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Nursing 4 Exam 2 > Unit 10 Cardiac Infections & Structures > Flashcards

Unit 10 Cardiac Infections & Structures Flashcards

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1
Q

What is Rheumatic fever?

What are the risk factors?

A

Acute inflammation of the heart involving all layers.
(common in 5-18 years old)

  • Poor hygiene
  • Close proximity
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2
Q

What is he jones modified criteria for Major and Minor signs and symptoms of Rheumatic Fever? Other?

A

Major:

  • Carditis
  • Polyarthritis
  • Erythema marginatum (macular lesions on back aggravated by heat)
  • Sydenham’s Chorea (facial twitching)
  • Subcutaneous nodules (painless nodules)

Minor:

  • Arthralgia (joint pain)
  • Fever
  • ASO titer (Antistrep antibodies)
  • Hx of RF or R. heart disease

Other:

  • SOB
  • Symptoms of HF
  • Murmor
  • Cardiomegaly on CXR
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3
Q

What is Rheumatic Fever treated with?

A

Penicillin

if allergic, azithromycin

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4
Q

What does Rheumatic Fever lead to if not treated?

A

Rheumatic Heart Disease later in life.

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5
Q

What is confirmed diagnoses of Rheumatic Fever?

A

2 “major” symptoms

or

1 “major” and 2 “minor”

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6
Q

What is Myocarditis?

A

Inflammation of myocardium; viral or bacterial

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7
Q

What is the collaborative care of Myocarditis?

A

Can resolve w/o intervention

In later stages:

  • Bedrest
  • Supportive care
  • Lasix
  • Steroids
  • IV Globulin Infusion
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8
Q

What are the symptoms of Myocarditis?

A

Flu-like symptoms

  • Fever
  • Fatigue
  • Pleuritic chest pain
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9
Q

What is Infective Endocarditis?
What are the major organisms?
What are the portals of entry?
What are the risk factors?

A

Infection of the endocardial surface of the heart.
(acute or subacute)
Destroys heart valves, etc.

Major organisms: Staph, Strep

Portals of entry: Oral, skin, Invasive procedures

Risk factors: Congenital heart disease, atrial septal defect, PDA, IV drug abusers

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10
Q

What is a characteristic lesion of Infective Endocarditis? Describe.

A

Vegetation - growth of bacteria on heart valves

They are easily breakable and can occlude blood vessels.

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11
Q

What are general symptoms of Infective Endocarditis?

A
  • Fever
  • Fatigue
  • Chills
  • Malaise
  • Anorexia
  • Arthralgia (joint pain)
  • Clubbing
  • Petichiae
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12
Q

What are specific symptoms of Infective Endocarditis?

A

Splinter hemorrhage (black line under nails)

Osler’s nodes (painful red lesions on hands and feet)

Janeway lesions (painless lesions on palms and feel)

Roth spots (hemorrhage spots in eyes)

New murmurs

System/organ embolization

Heart failure

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13
Q

What are the diagnostics/labs used/seen in Infective Endocarditis? Describe.

A

-History and physical (recent procedures especially dental, hx of valve disease)

  • CBC (increased leukocytes)
  • ESR (increased)
  • C/S (cultures taken before antibiotics)
  • Urinalysis (may show microscopic hematuria)
  • CXR (cardiomegaly)
  • EKG (different types of heart blocks)
  • ECHO (to detect vegetation)
  • TEE (NPO, IV conscious sedation)
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14
Q

What medications/interventions are used with Infective Endocarditis?

A

Bedrest

Antibiotics: - will need for 6 weeks, PT gets PICC line

  • Penicillins
  • Vancomycin (watch BUN and creatinine)
  • Amino-glycosides (gentymycin)

Antipyretics

Surgical repair

Follow-up lab work

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15
Q

Describe the level of risk and needing antibiotic prophylaxis for Infective Endocarditis.

A

Low risk:
-Hx of physiologic murmurs

Moderate risk:

  • Heart murmurs
  • Valvular disease

High risk:

  • Prosthetic valves
  • Surgical shunts
  • Hx of endocarditis
  • Other invasive procedures
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16
Q

What is Pericarditis?

What are the causes?

A

Inflammation of the pericardium

Causes: viral, bacterial, Post MI, ESRF, Rx’s like hydralazine

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17
Q

What are complications of Pericarditis?

A

Pericardial effusion

Cardiac Tamponade

Constrictive pericarditis

18
Q

What is Cardiac Tamponade and what are the signs and symptoms?

A

Compression of the heart that occurs when fluids build up between pericardium and myocardium.

S and S’s:

  • SOB
  • JVD
  • Tachycardia
  • Paradox pulses
  • EKG shows every other QRS big then small, repeating.
19
Q

What are signs and symptoms of Pericarditis?

A
  • Fever
  • Anxiety
  • Chest pain (increases when laying down)
  • Tachycardia/Tachypnea
  • Pulses paradox
  • JVD
  • Muffled heart sounds
  • Friction rub
  • EKG (slight ST elevation everywhere)
  • CXR (cardiomegaly)

(All increase in severity when laying down)

20
Q

What are diagnostics of Pericarditis?

A

Hx and physical

CBC

BMP

EKG

CXR

Mantaux test

Echocardiagram***gold standard

Pericardiocentesis

21
Q

What are interventions for Pericarditis?

A

Rx for underlying cause

Bedrest

NSAIDS***(for pain and inflammation)

Steroids

Pericardiocentesis (done sitting up)

22
Q

What are considered Diastolic murmurs?

