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BC3 Cardiac chap. 19
BC3 cardiac Chapter 19
| Question | Answer |
|---|---|
| Pericarditis: | inflammation of the pericardial layers;the adjoining diaphragm |
| Pericardial sac | two layers; (parietal layer, next to heart),visceral layer, the outer layer;10-50 ml of clear pericardial fluid inbetween |
| Dressler’s Syndrome | development of pericarditis:malaise, fever and levated WBC’s appearing weeks to months after an MI. |
| infectious pericarditis | increasing problem with immunocompromised pts |
| Repeat episodes of pericarditis may lead to | adhesions;leading to constrictive pericarditis |
| Constrictive Pericarditis | heart fails to fill during diastole due to the inability to stretch;diseased pericardium is surgically removed;diastolic filling impaired;-> dec.CO and systemic signs of HF |
| Asssessment of Pericarditis | 1. Chest pain (primary sx): pleuritic;worsens by breathing deeply or lying supine; 2. Dyspnea: relieved by sitting up;low grade fever, cough, malaise;Pericardial friction rub |
| : ischemic chest pain is not relieved by | a change in pt position |
| . Pericardial friction rub | rasping and scraping sound;not vary with inspiration and expiration |
| Labs & Diagnostics Pericarditis: | ECG;diffuse ST seg elevation, PR seg Depression,CBC,Cardiac Enzymes – may be elevated if myocardium is involved;Rheumatoid Factors;ANA (Antinuclear antibody) Titers; Blood cultures for infection;Viral Studies |
| Management symptoms with pericarditis | NSAIDS – ibuprofen, aspirin; Steroids; * Avoid anticoagulants if pt is recovering from MI; Goal: Pain relief & eliminate causative agents; Complications: Rare: Cardiac tamponade;Resolves over 2 – 6 weeks |
| MYOCARDITIS: | inflammation of the myocardium; any age group; may result from either toxins or immunological reaction; often subacute;may be a major cause of sudden death in young adults |
| MYOCARDITIS:May evolve into a chronic, progressive disease with a poor prognosis, such as | dysrhythmias; CHF; death |
| Causes of MYOCARDITIS: | - Idiopathic cardiomyopathy , bacteria virus, - immunological d/o’s;- connective tissue diseases; neoplasms ;renal failure ;- myocardial & pericardial injury; - radiation; drugs;persistent elevated WBC’s, Sed rates |
| Assessment:MYOCARDITIS | - Chest pain (pleuritic) : -Fatigue;- Dyspnea;- Palpitations; -Precordial discomfort |
| Labs & Diagnostics for MYOCARDITIS | - Serum enzymes slightly elevated; -Elevated WBC’s;- Elevated Sed rate;- DEFINITIVE DX: positive endomyocardial biopsy |
| Management of myocarditis : | supportive, potentially lethal, no cure |
| Angina Pectoris | sudden pain after heavy meal or exertion; Crushing, squeezing, choking pain; relief with rest and Nitrates |
| Acute MI | onset feeling of doom; more severe pain than angina; No relief with rest |
| Pericarditis | flu-like” sx’s for days or weeks; pleuritic , sharp, stabbing pain; NSAIDS, sitting up & shallow breathing bring relief |
| Acute Aortic Dissection | sudden intense pain assoc/w syncope; Ripping, tearing worst pain in pts. life; No relief |
| ENDOCARDITIS | infection of the endocardial (inner) surface of the heart, including the valves;rapid dx & tx is important. common S Aureus |
| causes of endocarditis | - Rheumatic heart disease; -Prosthetic valves; -IV drug abuse;-Mitral valve prolapse; |
| Development of infectious endocarditis requires? | Endothelial damage exposing the valve to turbulent blood flow: - leads to clots on the leaflet composed of fibrin and plates;clots or “vegetations” must be exposed to bacteria by way of blood transport/ dental or urilogical procedures |
| Infected vegetation interferes with normal valve functioning and ? | eventually damages the valve structure |
| Osler nodes | small, purplish erythematous skin lesions, occurring most frequently in the pads of the fingers or toes, and in the palms of the hands or the soles of the feet.raised & tender |
| Symptoms:endocarditis | w/in 2 weeks of the precipitating bacteremia;- Fever, malaise, anorexia, fatigue, wt loss; - heart murmers;-splenomegaly ;- petechiae; osler nodes;- Musculoskeletal complaints; - Systemic or pulmonary emboli; mycotic aneurysms |
| Management of endocarditis | ensure pt stabilized w/ complications & can maintain medical regime; daily nursing follow up;prolonged abx therapy begun as soon as blood cultures are drawn – don’t delay often continued after discharge; |
| Risk factors for endocarditis | Native Valve Endocarditis; mitral valve prolapse;lesions of mitral & aortic valves; IV drug abuse; Age > 60; dental, GU or GI manipulations |
| CARDIOMYOPATHIES | refers to diseases of unknown etiology involving the heart muscle. 3 types, 1Dilated, 2 Hypertrophic, 3Restrictive |
| Dilated (Congested)Cardiomyopathy | Dilation and impaired contraction of L or both ventricles; fatigue, weakness, CHF, esp L vent failure, dysrhythmias, Control heart failure& dysrythemias |
| Hypertrophic Cardiomyopathy | hypertrophy of L vent, sometimes R vent too; Hypertrophy of septum. |
| S/S of Hypertrophic Cardiomyopathy | Dyspnea, angina, fatigue, syncope, palpations, A-Fib, vent dysrythemia, CHF, sudden death |
| Tx; of Hypertrophic Cardiomyopathy | Beta Blockers; Pacemaker; surgery |
| Restrictive Cardiomyopathy | Restrictive filling and Reduced ventricular compliance of either or both ventricles |
| S/S of Restrictive Cardiomyopathy | Dyspnea, fatigue, CHF, Tricuspid & mitral valve regurg.; Heart blocks& emboli; Treatment control HTN, restrict exercise |
| Dilated Cardiomyopathy cause | increased ventricular cavity size in the face of normal or reduced L vent wall thickness and impaired systolic fx. Genetic, viral ALCOHOL, most common toxic |
| s/s Dilated Cardiomyopathy | If symptomatic: progressive dilation;mitral & tricuspid insufficiency; valve leaflets stretch and separate;L vent. Failure |
| Dysrhythmias:w/ Dilated Cardiomyopathy | V TAC- V FIB |
| Hypertrophic Cardiomyopathy | excessive myocardial hypertrophy out of proportion to the hemodynamic load. The heart is able to contract, but it is not able to relax, and remains abnormally stiff in diastole.common genetic malform..Characteristic feature: Diastolic dysfunction |
| Risk of sudden death with Hypertrophic Cardiomyopathy | usually ventricular dysrhythmia), even if asymptomatic or mildly symptomatic; screening has not yet been developed; L vent hypertrophy does not begin until adolescence |
| Restrictive Cardiomyopathy | Hallmark is a stiff ventricle or diastolic function. Cause may be myocardial hypertrophy , fibrosis or infiltration of the muscle.Classically presents as CHF with only a small or slightgly enlarged heart |
| Peripheral Vascular Disease PVD | includes a group of d/o’s involving arteries, veins and the lymphatic vessels of peripheral circulation. |
| Peripheral Artery Disease PAD | atherosclerosis when it obstructs the blood supply to the lower or upper extremities; Lower more common; men ages 50-75; develops in major bifurcations |
| Thromboanginiitis or Buerger’s disease | severe, chronic inflammatory disease affecting the intermediate and small arteries of the extremities, and may also involve adjacent veins and nerves |
Created by:
goryan
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