Patients with Structural, Inflammatory, and Infectious Cardiac Disorders Flashcards
patho of rheumatic fever and heart disease
Strep throat that was never treated
Immune system attacking the heart
* Systemic inflammatory condition from a complication of Group A beta-hemolytic streptococcal pharyngitis (rheumatic fever)
* Can affect pericardium, myocardium, and endocardium
* Produces lesions in the heart and damage to connective tissues
* Rheumatic heart disease develops later in life if not treated
s/s of rheumatic fever and heart disease
- Sore throat, fever, swollen glands (early)
- Headache, weakness, diaphoresis, irritability
- Nausea
- Erythema marginatum – non-itchy macular rash on trunk and extremities that blanches and does not scar
medical and nursing management for preventing rheumatic fever and heart disease
- Throat cultures - swab back of throat - need for diagnosis
- PCN* for treatment; clarithromycin or clindamycin if allergic
- Echo for diagnosis - valve and ventricular function
- Long-term prophylaxis antibiotics
- Once had it, more succeptible
- Annual cardiac evaluation
- Monitor for s/s of valvular disease, heart failure, thromboembolism, and arrhythmias - sign of reoccurance
- Treat strep as a prevention!!
patho of infective endocarditis
Serious infection of endocardium; can be systemic or pathogens enter through surgical or dental procedures or direct contamination
Vegetations = formation of platelets, fibrin, blood cells, and pathogens - clump together and grow on valves
–Can break off and cause emboli
Rapid onset
common risk factors of infective endocarditis
Body piercing
Degenerative valve disease
IV drug use (IVDA)
Nosocomial endocarditis - central line gets infected
IV lines
Prosthetic cardiac valves - replacements
History of endocarditis
clinical manifestations of infective endocarditis
Anorexia, myalgia, (fever and chills**), weight loss, back and joint pain, night sweats
Heart murmur
Osler nodes = painful, red nodules on pads of fingers and toes
Janeway lesions = painless, red or purple macules on palms and soles
Roth spots = oval retinal hemorrhages in eye with pale centers
Splinter hemorrhages - line up and down nail
Petechiae
CNS: headache, strokes
Cardiac: cardiomegaly, heart failure, splenomegaly, tachycardia
Abdominal discomfort
assessment of infective endocarditis
Positive blood cultures - never off existing IV line
–Three sets 24 hours apart before administration of antimicrobial (Vancomycin)
Echo
–Presence of vegetation or abscess or regurg
Elevated WBC
Anemia - decreased production of RBC or destroyed
Elevated ESR and C-reactive protein - from increased inflammation
ECG
–Heart Blocks
3 diagnostic criteria for infective endocarditis
Physical exam findings
Blood culture results
Echo findings
goal of infective endocarditis
eliminating the infection and preventing complications
medical and nursing management of infective endocarditis
Long-term IV antibiotics for 6 weeks
–Prevent complications of long-term IV therapy
–Take as prescribed and full course
–PICC line placement
Do not discharge pt with IV drug use history
Occasional blood cultures
Monitor for persistent infection, heart failure, kidney failure, or emboli
Valve replacement (if cause)
Recognize s/s of endocarditis and seek medical attention
Emotional support with coping strategies
Daily dental hygiene
Prophylactic before dental procedures
patho of pericarditis
Inflammation of the pericardium (sac around the heart)
Develops rapidly when the pericardial sac is inflamed
Can lead to pericardial effusion = accumulation of fluid in pericardium increased pressure on the heart (cardiac tamponade)
causes of pericarditis
Acute MI
Bacterial, fungal, viral infection
Cancer and radiation therapy
Chest trauma
Disorders of adjacent structures (aneurysm, pneumonia)
Meds (isoniazid, hydralazine, procainamide)
Flu, mono, chicken pocks
clinical manifestations of pericarditis
Chest pain that is persistent, sharp, pleuritic (deep breaths), and retrosternal (internal)
–Can radiate to neck, shoulders, arms
–Aggravated by deep inspiration, coughing, lying down, or turning
–Relief of pain when sitting forward
Friction rub
Mild fever, increased WBC
Anemia, elevated ESR and C-reactive protein (inflammation)
Nonproductive cough
Dyspnea
SOB
assessment/diagnosis of pericarditis
Diagnosis (2 out of 4 to diagnose)
–Pleuritic chest pain
–Pericardial friction rub
–ECG with widespread ST elevation without T-wave inversion
–Pericardial effusion (new or increased)
Echo - looking for effusion - cardiac tamponade?
goal of treating pericarditis
symptom relief and detect s/s of cardiac tamponade
medical and nursing management of pericarditis
Treat underlying cause if known
NSAIDs and aspirin for inflammation
Pain management
Colchicine in combo with anti-inflammatories to reduce inflammation for recurrent
Sit upright and leaning forward to reduce pressure on pericardium
Restrict activity until pain resides
Psychological support, education, and reassurance
treatment for pericarditis
C - Colchicine
U - underlying cause
P - Pain relief (NSAIDs, aspirin and PPI)
S - steroids
patho of pericardial effusion
Accumulation of fluid in the pericardial sac
side effects of pericardial effusion
Raises pressure within pericardial sac compression of the heart
Can accumulate slowly and heart can stretch to accommodate
Can accumulate rapidly –> cardiac tamponade*
Can lead to shock and death if not treatedcaus
causes of pericardial effusion
pericarditis,
HF,
metastatic carcinoma,
chemo,
cardiac surgery,
trauma
clinical manifestations and assessment of pericardial effusion
chest pain
SOB
compression of near structures
Feeling of fullness within chest; ill-defined pain
Engorged neck veins with inspiration (Kussmaul sign)
Dyspnea, cough, and labile or low BP
Pulses paradoxus
–Difference in SBP heard during inhalation and exhalation
–Exceeds 10 mm Hg is abnormal
Pericardial friction rub
Cardinal signs of tamponade: falling SBP, narrowing pulse pressure, JVD, muffled heart sounds
CXR and Echo confirms diagnosis
what is happening in pulses paradoxus
Difference in SBP heard during inhalation and exhalation
Exceeds 10 mm Hg is abnormal
Narrowing pulse pressure - difference between systolic and dyastolic
Beck’s triad
falling SBP
JVD
muffled heart sounds
cardinal signs of cardiac tamponade
falling SBP
narrowing pulse pressure
JVD
muffled heart sounds
medical and nursing management with pericardiocentesis
Puncture of pericardial sac to aspirate fluid
Have emergency resus equipment at bedside
Elevate HOB to 45-60 degrees
Initiate peripheral line with IV infusion
Ultrasound guided needle to aspirate fluid
Feels immediate relief -
Fluid immediately sent to lab
Monitor for coronary artery puncture, arrythmias, pleural laceration, gastric puncture, myocardial trauma
medical and nursing management of pericardiotomy
AKA pericardial window
Portion of pericardium is excised to allow fluid to drain into mediastinum and reabsorbed in lymphatic system
Care for cardiac surgical client
–like the CABG tx
patho of acute pericardial tamponade
- sudden fluid accumulation
- pericardium cannot adjust
–dramatic increase in pressure inside pericardial sac
causes of acute pericardial tamponade
chest trauma
ruptured aorta
ruptured of ventricle after a heart attack
