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chpt 37 heart
inflammatory & structual disorders
| Question | Answer |
|---|---|
| up to how many liters of O2 can you give? | up to 6L, but past 4L, use a mask and not a nasal canula |
| what's the most important pt teaching for endocarditis? | handwashing |
| subacute | insidious, gradual onset, lasts longer, less virulent |
| acute | last shorter, highest virulence, rapid onset, sickest |
| Endocarditis | BACTERIAL; streptococcus viridans, pyogenes & pneumoniae, staph areus, fungi, chlamidiae, viruses |
| Endocarditis dx which you must not miss | strep infection |
| what happens with certain endocarditis | mormally blood flow through valves is smooth, but if damaged (rheumatic fever), bacteria grabs a hold |
| what's a vegetation lesion | the "cauliflower-like appearance in the endocardium- white & patchy |
| Dx tool for vegetation & it's nursing intervention | the TEE & echocardiogram- pt is to be NPO, chest x-ray to detect size |
| what do you do before fiving ASA or ANBX | take pt blood |
| endocarditis diagnostic tests | hx: invasive procedures, UTI, RTI, blood culture from 3 different venipuncture sites, 20 min intervals, cultures kept 3 weeks, mild leukocytosis,EKG to detect AV block, cardiac cath to detect fx |
| collaborative care for endocarditis | prophylactic antbx for dental procedures (even cleaning)-- ONLY for those w/previous endocarditis, previous open heart surgery, congenital HF, and PROSTHETIC CARDIAC VALVES |
| long-term IV ANBX | given @ home w/home health nurse |
| why does ANBX for tx endocarditis need to be long term (2-6weeks)? | no blood supply to that region |
| poor outcome w/what type of endocarditis? | fungal endocarditis, prosthetic valvular endocarditis (metal)--early valve replacement recommended |
| drug therapy for endocarditiis | accurate ID of organism necessary-- but PENICILLAN is used |
| TX for endocarditis | ANBX, rest periods, monitor labs :WBC, ROM and TED hose, bturn cough and breath Q2H pt can walk around if they don't have fever |
| peak and trough for endocarditis | Peak levels drawn 30 minutes after end of infusion. Trough levels drawn immediately before the next dose. Levels drawn around 3rd/4th dose to reach steady-state.peak 4-12, trough <1.5 |
| Acute pericarditis etiology & pathophysiology | VIRAL-->inflammation of both layers, most often idiopathic but can be caused by MI (w/in 24 hours), TB neoplasm, trauma |
| Acute pericarditis S/S | severe chest pain, coordinates w/breathing, worst when supine, rapid shallow breaths to avoid pain |
| halmmark finding pericarditis | pericardia frx rub left sternal border, If pt has had MI- check for frx rub |
| pericarditis nursing intervention | have pt lean forward |
| what drug given for endocarditis | NSAIDS, not morphine, to relieve pain AND inflammatory (give w/food & milk) |
| 2 complications from pericarditis | cardiac tamponade(systolic & diastloic equalize), & pleural effusion (distant heart sounds & limits motion of the heart) |
| if too much fluid in pericardial sac- what is done? | pericardial centesis (when SBP reduced by 30mmHg) |
| what procedure is done to check inflammation of pericarditis | constant EKG to see if it's getting better |
| what do you tx for pericarditis | underlying cause (MI, TB, infx), anxiety (talk to them) |
| what is avoided w/pericarditis? | steroids |
| MI vs Pericarditis | MI is not relieved by position change |
| pulsus paradoxis | BP exaggeration of 10 mmHg- decreases during inhalation, increases w/exhalation- indicates pericarditis/cardiac tamponade |
| chronic constrictive pericarditis | results from scarring, loss of elasticity, accumulation of fibrin & calcium, impaired stretch during diastole, less space |
| CT scan and MRI contraindication | metal/pacemakers |
| myocarditis | inflammation of myocardium caused by a VIRUS, bacteria, fungi, radiation |
| myocarditis s/s | stabbing chest pain, palpitation, fever--accompanies pericarditis |
| myocarditis nursing intervention | keep pt in a high fowlers position |
| rheumatic fever | inflammatory dz of the heart involving all layers |
| most serious comlication of rheumatic fever | rheumatic heart dz |
| rheumatic fever characterized by | scarring and deformity of the heart valves resulting from rheumatic fever |
| rheumsatic fever dx that cannot be missed | strep throat |
| Aute rheumatic fever is d/t? | inflammation of all 3 layers of the heart occuring as a delayed sequela of GROUP A STREPTOCOCCAL INFX |
| Aute rheumatic fever effects what part of the body? | heart, joints, skin, CNS |
| layers effected by acute rheumatic fever/dz | 1. rheumatic endocarditis- found primarily in the valves (mitral/aortic)- regurgitation & stenosis 2. rheumatic myocardial damage: ASCHOFFS BODIES or nodules- cause scarring 3. rheumatic pericarditis: bot layers |
| rheumatic heart fever s/s | similar to CHF--> murmurs, regurgitation/stenosis of valves, cardiac enlargement, pericarditis w/distant heart sounds, frx rub, signs of effusion, chorea (ataxia), pink map-like rash, SQ nodules on bony prominences |
| rheumatic fever complications | chronic rheumatic carditis d/t valvular structure, valve stenosis, regurgitation, aortic dilation, arrythmia, ventricular dysfx, leading cause of MITRAL VALVE STENOSIS & REPLACEMENT |
| rheumatic fever shows what on an EKG | prolonged QT interval |
| rheumatic fever drugs & tx | bed rest, initial & prophylactic antbx, ASA, CORTICOSTEROIDS |
| biologic valves have what as a s/e | calcification |
| rheumatic fever nursing mngmt | rest, educate to prevent streptococcus infx by taking ANBX full course |
| what is contraindicated w/valvular heart dz | nitroglycerin- preload needed to push blood through valves |
| what is mitral valve stenosis | narrowing and constriction of heart d/t stuff sticking to it and sticking to it |
| major cause of mitral valve stenosis | RHEUMATIC HEART DZ, other inflammatory causes: congenital, rheumatic arthritis, lupus |
| mitral valve shape | "fish mouth" |
| mitral valve stenosis s/s | similar to HF: dyspnea, A-fib, fatique, loud S1 and murmur |
| mitral valve regurgitation | backwards flow into LA |
| mitral valve prolapse is what? | buckling of leaflets into atrium during systole |
| mitral valve concers | no caffeine & benign for most of their lives |
| Aortic valve stenosis etiology | 1/3 of originial size for orofice, congenital, results from RHEUMATIC fever, increases w/age d/t fibrocalcific degeneration |
| Hallmark finding for aortic stenosis | SYSTOLIC MURMUR |
| aortic valve prognosis | poor- need valve replacement |
| Aortic valve stenosis s/s | angina, HF, syncope--> nitroglycerin contraindicated |
| Aortic valve regurgitation | LIFE THREATENING EMERGENCY d/t endocarditis, trauma, dissection, rheumatic heart da, syphilis, congenital bicuspid issues |
| Aortic valve regurgitation s/s | hypotension, weakness, severe dyspnea, "WATER HAMMER PULSES,"rapid beat which declines rapidly, S3 S4 murmur |
| valve replacement teaching | Coumadin for life w/prosthetic valves |
| pregnant women cannot have | prosthetic valves b/c they cannot use coumadin |
| is valve surgery palliative or curative | palliative |
| what lab values are checked w/valve replacement | INR done monthly (2.5-3.5 okay) |
| older people have a better chance w/MI b/c... | they have collateral circulation |
Created by:
arsho453
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