A

MS ARD = Mitral stenosis, Aortic regurgitation = Diastolic

everything else is systolic.

23
Q

What are the two atrio-ventricular valves?

A

Mitral valve (LA-LV)

Tricuspid valve (RA-RV)

24
Q

Describe Valvular Heart Disease.

A

Most valvular lesions are due to Rheumatic heart disease.

Valve abnormalities are either:

Regurgitation = cannot close properly
Stenosis = cannot open properly
25
Q

What are the types of Mitral Valve Disease?

A

Mitral stenosis

Mitral regurgitation

Mitral valve prolapse

26
Q

What is Mitral Valve Stenosis? What happens in it?

What is most common cause and other causes?

A

The valve fuses/hard to open.

Obstruction to blood flow from LA to LV.
Increases LA pressure, LA size, and RV size.

Rheumatic fever is the most common cause.*
Other causes: Calcium deposits, Atrial myxoma, Thrombus formation.

27
Q

What are signs and symptoms of Mitral stenosis?

A

SOB

Blood tinged sputum

JVD

Irregular pulse

Right para-sternal pulsations

Loud first heart sound

Diastolic murmur

28
Q

What is Mitral valve regurgitation?
What happens in it?
What are the causes?

A

Valve does not close completely during systole.

Blood flows back into left atrium.

Causes:
Rheumatic fever
Infective endocarditis
Papillary muscle dysfunction

29
Q

What are signs and symptoms of Mitral Regurgitation?

A
  • Dyspnea on exertion
  • Orthopnea
  • PND (waking up from sleep from SOB)
  • Dry cough
  • Hemoptysis
  • Pulmonary edema (left atrial failure)
  • Atrial fibrillation
  • Embolic phenomena
30
Q 
Describe Mitral Valve prolapse. 
What are the risk factors?
What are the signs and symptoms?
What is the treatment?
What do you want to avoid?
A
  • Associated with Mitral valve regurgitation
  • Valve is very dysfunctional

Risk factors: family Hx, female gender, marfan’s syndrome

S and S’s:

  • Asymptomatic
  • Palpations
  • Dizziness

No treatment required, CCB’s or Beta-Blockers for prophylaxis.

Avoid caffeine and cough/cold medication(ephedrine).

31
Q

Describe Aortic Stenosis.
What are the causes?
What are the signs and symptoms?
What is the management of it?

A

Valve doesn’t open properly, left ventricle hypertrophies.

Causes:

  • Old age
  • Calcium deposits
  • Congenital
  • Rheumatic fever

SandS’s:

  • Asymptomatic
  • Angina
  • Dyspnea
  • Syncope

Management:
Trans Aortic Valve Replacement (TAVR)

32
Q

What is Aortic regurgitation?
What are the causes?
What is a major symptom?

A

Aortic valve doesn’t close properly.

Causes:

  • RF
  • Endocarditis
  • Syphilis
  • Marfan’s syndrome*
  • Aortic syndrome

Major symptom - severe back pain.

33
Q

What are the diagnostics for Valvular disease?

A

History and physical

EKG (broad P wave, double bump P wave)

Echocardiogram**standard

CXR

Cardiac cath

TEE**gold standard

34
Q

What is the medical and surgical care for valvular disease?

A

Medical:

  • Prophylaxis of Infective endocarditis
  • Oral anti-coagulation
  • Healthy diet
Surgical:
- Valvuloplasty 
- Closed commissurotomy 
- Open commissurotomy
- Annuloplasty
- Valve replacement 
(mechanical or 
tissue like allograft-cadaver, xenograft-animal)
35
Q

What is Dilated Cardiomyopathy?
What does it result in?
What are some causes?

A

Enlarged and weakened left ventricle
Most common type of Cardiomyopathy.

Results in loss of systolic function; systolic heart failure.

Causes:

  • ETCOH
  • Ischemia
  • Myocarditis
36
Q

What are signs and symptoms of DCM?

A

S3 gallop and murmurs

Rales on auscultations of lungs

Cardiomegaly

Decreased myocardial contractility

Decreased cardiac output

PMI displaced

37
Q

Describe Hypertrophic Cardiomyopathy.
Is it a systolic or diastolic issue?
What are some causes?

A

Ventricular hypertrophy and septal hypertrophy with or without LV outflow obstruction.
(muscle so big/thick that blood barely gets pushed out!)

  • Diastolic dysfunction/HF.
  • Forceful contractions
  • Preload issue

Causes:
-Genetics, severe HTN

38
Q

What are signs and symptoms of Hypertrophic Cardiomyopathy?

A

Asymptomatic

Syncope

Angina

Decreased cardiac output

Arrhythmias

Bisferiens pulse

Forceful PMI

S3/S4 gallop

39
Q

What is Restrictive Cardiomyopathy?

What can be assessed in R CMP?

A
  • A rare storage disorder.
  • Inadequate filling of ventricles
  • Contraction of the heart is fine, the relaxation/filling is abnormal

Diastolic HF and JVD

40
Q

What is the collaborative care for all the cardiomyopathy issue?

A

Medicate underlying causes

Diuretics/ digoxin/ nitrates

Anticoagulation

Beta-blockers in HCM

Ventriculomyotomy muscle resection for HCM

ACEi for DCM

Heart transplant for DCM, RCM

41
Q

What is the most common complication of prosthetic valves?

A

Endocarditis

42
Q

What is pulses paradox?

A

VS drop during inspiration

Nursing 4 Exam 2 (6 decks)

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