Week 13: HF, PVD, Carditis Flashcards

1
Q

Cardiac Infection / Carditis

A

Infectious Processes Involving the Heart

Involves various layers - endocardial, myocardial, and pericardial

Various etiologies

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2
Q

Layers of the Heart in to out

A

Endocardium, Myocardium (Muscle Middle), Epicardium

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3
Q

Pericarditis

A

Inflammation of the pericardial sac

can be primary or secondary - due to surgery or medical causes

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4
Q

s/s of Pericarditis

A

constant subclavicular chest pain - worse with turning or lying flat

pain improved with leaning forward or sitting position

friction rub - grating, creaking sound with each heartbeat

Increased WBC, Temp, ESR, and CRP

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5
Q

What could it mean if a patient is in too much pain to sit back during assessment in semi-fowlers

A

if they cannot sit forward it may indicate pericarditis

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6
Q

Nursing Care for Pericarditis

A

Bed rest if s/s decrease CO until fever is normalized, chest pain and friction rub gone

Morphine, Corticosteroids, NSAIDs, Meds

Observe for s&s of cardiac tamponade - pericardiocentesis

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7
Q

Endocarditis

A

life threatenining inflammation of the inner lining of your heart’s chambers and valves (endocardium)

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8
Q

Where does the infection for endocarditis come from

A

bacteria, fungi, or other microorganisms from another part of the body such as the mouth, limb abscess, or lung infection that spreads through the bloodstream and attaches to damaged areas in the heart (it loves attaching to valves)

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9
Q

If endocarditis is not treated quickly what can happen

A

it can damage or destroy the heart valves

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10
Q

Treatments for Endocarditis

A

IV antibiotics long term (6+ weeks) and sometimes surgery

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11
Q

What are some risk factors for endocarditis

A

poor dental hygiene

cardiac disease (prior)

COVID-19

IV drug user

central line access

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12
Q

Important Nursing Care Considerations for Endocarditis Tx

A

Stabilize the patient depending on the stage

Carry out the provider’s orders to find the source (cultures, monitor labs, radiology exam)

Monitor cardiorespiratory status

Monitor for S&S of sepsis

administer ordered IV antibiotics for some time

Holistic/Wrap around care (social work, substance abuse providers, other specialists)

LISTEN WITHOUT BEING JUDMENTAL

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13
Q

5 Cardiac Valvular Disorders

A

Mitral Valve Prolapse

Mitral Regurgitation

Mitral Stenosis

Aortic Regurgitation

Aortic Stenosis

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14
Q

Diagnostic Testing for Valvular Disorders

A

2D Echocardiogram

Cardiac Catheterization

MRI

CT Scan

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15
Q

Valve Disease: Prolapse

A

Portion of the valve leaflets protrude into the atrium during systole

so, the valve wont stay closed during systole

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16
Q

S/S and Characteristics of Valve Prolapse

A

few symptoms

seen in young women

fatigue
palpitations
SOB
lightheadedness

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17
Q

Valve Disease: Incompetence

A

the valve wont stay closed durign systole

cannot close when blood is pumping

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18
Q

s/s and characteristics of valve incompetence

A

few symptoms

seen in young women

fatigue

SOB

palpitations

lightheadedness

(Similar to prolapse)

