Structural & Inflammatory Conditions of the Heart - EXAM 4

Question 1

What are acyanotic heart defects?

Answer 1

Heart defects that do not cause a problem with oxygenation of the blood

Question 2

What are cyanotic defects?

Answer 2

Heart defects that cause a problem with oxygenation of the blood

Question 3

What is a patent ductus arteriosus (PDA)?

Answer 3

ACYANOTIC

• Failure of the fetal ductus arteriosus to close in the first few weeks of life
• Produces a murmur
• Asymptomatic or heart failure, depending on size
• Treated with Rx, surgery, or minimally invasive techniques
• Great prognosis, easy to fix

Question 4

What is a ventricular septal defect (VSD)?

Answer 4

ACYANOTIC

• Abnormal opening between the left and right ventricle
• Small as a pinhole or multiple, involving muscle and memebrane
• Surgical treatment can be palliative or complete, invasive or minimally invasive, and may involve patches
• Prognosis is very good, depending on extent of defect

Question 5

What is the effect of PDA and VSD on pulmonary blood flow?

Answer 5

1. Respiratory assessment
2. Cardiac heart failure not uncommon due to too much right sided blood (left side of heart has more pressure normally)
3. Positioning/Oxygenation to support breathing
4. Prevent respiratory tract infections (pneumonia)
5. Prompt antibiotics for frequent pulmonary infections

Question 6

What is hypoplastic left heart syndrome (HLHS)?

Answer 6

• Severe defect results in cyanosis, with SpO2 less than 90% and often less than 80%
• May be fatal if unrecognized in fetal life
• If recognized, measures will be taken at time of birth, with surgery within a day or so of birth
• Three stage surgery in first five years of life
• Many babies with this condition are given only palliative care

CYANOTIC

Question 7

What is infective endocarditis?

Answer 7

1. Infection of the inner lining of the heart (and valves)
2. Usually bacterial, associated with underlying heart problems
3. Vegetation build up
4. Embolization
5. Antibiotic treatment and prophylaxis

Question 8

What is pericarditis?

Answer 8

• Acute infection of sac around the heart
• Chronic constrictive
• Inflammation of the pericardial sac
• Can be caused by microbes, MIs, or autoimmune conditions

Question 9

What is myocarditis?

Answer 9

• Inflammation of the myocardium
• Typically microbial cause, but may be due to medications or an autoimmune reaction
• Can lead to cardiomyopathy
• Decreased cardiac output

Question 10

What are some nursing diagnoses for those with structural and/or inflammatory conditions of the heart?

Answer 10

1. Decreased Cardiac Output (or risk for)
2. Ineffective Breathing PAttern
3. Activity Intolerance
4. Pain
5. Anxiety

Question 11

What are some outcomes for patients with structural and/or inflammatory heart conditions?

Answer 11

1. Assist in measures to improve cardiac function
2. Decreased cardiac demands
   
   1. Reduce preload
   2. Reduce afterload
3. Reduce respiratory distress
4. Maintain nutritional status (ped especially)
5. Psychosocial support

Question 12

What should be done for initial postoperative care of patients with congenital heart defects?

Answer 12

1. Respiratory support
   
   1. Intubated/ventilated
2. Meds
   
   1. Vasopressors/morphine
3. Pacemaker
4. IV fluids

Question 13

What should be done for follow-up post-operative care of patients with congential heart defects?

Answer 13

1. Postop pulmonary toliet
2. Nutrition support (NG, PO)
3. Rest and sleep
4. Meds
   
   1. Digoxin to increase contractility
   2. Diuretics to decrease preload
   3. ACE inhibitors to increase afterload

Question 14

What complications could arise from mechanical valve replacement?

Answer 14

1. Infection
2. Anemia
3. Platelets (clots)

So, lifelong anticoagulation therapy

Question 15

What is mitral valve stenosis?

Answer 15

The mitral valve separates the upper and lower chambers on the left side of the heart. Stenosis is a condition in which the valve does not open fully, restricting blood flow. Mitral stenosis is a disorder in which the mitral valve does not open fully

Question 16

What is mitral valve regurgitation?

Answer 16

Mitral valve regurgitation — or mitral regurgitation — is when your heart’s mitral valve doesn’t close tightly, allowing blood to flow backward in your heart. As a result, blood can’t move through your heart or to the rest of your body as efficiently, making you feel tired or out of breath.

Question 17

What is mitral valve prolapse?

Answer 17

Mitral valve prolapse (MVP) occurs when the valve between your heart’s left upper chamber (left atrium) and the left lower chamber (left ventricle) doesn’t close properly.

During mitral valve prolapse, the leaflets of the mitral valve bulge (prolapse) upward or back into the left atrium as the heart contracts.

Mitral (MY-trul) valve prolapse sometimes leads to blood leaking backward into the left atrium, a condition called mitral valve regurgitation

Question 18

What is aortic valve stenosis?

Answer 18

The aorta is the main artery carrying blood out of the heart. When blood leaves the heart, it flows through the aortic valve, into the aorta. In aortic stenosis, the aortic valve does not open fully. This decreases blood flow from the heart

Question 19

What is aortic valve regurgitation?

Answer 19

Aortic valve regurgitation — or aortic regurgitation — is a condition that occurs when your heart’s aortic valve doesn’t close tightly. Aortic valve regurgitation allows some of the blood that was just pumped out of your heart’s main pumping chamber (left ventricle) to leak back into it.

The leakage may prevent your heart from efficiently pumping blood to the rest of your body. As a result, you may feel fatigued and short of breath.

Question 20

What is vegetation?

Answer 20

Endocarditis is caused by a growth of bacteria on one of the heart valves, leading to an infected mass called a “vegetation.” The infection may be introduced during brief periods of having bacteria in the bloodstream, such as after dental work, colonoscopy, and other similar procedures.