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406 Exam 3 > Valvular disorders > Flashcards

Valvular disorders Flashcards

1
Q

Infective endocarditis

A

Can cause damage to valves

Subacute: In those w/ preexisting valve disease
-req months of treatment

Acute: In those w/ healthy valves
-Rapidly progressive disease

Caused by IVDA (IV drug abuse)

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2
Q

Risk factors for infective endocarditis

A 
Aging
IVDA
Prosthetic valve
Dialysis
Hospital IV devices carrying healthcare assoc. infection
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3
Q

IE manifestations

A 
Low CO
Organ damage from emboli
Heart murmur
Fever!!!!
Arthralgia/myalgia
Clubbing of fingers

Splinter hemorrhages (black streaks in nail bed)

Osler’s nodes (painful red/purp pea sized lesions)

Janeway’s lesions (flat, painless small red spots)

systolic murmur

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4
Q

Diagnostics for IE (assessing)

A

Dental, surgical, gynecological procedures in past 3-6 months

blood drawn from 3 different sites in an hour

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5
Q

Guidelines for dx of IE

A

2 major + 1 minor
1 major + 3 minor
5 minor

Major:

  • Pos blood cultures (MOST IMPORTANT)
  • Microorganisms consistent w/ IE from 2 separate cultures
  • Endocardial involvement
  • New valvular vegetation

Minor:

  • Predisposing heart condition or IV drug use
  • Vascular phenomena
  • Immunologic phenomena
  • Microbiologic evidence
  • Echocardiograph findings consistent w/ IE but not meeting major criteria

Chest x ray can show Cardiomegaly

ECG: 1st or 2nd AV block

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6
Q

Vegetations forming from IE

A

Primary lesion of IE
Can embolize
Risk INCREASES once treatment starts

L heart: embolize to all organs

R heart: embolize to lungs

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7
Q

Target organ damage from IE

A

Spleen: Sharp LUQ pain, rigid

Kidney: Low urinary output, flank pain, hematuria, azotemia (nitrogen in blood)

Arms/legs: gangrene

Brain: Hemiplegia, ataxia, aphasia, LOC change

Pulmonary embolism

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8
Q

Most important IE diagnosing factor

A

POSITIVE BLOOD CULTURE

- report to provider

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9
Q

IE collab care

A

Prophylaxis:
-antibiotics

Amoxicillin 3g po 1h prior

If allergic to penicillin: Clindamycin 600mg po 1h prior

High risk: Amoxicillin 1g IV, gentamycin 120mg IV at induction. Amoxicillin .5g PO 6hr after

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10
Q

IE drug therapy

A

MUST identify causative organism first!!!

Long term treatment: IV antibiotics in hospital and after discharge

Monitor w/ more blood cultures

Monitor antibiotic levels for therapeutic range

Fungal/prosthetic valve endocarditis responds poorly to treatment- expect valve replacement and long term antibiotics

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11
Q

Long term implementation

A

Long term antibiotics on PICC

If shows S&S of HF go back to inpatient

Teach S&S of infection, HF, emboli (confusion, decreased CO, skin discoloration)

Eval:
Normal temp
Tolerating ADLs
Urinary output 30+mL/hr
Demonstrate understanding
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12
Q

Pericarditis

A

Acute (rapid)
Subacute (weeks-months after an event)
Chronic (6+months)

causes:
Often idiopathic
Infectious: Viral, bacterial, fungal, LYME
Non-infectious: Acute MI, Ca, renal failure, trauma

Autoimmune: Dressler syndrome (post MI syndrome), drug reactions, Rheumatic disease

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13
Q

Acute pericarditis manifestation triad

A 
Pain:
Progressive, severe, sharp
-Inc. with inspiration and when supine
May radiate to neck, arm, L shoulder
-Dyspnea: deep breathing hurts-->lot of small breaths--> tachypnea

Friction Rub: HALLMARK SIGN
- Scratching, grating, high pitched
Heart rubbing on viscera–> inflamed!
Heard best at L sternal border w/ pt lean forward

ECG changes:
ST elevation

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14
Q

Acute pericarditis pain symptoms

A 
Pain:
Progressive, severe, sharp
-Inc. with inspiration and when supine
May radiate to neck, arm, L shoulder
-Dyspnea: deep breathing hurts-->lot of small breaths--> tachypnea
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15
Q

Acute pericarditis Friction Rub symptoms

A

Friction Rub: HALLMARK SIGN
- Scratching, grating, high pitched
Heart rubbing on viscera–> inflamed!
Heard best at L sternal border w/ pt lean forward

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16
Q

Acute pericarditis ECG change symptoms

A

ST elevation

17
Q

Acute pericarditis FRICTION acronym

A 
Friction rub, fever
Radiating substernal pain to L shoulder
Inc. pain in supine
Chest pain: stabbing/sharp/dull
Trouble breathing: Orthopnea
Inspiration causes pain
Overall sick feeling/weak
Noticeable ST changes
18
Q

