 42

How long after strep infection does rheumatic fever present?

Answer 42

2-3 weeks

Question 43

Diagnostic Studies for Rheumatic Fever

Answer 43

Positive Throat Culture; ASO Tiger; Increased ESR & CRP; Echo; CXR

Question 44

Nursing Care Rheumatic Fever

Answer 44

Prevention; Penicillin/Cephalosporins; Anti-inflammatories and Corticosteroids; Prophylactic antibiotic treatments for medical procedures