Valve disease & Cardiac Inflammatory conditions

Question 1

5 questions on inflammatory and valve disease on exam 3

Question 2

what is the pericardium ?

Answer 2

protect the heart, it covers the heart

Question 3

what does pericarditis mean ?

Answer 3

inflammation of the pericardium causing pericardium to be less elastic and compress the heart

Question 4

what is pericarditis mainly caused by ?

Answer 4

bacteria or virus

Question 5

pericarditis is often progressive, frequent severe chest pain but worsen when ?

Answer 5

inspiration and when lying flat
( deep breath and learning forward )

Question 6

why do you think patients who have pericarditis avoid taking deep breaths and leaning forward?

Answer 6

youre filling your chest, which puts pressure on the heart

and when you lean forward, heart moves and rubs against your chest wall

Question 7

what are some clinical manifestations of pericarditis ?

Answer 7

dyspnea
fever - its an infection
chills
fatigue

Question 8

what are you going to hear in pericarditis ?

Answer 8

pericardial friction rub

Question 9

if pericarditis is chronic, you may have what ?

Answer 9

right ventricular failure - goes into the pitting edema

Question 10

how do we manage pericarditis ?

Answer 10

high fowlers
blood culture - infection
oxygen

Question 11

what is the medication for pericarditis ?
and why ?

Answer 11

NSAIDS or steroids
- this an inflammatory conditions

Question 12

what is cardiac tamponade?

Answer 12

the entire heart fills up with fluid, remember its like drowning

Question 13

cardiac tamponade is an emergency, so what are some procedures we are going to do in order to help aid all the fluid build up ?

Answer 13

pericardiocentesis
pericardial window
pericardectomy

Question 14

when youre listening for heart sounds, what is it going to sound like in a patient with cardiac tamponade?

Answer 14

muffled heart sounds

Question 15

what are some medications we are going to give to patients with cardiac tamponade ?

Answer 15

NSAIDS

Question 16

what is infective endocarditis ?

Answer 16

disease of the endocardium, including the heart valves - usually aortic and mitral

Question 17

how does infective endocarditis come to be?

Answer 17

bacteria enters blood stream, adheres to endocardium and valves, with previous damage and develops into vegetation which can become emboli

Question 18

left sided vegetation can move to where ?
for infective endocarditis

Answer 18

brain, kidneys, spleen

Question 19

right sided vegetation can move to where?
for infective endocarditis

Answer 19

lungs (pe)

Question 20

notes
some risk factors for infective endocarditis
- age
- prosthetic valves
- hemodialysis
- iv drug abuse
- iv access/infection
-hemodialysis

tongue piercing !

Question 21

what are some clinical manifestation of infective endocarditis ?

Answer 21

clubbing - chronic
fever
chills
weakness
malaise
back pain
weight loss

Question 22

typically in patients who have infective endocarditis, typically you will hear a new or worsening what?

Answer 22

systolic murmur

Question 23

if infective endocarditis is not treated, they may end up getting what?

remember think of how the vegetation plays a part in the body

Answer 23

heart failure

Question 24

what are some manifestations secondary to septic embolism we can potentially see in a patient with a infective endocarditis ? (4)

josr!!

Answer 24

splinter hemorrhages in nail beds
( black longitudinal streaks )

osler nodes on fingertips or toes
( painful, red pea size lesson )

janeways lesions on pads of the fingers/toes
( flat, red spots )

Roths sports
( retinal lesions )

Question 25

what are some diagnostic studies for patients who have infective endocarditis ?

Answer 25

history blood cultures fluids rest valve replacement

Question 26

typically the end treatment for patients who have infective endocarditis is to give them what? additional information if you are having procedures, you need to give antibiotics before hand because the risk of progressive disease is at risk

Answer 26

prophylactic antibiotics treatment

Question 27

nursing assessment notes Objective data Fever Osler’s nodes Splinter hemorrhage Janeway’s lesions Petechiae, purpura Peripheral edema, clubbing Tachypnea, crackles Dysrhythmia, tachycardia, murmurs, S3, S4 Retinal hemorrhages

Question 28

nursing diagnosis notes Decreased cardiac output Activity intolerance Hyperthermia Impaired comfort Knowledge deficit nursing management notes Assess for risk factors and physical evidence Patient will be on IV antibiotics for weeks Teach patient to rest DVT prophylaxis-compression stockings, ROM, Prevent atelectasis: turn, cough, deep breathe Q2 hours Patient to monitor temperature, look for signs of complications, finish antibiotic treatment

Question 29

what is rheumatic fever and caused by? occurs ____(when) after____(what) how do we prevent rheumatic fever?

Answer 29

acute inflammation of the heart resulting from group a stream infection 2-3 weeks after strep infection proper treatment of strep infections

Question 30

what is rheumatic heart disease ? what is the treatment for this and for how long?