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19
Q

Valve Disease: Stenosis

A

Obstruction of blood flow

Valve does not open completely during systole

improper opening

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20
Q

S/S of Valve Stenosis

A

fatigue d/t lowered CO

SOB

cough and hemoptysis

weak, irregular pulse

murmur

CHF

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21
Q

Valve Disease: Regurgitation

A

valve does not close tightly

allows blood to flow backward into the heart

some people may NOT need tx

improper closing

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22
Q

S/S and Characteristics of Valve Regurgitation

A

SOB

fatigue

lightheadedness

rapid fluttering heartbeat

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23
Q

What may more serious valve regurgitation cases need

A

medications like diuretics and blood thinners, or surgery

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24
Q

Types of Replacement Valves

A

Mechanical Valves

Tissue (Biologic) Valves

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25
Mechanical Valves
Heart valves that do not deteriorate or become infected easily Thrombogenic and require life long anticoagulation therapy (Coumadin)
26
Tissue (Biologic) Valves
Xenograft, Homograft, and Autograft
27
Xenograft
Tissue Valve / Heterograft Pig or Cow Valve Transplant
28
Homograft
Tissue Valve / Allograft Human Valve Transplant
29
Autograft
Tissue valve Patient's own valve transplant
30
Nursing Management Considerations for Valvular Disorders
prophylactic antibiotics (esp. for dental procedures) anticoagulants - lifelong therapy post-mechanical valve replacement cardiovascular follow-up education!!!
31
Balloon Valvuloplasty
A less invasive surgery for valvular stenosis It opens the valve and vessel up to be more functional with an inflated balloon
32
Surgical Valvuloplasty
For Incompetent Valves - Valve Incompetence Closing the Valve basically
33
Self Concept Factors r/t to Cardiac Infections and Valve Disorders
Fear Addiction / Lifestyle Choices Guilt/Shame (over choices and addictions) Physical Care of Self Beliefs about Self
34
Congestive Heart Failure (CHF)
Impaired cardiac pumping, vasoconstriction and fluid retention an inability of the heart to pump sufficient blood to meet the body's needs RIGHT OR LEFT SIDED
35
Is CHF a disease
Not a disease, but is associated with other problems - CAD (60%), HTN, MI, Valvular Dysfunction, cardiomyopathy
36
What are the majro risk factors for CHF
Advancing Age and CAD
37
Contributing Factors for CHF
#1 Advancing Age and CAD HTN DM Tobacco Obesity High Serum Cholesterol
38
What may patients exhibit with CHF
ventricular dysfunction reduced exercise tolerance diminished QOL self concept issues shortened life expectancy
39
Why is CHF increasing in incidence
due to improved survival after CV events AND increasing aging population CHF is a major reason for admission in elderly patients - comorbidities are causing this
40
How many people ahve CHF
5 million
41
What is the most common reason for admission in adults >65 yo
CHF
42
CHF is associated with ...
high morbidity, mortality, and economic cost
43
What are the disparities in CHF for Asian Americans
higher risk of ACE inhibitor related cough lower rates of CHF
44
What are the disparities in CHF for AA and Hispanic Americans
Higher incidence, higher mortality & develops at an earlier age than caucasians experience more ACE inhibitor related angioedema
45
How does CHF differ in Men compared to Women
Men experience more systolic dysfunction Better response to ACE Inhibitor therapy (less mortality)
46
How does CHF differ in Women compared to Men
Experience more disatolic dysfunction Higher risk of ACE cough More frequently experience a major depression *May be a hormonal thing that explains why ACE response is worse in women*
47
Clinical Picture of Left Sided Heart Failure
Nocturnal Dyspnea Cough Crackles Wheezes Blood Tinged Sputum Restlessness and Confusion Orthopnea Tachycardia Exertional Dyspnea Cyanosis Hypoxia causes much of this
48
in Left Sided Ventricular Failure what causes the pulmonary congestion
the LV not emptying
49
What would a left sided ventricular failure CXR show
CXR would show fluffy infiltrates: fluid in alveoli
50
What sort of things are auscultated in L Sided Ventricular Failure
Lung sounds - crackles
51
S/S of Pulmonary Decompensation from Left Sided Ventricular Failure
Pulsus Alternans Increased HR S3 > S4 Heart Sounds Pleural Effusion Mental Status Changes - restlessness, confusion Weakness and fatigue anxiety and depression shallow respirations paroxysmal noctural dyspnea orthopnea dry hacking cough nocturia mental status changes - hypoxia
52
