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68wm6 p2 inf dis
Inflammatory diseases of the heart
| Question | Answer |
|---|---|
| What is rheumatic fever? | an inflammatory disease caused by Group A hemolytic streptococci pharyngitis or URI. |
| What is the most affected site of infection from rheumatic fever in the heart and what does it result in? | Heart valves, valvular stenosis |
| What are the generalized S/S of rheumatic fever? | *Increased pulse *Epistaxis *Anemia *Nodules found on the joints and subcutaneous tissues *Joint involvement |
| What are more specific S/S of rheumatic fever? | *Joint pain (polyarthritis) *HALLMARK SYMPTOM IS A HEART MURMUR. *Erythema marginatum *Involuntary purposeless movement (Sydenham’s Chorea). *Skin manifestations of small erythemtous circles |
| What is Erythema Marginatum? | wavy lines on the trunk and abdomen that disappear rapidly. |
| Define pericarditis: | Inflammation of the pericardium, the membranous sac enveloping the heart. |
| How does pericarditis affect normal heart function? | Fibrous constriction occurs gradually and causes severe compression to prevent normal filling during diastole. |
| What can cause pericarditis? | Fibrous constriction occurs gradually and causes severe compression to prevent normal filling during diastole. *Bacterial, viral and fungal infection *ESPECIALLY COMMON AFTER THORACIC SURGERY *MI *Chest trauma *Cancer *Azotemia |
| Pericarditis often mimics the pain of what other serious heart condition? | MI |
| What is the hallmark symptom of pericarditis? | Pericardial friction rub |
| What may occur when blood, excess fluid or pus accumulates in the pericardial space? | Cardiac Tamponade (Pericardial tamponade) |
| What can pericarditis cause the pulse to exhibit? | Pulsus Paradoxus (Paradoxical pulse) |
| What visible sign presents as cardiac tamponade progresses? | Distended neck veins due to the right atrium being impaired. |
| Acute onset of pain from pericarditis begins where, is aggravated by what, and is relieved by what? | Pulsus Paradoxus *Acute onset begins suddenly over the sternum and radiates to the neck. *Pain increased by moving and deep breathing. *Relieved by sitting up and leaning forward |
| If upon auscultating the chest of a PT and you hear 'friction', find the heart sounds muffled and find a rapid forcible pulse and rapid shallow breathing, what do you suspect? | Pericarditis |
| What is rheumatic fever? | an inflammatory disease caused by Group A hemolytic streptococci pharyngitis or URI. |
| What is the most affected site of infection from rheumatic fever in the heart and what does it result in? | Heart valves, valvular stenosis |
| What are the generalized S/S of rheumatic fever? | *Increased pulse *Epistaxis *Anemia *Nodules found on the joints and subcutaneous tissues *Joint involvement |
| What are more specific S/S of rheumatic fever? | *Joint pain (polyarthritis) *HALLMARK SYMPTOM IS A HEART MURMUR. *Erythema marginatum *Involuntary purposeless movement (Sydenham’s Chorea). *Skin manifestations of small erythemtous circles |
| What is Erythema Marginatum? | wavy lines on the trunk and abdomen that disappear rapidly. |
| Define pericarditis: | Inflammation of the pericardium, the membranous sac enveloping the heart. |
| How does pericarditis affect normal heart function? | Fibrous constriction occurs gradually and causes severe compression to prevent normal filling during diastole. |
| What can cause pericarditis? | Fibrous constriction occurs gradually and causes severe compression to prevent normal filling during diastole. *Bacterial, viral and fungal infection *ESPECIALLY COMMON AFTER THORACIC SURGERY *MI *Chest trauma *Cancer *Azotemia |
| Pericarditis often mimics the pain of what other serious heart condition? | MI |
| What is the hallmark symptom of pericarditis? | Pericardial friction rub |
| What may occur when blood, excess fluid or pus accumulates in the pericardial space? | Cardiac Tamponade (Pericardial tamponade) |
| What can pericarditis cause the pulse to exhibit? | Pulsus Paradoxus (Paradoxical pulse) |
| What visible sign presents as cardiac tamponade progresses? | Distended neck veins due to the right atrium being impaired. |
| Acute onset of pain from pericarditis begins where, is aggravated by what, and is relieved by what? | Pulsus Paradoxus *Acute onset begins suddenly over the sternum and radiates to the neck. *Pain increased by moving and deep breathing. *Relieved by sitting up and leaning forward |
| If upon auscultating the chest of a PT and you hear 'friction', find the heart sounds muffled and find a rapid forcible pulse and rapid shallow breathing, what do you suspect? | Pericarditis |
| What is the action of immunosuppressants? | Interfere with the ability of the immune system to respond to antigen stimulation by inhibiting cellular and humoral immmunity. |