Answer 30

chronic scarring and deformity of the heart valves 5 years and may need lifelong prophylaxis

Question 31

valve disease section time !

Question 32

you can have two types of valve conditions, which are?

Answer 32

stenosis regurgitation or insufficiency

Question 33

what does stenosis mean ?

Answer 33

valve are stiff and do not open easily ( think a set of doors that sticks and must be pushed hard to open ) openings are smaller

Question 34

what does regurgitation or insufficient mean ?

Answer 34

valve do not close completely

Question 35

how does blood flow work for each stenosis regurgitation or insufficiency

Answer 35

forward blood flow backward blood flow

Question 36

she mentions how we need to know the valve locations and where it is to listen to before we do that what are the 5 valves ?

Answer 36

aortic pulmonary erbs point tricupsid mitral

Question 37

now give me the landmark location to where we are going to need to know where to listen to aortic pulmonary erbs point tricuspids mitral

Answer 37

2nd intercostal space to the right sternal border 2nd intercostal space to the left sternal border 3rd intercostal space to the left sternal border 4th intercostal space to the left sternal border (apex), 5th intercostal space, midclavical line (point of maximum impulse)

Question 38

between stenosis and regurgitation or insufficiency, which one is worse and why ? and why

Answer 38

stenosis - because its very hard for the blood to even move compared to insufficiency - because it is at least moving, but just moving backwards

Question 39

mitral valve stenosis goes from the what ?

Answer 39

left atrium to left ventricle

Question 40

what is the most common cause for rheumatic heart disease ?

Answer 40

mitral valve stenosis

Question 41

what is the result from mitral valve stenosis?

Answer 41

decreased blood flow from left atrium to left ventricle, blood can back up into pulmonary vasculature

Question 42

so with mitral valve stenosis, we understand that the blood from the left atrium and left ventricle is decreased causing what to increase and putting risk of getting ?

Answer 42

increased in left atrial pressure/volume increase in pulmonary vasculature atrial fibrillation

Question 43

what is the most important clinical manifestion for patient who have mitral valve stenosis ?

Answer 43

exertion dyspnea due to decreased lung compliance

Question 44

what is mitral valve regurgitation ?

Answer 44

when the mitral valve doesn't close completely

Question 45

what are some examples/causes of mitral valve regurgitation ?

Answer 45

myocardial infarction chronic rheumatic heart disease mitral valve prolapse ischemic papillary muscle dysfunction infective endocarditis

Question 46

what is some acute mitral valve regurgitation clinical manifestations? remember with acute, the valve is not closing properly, so instead the blood is going backwards, so the patents are going to end up with ?

Answer 46

therady peripheral pulses tachycardia pulmonary edema - crackles - frothy

Question 47

if we do not fix mitral valve regurgitation, what time of shock can they develop ?

Answer 47

cardiogenic shock

Question 48

what are some chronic mitral vital regurgitation clinical manifestions ?

Answer 48

left ventricular failure after a long time - weakness, fatigue, palpitation

Question 49

what is the treatment of mitral value regurgitation ?

Answer 49

fix the valve

Question 50

what is mitral valve prolapse?

Answer 50

abnormality of mitral valve leaflets allowing leaflets to prolapse back into left atrium during systole - they can close, but they aren't in the space where its suppose to be

Question 51

most of the time people who have mitral valve prolapse dont have what?

Answer 51

symptoms

Question 52

how are we going to manage mitral valve prolapse ? (3)

Answer 52

antibiotics beta blockers - help with chest pain avoid stimulants

Question 53

the aortic valve goes from you ___to your ?

Answer 53

left ventricle to your aorta

Question 54

what is aortic valve stenosis ?

Answer 54

obstruction of blood flow from left ventricle to aorta

Question 55

aortic valve stenosis clinical manifestations ?

Answer 55

angina dyspnea on exertion syncope on exertion

Question 56

aortic valve insufficiciency manifestion?

Answer 56

dysonea fatigue angina

Question 57

remember stenosis aortic is an emergency and needs to be fixed insufficiency can be delayed

Question 58

what are some diagnostic things we can do?

Answer 58

ct scan echocardiogram cardiac catherterization

Question 59

with aortic valve stenosis, we want to avoid giving nitroglycerin because why ?

Answer 59

reduces preload and blood pressure can worsen chest pain

Question 60

what are some medications we are going to give to aid aortic problems ?

Answer 60

vasodilators positive inotropes diuretics beta blockers sodium restriction anticoagulation therapy antidysrhythmias

Question 61

what is a procedure we can do for valvular heart disease ?

Answer 61

percutaneous transluminal ballon valvuloplasty

Question 62

if we can't repair the valve, we have to replace it. mechanical (artifical) last longer, requires anicoagulations development of clot biologic (tissue) bovine (cow) porcine(pork) human no anticoagulation is needed, only last 10 years