Clinical Picture of Right Sided Heart Failure
Fatigue Increased Peripheral Venous Pressure Ascites Enlarged Liver and Spleen Distended Jugular Veins Anorexia and Complaints of GI Distress Swelling in Hands and Fingers Dependent Edema (trunk or torso area)
53
What does right ventricular failure cause
backup of blood into the venous systemic circulation
54
Right sided heart failure may be caused by ...
pulmonary heart disease valve disease disease of myocardium
55
S/S of Right Sided Ventricular Failure
Edema - legs, scrotum, sacrum Dependent, bilateral pitting edema Weight gain poor tissue perfusion fatigue anxiety Right upper quadrant pain liver enorgement and failure anorexia, GI bloating ascites, anasarca hepatomegaly nausea weakness
56
NYHA Classification
Classifications of Heart Failure from I, II, III, and IV Treatment guidelines are in place for each stage
57
Stage I HF
no symptoms with normal physical activity normal functional status
58
Stage II HF
mild symptoms with normal physical activity comfortable at rest slight limitation of functional status
59
Stage III HF
moderate symptoms with less than normal physical activity comfortable only at rest marked limitation of functional status
60
Stage IV HF
severe symptoms with features of HF with minimal physical activity even at rest severe limitation of functional status
61
Commong HF Symptoms
fatigue palpitations chest pain dyspnea syncope
62
BNP
B Type Natreutic Hormone - cardiac hormone released by monocytes in ventricles and plays a big role in hemostasis in volume control Has a significant role in HF diagnosis
63
Elevated BNP of _____ pg/mL is highly sensitive and specific for dx of HF
>100 pg/mL
64
What reflects the severity of heart failure diagnostically
the plasma concentration of BNP
65
What are some other labs to look at for HF diagnosis
lipid profile coagulation profile CBC CRP Electrolytes
66
Hemodynamic Monitoring
Measures the pressure in the chambers of the heart using invasive equipment and continuous monitoring Needs specialized nursing educatio Used in acute HF
67
What sort of catheters may be used for hemodynamic monitoring? What are both capable of?
CVC - central venous catheter Swan Ganz Catheter (PA Catheter) *Both are capable of measuring pressures in portions of the right heart: CVP (right atrium or superior vena cava) and PA (Pulmonary artery pressure)
68
Nursing Interventions for Chronic Heart Failure related to Activity
avoid activities in extreme hot, cold, or humid weather modify activities to conserve energy positioning: elevation of the HOB to facilitate breahting and rest, support of arms monitor VS wiht activity cardiac rehabilitation bed rest for acute exacerbations encourage regular physical activity - 30-45 minutes a day exercise training pacing of activities (give more time to complete) wait 2 hours after eating for physical activity
69
Nursing Interventions for Chronic Herat Failure related to Fluid Volume Excess
assessment for symptoms of fluid overload daily weight I&O diuretic therapy; timing of meds fluid intake/resuscitation maintenance of sodium restriction positioning - may elevate legs if no respiratory compromise, otherwise legs down
70
Nursing Interventions: Patient Education Topics for Chronic HF
Diet Stress Management Prevention of infection know how and when to conact health care provider include family in teaching before the body gets to CHF - prevention teaching
71
What is the diet like with chronic heart failure
small frequent meals bland low residue diet edema may "cover malnutrition" - know this and make the patient aware
72
Zone Management Tool
Education tool for patients with chronic heart failure It is a tool of green, yellow, red that tells what to do when experiencing certain symptoms
73
Green Zone S/S and What to do (Zone Management)
You have: no SOB, weight gain more than 3 pounds a day, swelling of fett, ankles, legs, or stomach, and no chest pain What to do: Keep up the good work, take your medicine, eat a low salt diet, weight daily
74
Yellow Zone S/S and What to Do (Zone Management)
You have: weight gain of 3 poounds in 1 day or 5 pounds in one week, SOB, swelling, feeling more tired, dizziness, new or unusual cough, hard to breath lying down - need to sleep sitting in a chair what to do: Call the doctor or nurse
75
Red Zone S/S and What to Do (Zone Management)
You have: Hard time breathing, struggling to breathe even at rest, chest pain or discomfort, feeling faint What to do: CALL 911 OR Get help, go to the ER
76
Common medications for CHF
ACE inhibitors ARB receptor blockers Nitrates Beta Blockers Diuretics Digitalis Calcium channel blockers
77
Aquapheresis