| What are used to suppress the immune responses in nephrotic syndrome of childhood and severe rheumatoid arthritis? | cyclophosphamide and methotrexate |
| What are used with corticosteroids for the prevention of transplantation rejection reactions? | *azathioprine (Imuran). *cyclosporine (Neoral, Sandimmune, Gengraf). *mycophenolate (CellCept). |
| What is is a recombinant immunoglobulin antibody that alters T-cell function. | Muromonab-CD3 |
| What are some contraindications of muromonab-CD3? | *Fluid volume overload *Fever > 100 degrees F *Herpes zoster *Chickenpox or recent exposure to chickenpox |
| What increases the absorption of muromonab-CD3? | Concurrent digestion of grapefruit or grapefruit juice increases absorption and should be avoided. |
| What can increase the risk of toxicity of methotrexate | nephrotoxic drugs, large doses of aspirin, or NSAIDs. |
| The normal value of neutraphils while on immunosuppressants? | 3000-7000 mm3. |
| What value of neutrophils indicates neutropenia? | <1000 mm3 |
| What is the value of severe neutropenia? | < 500 mm3. |
| True or False: Due to the depressing nature of the hospital stay while on immunosuppressants, fresh flowers are highly encouraged to liven up the room. | False. Fresh flowers and live plants are discouraged in the room, as well as fresh fruits and vegetables in the diet. |
| What should be done with doses of chemotherapy while the neutrophil levels are low? | Hold until levels are back to normal. |
| What inhibits the metabolism of azathioprine? | Allopurinol |
| What immunosuppressant is it important to check for fluid overload in? | muromonab-CD3 |
| What may be used to treat early reactions to immunosuppressants? | Acetaminophen and antihistamines |
| to prevent or minimize manifestations of Cytokene Release Syndrome (CRS) if given 1-4 hrs before 1st dose of immunosuppressants? | Methylprednisolone sodium succinate |
| What is cytokene release syndrome? | When the neutrophils release cytokene prior to destruction when the antibodies bond to them causing a systemic inflammatory response (non-infective fever) |
| what may be given 30 min after the 1st and possibly 2nd dose to control respiratory side effects of immunosuppressants? | Hydrocortisone |
| What is the lab value for therapeutic serum levels of cyclosporin? | 50 - 300 ng/mL |
| What is the lab value for the toxic serum level of cyclosporin? | > 400 ng/mL |
| What happens if there are subtherapeutic serum levels of cyclosporin? | Increased risk of organ rejection. |
| Why should the PT practice proper mouth care with a topical anti-fungal agent? | To prevent candidiases |
| How should PO cyclosporin be administered? | With milk, juice or meals |
| What should be done with cyclosporin prior to IVPB | 1 Dilute each 1 ml (50 mg) immediately before use with 20-100 mL of D5W or 0.9% NaCl for injection |
| How quickly should cyclosporin be infused? | Infuse slowly over 2-6 hrs via infusion pump, or over 24 hours via continuous IV |
| What foods should the PT avoid while on cyclosporin | Grapefruit or Grapefruit Juice |
| What are the adverse effects of Azathioprine? | *Leukopenia I *nfection *Megaloblastic anemia |
| Define infective endocarditis: | infection or inflammation of the inner layer of heart tissue, particularly the heart valves. |
| What are at risk factors for infective endocarditis? | *Cardiac surgery. *Intrusive procedures such as dental procedures, minor surgery, or urinary catheters *IV drug abusers. (Higher Risk) |
| What are the most common organisms involved in infective endocarditis? | *Streptococcus viridians *Streptococcus pyogens *Enterococci *Staphylococcus epidermis *Staphylococcus aureus |
| What are subjective s/s of infective endocarditis? | *Flu-like symptoms. *Chest pain. *Chills. *Joint pain. |
| What are objective s/s of infective endocarditis? | *Purplish painful nodules on the pads of the fingers and nose. *Black longitudinal line (splinter hemorrhages) in the nails. *Petechiae in conjunctiva, mouth and legs *Heart murmur |
| How are IV antibiotics to be given for infective endocarditis? | Large doses of IV antibiotics, over 2-6 week period or longer, after blood cultures done |
| Define myocarditis: | Inflammation of the myocardium or muscle layer of the heart. |
| How should the bed be kept for a PT with an inflammatory heart condition | Head of the bed elevated at 45 degrees. |
| How often should the vitals be obtained in a PT with an inflammatory heart condition? | Every 2-4 hours. |
| What are three nursing diagnosis R/T nursing care of a patient with pericarditis, endocarditis, and myocarditis? | *CO decreased R/T inflammatory process *Fluid volume excess R/T ineffective pumping action *Pain r/t inflammatory process |
Created by:
Shanejqb
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