Acute pericarditis complications: Pericardial effusion

A

Pericardial effusion: fluid in pericardium
Rapid: trauma
Slow: infectious

S&S: 
Cough
Hiccups (phrenic nerve)
Hoarse voice (Laryngeal nerve)
Muffled heart tones
19
Q

Acute pericarditis complications: Cardiac tamponade

A

Cardiac tamponade:

  • Acute- rupture of heart/trauma
  • Sub acute: Renal failure

S&S

  • chest pain
  • Confusion, anxiety, restless
  • Muffled heart sounds
  • Tachypnea, tachycardia

May need to be treated w/pericardiocentesis

20
Q

Acute pericarditis diagnostics

A

ECG: ST elevation globally, PR depression

Labs:
-Elevated CRP, ESR
Leukocytosis

troponin elevation in ST elevation

21
Q

Treatment of Acute pericarditis

A

antibiotics if infectious

NSAIDS

Corticosteroids

Pericardiocentesis (tamponade)

Assess pain, treat
High fowlers
Monitor for tamponade, JVD w/clear lungs, hypotension, tachycardia

May need pericardiectomy (complete resection)

22
Q

Rheumatic Heart disease (RHD)

A

Causes rheumatic fever: 2-3 wks post group A strep pharygitis

Can involve all layers of the heart
Can scar valves (thick, less mobility, harder to open and close)

Nodules (Aschoff’s bodies) within heart

23
Q

Criteria for RHD

A

Two major or 1 major 1 minor

Must also have evidence of group A strep infection

Major:
-Carditis (Most important)–> 3 signs
Heart murmur, Cardiomegaly and HF from myocarditis, pericarditis w/ muffled heart sounds, friction rub, effusion

  • Mono/polyarthritis
  • Sydenham’s Chorea-> abnormal movement disorder
  • Erythemia marginatum-> pink rings on trunk and inner surfaces arms and legs
  • SubQ nodules

Minor:
Fever
Polyarthralgia
Inc WBC, ESR, CRP

24
Q

Drugs for RHD

A

Eliminate the cause w/ antibiotics

antibiotics won’t alter the course of the disease, just help eliminate spread

symptomatic relief w./ NSAIDs, ASA, corticosteroids

Important nursing dx:
Altered tissue perfusion r/t decreased contractility AEB___

25
Q

RHD health promotion:

A

RHD is preventable: early detection of A strep pharygitis

Treated w/ penicillin

Home care:
If you had it before, likely to have it again- prophylactic monthly injection of IM penicillin

RF w/o carditis need prophylaxis until age 20 for minimum of 5 years.

Extra dosage if surgery or dental work

Seek medical care if

  • excess fatigue
  • dizzy
  • palpitations
  • Dyspnea on exertion
26
Q

MV stenosis

A

Restriction of blood flow from LA to LV

Pressure builds back eventually to lungs and right side of heart

Manifestations:
Dyspnea on exertion
A-fib
Chest pain
Decreased CO
Emboli from L atrium stasis 
Hemoptysis (blood in spit)
Pulmonary edema

Common cause Rheumatic Fever

27
Q

MV regurgitation

A

Incomplete closure

blood regurgitates back from LV to LA

LV and LA overworked to maintain CO=hypertrophy

Acute can result in pulmonary edema/shock- no time for structures to adapt

Acute signs: Thready peripheral pulse, cool clammy skin, low CO

Chronic: Weakness, fatigue, palpitations, orthopnea, paroxysmal nocturnal dyspnea

28
Q

Aortic valve stenosis

A

Often discovered in childhood

Older adults: Rheumatic fever is common cause

Blood flow restricted leaving LV- similar symptoms to mitral valve stenosis

Clinical manifestations
Low CO
LV hypertrophy
Pulmonary HTN, HF
Triad:---> Angina, syncope, DOE

DON’T USE NITROGLYCERIN–> kills preload

29
Q

AV regurgitation

A

Flow back from aorta to LV (B A D)

volume overload

Eventually backflow to right heart, L heart failure

If acute:

  • Severe dyspnea
  • Chest pain
  • Hypotension
  • shock (?)

Chronic:

  • DOE
  • Paroxysmal nocturnal dyspnea
30
Q

Valve heart disease diagnostic/treatment

A

conservative therapy

Percutaneous transluminal balloon valvuloplasty
-Mitral, pulmonic, and tricuspid stenosis

Valve repair (BEST CHOICE SURGERY)

Mechanical Valve replacement: Lasts longer w/more risks (clotting, need anticoags)- used in younger

Non mechanical valve replacement: Last less long, lower risk. For elderly

31
Q

Tricuspid valve (refresher)

A

Between R atria and R ventricle

32
Q

Bicuspid valve (refresher)

A

Between L atria and L ventricle

406 Exam 3 (10 decks)

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