Simple Ultrafiltration of fluids being pulled from a CHF patient that occurs over 2-12 hours It is controlled with sodium and water intake and output automated - no clinically significant impact onf lyte balance, BP, or HR Almost like a CHF Dialysis *see video on blackboard*
78
Complications of Heart Failure
thromboembolism pulmonary edema cardiogenic shock pericardial effusion and cardiac tamponade sudden cardiac death / cardiac arrest *resp compromise complications are the most serious due to quick death*
79
Ways to Prevent PE Early - Nursing Interventions
monitor lung sounds assess for decreased activity tolerance assess for increased fluid retention long term anticoagulation medication
80
Nursing Interventions for PE
HIGH FOWLERS POSITIONE AND DANGLE LEGS O2, VS, assess LOC indwelling catheter assess ABGs and lab values administer ordered meds: vasodilators, analgesics, diuretics, inotropics, bronchodilators monitor for pink frothy sputum from coughing
81
3 Important Nursing interventions for Cardiogenic Shock
correct underlying problem medications circulatory assist devices
82
What underlying problems cause cardiogenic shock
Rhythm problems the most common reason: MI CHF Tamponade Dysrhythmias
83
Medications for Cardiogenic Shock
Diuretics Positive inotropic agents and vasopressors
84
What sort of circulatory assist devices are used in cardiogenic shock
intra-aortic balloon pump (IABP) extracorporeal membrane oxygenation (ECMO)
85
IABP
intra aortic balloon pump improves heart flow and improves heart flow to vessels decreases workload of the heart with an 85-90% occlussive balloon blocking the aorta
86
ECMO
veno arterial (VA) extracorporeal membrane oxygenation (ECMO) Blood is pulled from a vein, sent through the ECMO machine where it is oxygenated and then sent back to the body via an artery Like dialysis but specific to cardiac system
87
Nursing Interventions for Pericardial Effusion and Cardiac Tamponase
monitoring pericardiocentesis and pericardiotomy sites Monitoring cardiorespiratory and hemodynamic status monitor chest tube
88
Your client has been diagnosed with CHF. What discharge teaching will you provide?
Weigh self daily at the same time and before breakdast take your pulse before taking digoxin take your diuretic in the morning notify MD if you gain 2-3 pounds in a day notify MD if you gain 5 pounds in a week
89
Your patient notices yellow rings around the lights in her room. You suspect what?
Digoxin Toxicity
90
Your patient's potassium level is 3.2 this morning. She is also on Digoxin and Lasix. You will do what interventions?
hold both and get order for K+ (should be 3.6-5.2)
91
Your patient's digoxin level comes back as 0.4 ng/mL, you know this level is ___?
low
92
3 Types of Peripheral Vascular Disease (PVD)
Aterial Venous HTN
93
Arterial
oxygen carrying vessel damage/occlusion ARTERIES FEED THE TOES
94
Venous
portal for transport to the heart VEINS PULL BACK TO OUR NOSE
95
Hypertension
vessel damage force of blood icnreased causing higher pressure
96
Function fo the Vascular System
Blood and nutrients to organs O2 for aerobic metabolism Collection fo waste products to ecretory organs Movement and return of immune system components
97
The perfusion of the vascular system depends on...
the heart, the main pump
98
if the heart fails what happens to the vascular system
the adequacy to supply of the vascular systme fails
99
What are some local and systemic vessel regulators
trauma histamine muscle metabolites heat cold nervous system hormones
100
Risk Factors for Vascular Compromise
hypercholesterolemia hyperlipidemia HTN obesity smoking diabetes sedentary life genetics
101
What happens if the flow rate of the vessels decreases?
decreased flow = decreased O2 to tissue = causes ischemia and malnutrition
102
How do the arteries change with metabolic needs?
Increased need = arterial dilation Decreased need = arterial constriction
103
What happens when vessel function is impaired?
Cells are malnourished Arterial - no O2 or nutrients Venous - system clogged with wastes and excess fluid Chronic function impairment will lead to arterial and/or venous fysfunction
104
Symptoms fo Venous Insufficiency
Varicose Veins Darkened Hard or Leathery Skin Swelling Pain and Heaviness Leg Cramps or Spasms Restless Leg Syndrome Itchy Skin
105
What do veins do
return deoxygenated blood to the heart have thinner less muscular walls flow is controlled by valves - when the valves are incompetent they cannot push or pull blood back up to the central circulation
106
Manifestations of Venous Compromise (Venous Ulcers)
"Gaiter Region" - most common area Skin Brown, Scaly, Hard Copious Serous Exudate - common Wound bed tissue range red granulation to fibrinous tissue to necrosis Commonly have cellulitis May lead to lymphedema Increased venous stasis and edema
107
What do Venous Ulcers Look like?
Hemosiderin Staining Brown Colored Skin Weeping Tissue
108
Interventions for Venous Insufficiency
Walking Combo Exercise and Rest Elevate legs too/Elevation Compression/Pressure Stockings Infection Control and topical Antiinfectives Debride large non healing wounds Skin grafting Improve mobility Adequate nutrition COMPRESSION COMPRESSION COMPRESSION!
109
What is the ideal exercise for venous insuffiencies ?
Walking - done in a progressive fashion
110
Particularly in arterial disease what should be a guide to activity?
Pain - it signals decreased O2 Exercise UNTIL pain Increases collateral circulation and muscle activity helps move the fluid around
111
What is important in venous sufficiency that you should not do if there is also arterial insufficiency
compression
112
Arterial Ulcers
Extremely Painful and often infected limb threatening ischemia ulcers Treatment is difficult and outcomes are unpredictable - because of poor circulation
113
Where are arterial ulcers typically found
on or between the toes on the upper surface of the foot over the metatarsal heads
114
What results in arterial ulcers
decreased blood supply
115
Arterial Ulcer Limbs may be ...
cool to the touch
116
What do arterial ullcers look like?
Punched Out Infected Ulcers Can be necrotic Usually a defined circular lesion on the feet
117
What is the major symptom of arterial insuffieincy
Intermittent Claudication
118
Intermittent Claudication
Pain - sharp, stabbing, decreases with rest, and dependent position often occurs at night Pain in the lower legs from arterial insufficiency Can be aching with mild cramping along with the pain More comfortable at rest and dependent position -arterial insufficiency poorly tolerates activity
119
Diagnostics for Arterial Disease
doppler studies angiography ankle brachial indexes (doppler) treadmill testing
120
Interventions for Arterial Insufficiency
LOWER feet and raise head - because of deficit of blood in extremities RAISE feet and lower head - to reverse pooling of deoxygenated blood in extremities Avoid standing still for extended periods of time Control pain
121
Surgical Management Modalities for Arterial Insufficiencies
Vascular Grafting - bypass grafting Surgical revascularization is required in advanced cases - esp if problem with ulcer healing (Endarterectomy)
122
Why should some arterial insufficiency patients NOT exercise
Increases in metabolic demand - stopping exercise to prevent infection in central circulation If they have increased metabolic demand there can be / worsening of leg ulcers, cellulitis, gangrene, acute thrombotic occlusion or condition
123
Patient Education for Arterial Ulcers
Do NOT cross legs No constriction/compression Warmth-avoid cold STOP Nicotine! (jagged marks in arteries causing occlusion) Nutrition - esp Vitamin B and C Avoid injury Good hygiene Foot care - shoes, inspection Adequate Fluids Emotions! - stimulated SNS
124
Deep Vein Thrombosis (DVT)
a blood clot (thrombus) forms in one or more of the deep veins in the body
125
Interventions for Prevention of DVTs
Hospitalized pts at risk: ``` TEDS SCDS Heparin SC Lovenox SC Maintain Mobility ROM Isometrics NSAIDS ```
126
Treatment for Existing DVT
elevate legs Do NOT cross legs heat application anticoagulants - IV heparin (APTT, PTT, INR) and Coumadin (PT and INR) Thrombolysis with t-Pa Embolectomy Insertion of venous filter (prevent movement to the chest)
127
Medications and Substances that cause Vasoconstriction and can worsen DVT
Licorice Nicotine Caffiene Chewing Tobacco Amphetamines
128
Abdominal Aortic Aneurysm (AAA)
an enlargement of the aorta, the main blood vessel that delivers blood to the body, at the level of the abdomen serious medical problem - classified by shape and location Can rupture and be fatal
129
Cause of AAA
atherosclerotic disease
130
Risk Factors for AAA
HTN, Smoking, Genetics
131
S/S of AAA
HTN Back pain with AAA Bruit or thrill Abdominal Mass Throbbing or beating feeling in abdomen
132
Diagnostics for AAA
CT Scan Ultrasound Cardiac Catheterization
133
Treatment for AAA
Surgical Repair and Resection - graft or stent Monitor
134
Self Concept Aspects for Patients with Vascular Disorders
fear of the unknown, limb threatening motivation - why bother - may be tired of condition tired of a chronic disease may be fighting addiction - nicotine financial affects self concept physical limitations does the patient buy into the plan, if not why ?
135
Patient Education topics for Vascular Disorders
exercise within limits of pain when to seek medical attention how to control precipitating factors: DM, Smoking, Sedentary lifestyle, Diet, Stress *Think about hwo to get them to buy into change