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Cardiac Disorders II
Chp 27 Cardiac Disorders- Inflammatory
| Question | Answer |
|---|---|
| What is rheumatic fever and what is its cause? | It is a systemic inflammatory disease caused by an abnormal immune response to Group A Strep |
| Who is at highest risk for the disease? | Children ages 5-15 although it can happen at any age |
| What else besides the heart does Strep A attack when it is in a systemic inflammatory form? | It can attack the connective tissues in blood vessels, joints, and subcutaneous tissues. |
| What areas of the heart does Strep A affect when it is a systemic inflammatory form? | the valves,(particularly the leaflets), the myocardium and the pericardium ( these are usually mild compared to the valves) |
| what is the damage to the heart by Strep A called? | Rheumatic heart disease (HD) |
| What exactly does RHD do to the heart? | It causes slow and progressive valve deformity that occurs following repeated episodes of rheumatic fever. |
| How exactly are the valves damaged with RHD? | The valve leaflet become rigid and deformed causing stenosis or regurgitation of the valve. |
| Describe heart valve stenosis in RHD. | The valve leaflets fuse and obstruct blood flow. |
| What is stenosis urgitation? | The valve fails to close properly and allows blood to flow back through it. |
| What valve is particularly affected by RHD? | The left mitral valve particularly, but all of those on the left side of the heart to a lesser degree. |
| When can one expect to see the manifestation of RHD after a Strep A infection? | Within 2-3 weeks |
| What percentage of pts with rheumatic fever develop heart disease? | 50% |
| What four lab tests would we look to to indicate possible heart problems from RF? | Elevated WBS, (particularly erythrocyte sedimentation rate (ESR)), positive C-reactive protein, antistreptolysin-O titer (that rises within two months of the disease), cardiac enzymes |
| What test is helpful to dx heart damage from RF? | An echocardiogram. |
| What does tx from acute Rh focus on? | resolving the infection, preventing reoccurrence,managing its manifestation |
| How exactly is that done? | by reducing cardiac workload when the infection is acute and increasing activity over 4-6 weeks once it is resolved. |
| What 3 meds are given when RF is acute? | antibiotics for the infection, aspirin or other NSAID for joint pain and fever, corticosteroids for severe pain. |
| What 5 thing should a nurse ask or observe when assessing for RHD? | 1)Ask about recent strep infections 2) listen for complaints about SOB, fever and joint pain 3) get data on heart rate, sounds, respiratory rate and breathing sounds 4) look for redness, swelling or heat on the trunk or extremities 5) note mental status |
| What should aspirin or NSAID be given with for RHD? | food, milk or antacids to decrease gastric irritation. |
| What are three sign of aspirin toxicity? | Tinnitus, vomiting. gastric bleeding |
| What should the nurse apply for complaints of joint pain? | A warm compress |
| what are the manifestation of strep throat? | red, fiery looking throat,pain on swallowing, enlarged cervical lymph nodes, temp of 101-104, headache |
| why is it important to know this information? | Because RHD is preventable if strep throat is treated early |
| What other three things are important for people with chronic strep A to know? | antibiotics can be given as a prophylaxis for those with chronic problems, antibiotics should be given before invasive surgical procedure, dental care and prevention of gum disease has a direct effect on developing problems from Strep A and RHD |
| What other heart problem are those with RHD at risk for? | infective endocarditis |
| What should pts with RHD limit from their diet? | Salt |
| What is endocarditis? | inflammation of the endocardium from an infective process. |
| Who does endocarditis usually affect? | Those with preexisting heart disease. |
| How does bacteria usually enter pts who develop endocarditis? | during invasive procedure or on medical devices |
| What are four ways a pt can come in contact with bacteria that causes endocarditis through a medical procedure or device? | Via an indwelling urinary cath or intravenous cath, dental procedures, heart surgery,IV drug abusers |
| What are the two most common places for infective endocarditis to manifest? | The left side of the heart, the mitral valve in particular |
| Where would pts with IV drug use tend to get endocarditis? | The right side, the tricuspid valve in particular |
| How is endocarditis usually classified? | By the disease's onset and course |
| What are three types of infective endocarditis? | Acute, subacute and progressive |
| What is the onset, cause and course of acute endocarditis? | abrupt onset and rapid progression-severe disease cause usually by Strep A |
| What is the onset and course of subacute endocarditis? | Gradual onset and is seen most often in those with preexisting heart disease. |
| What is the usual cause of subacute endocarditis? | Step. viridans |
| How exactly do microbes cause endocarditis? | They travel to the bloodstream and attach to the endocardial lining of the heart. They become enmeshed in fibrin and platelets. The covering helps them to evade the immune system. |
| What area of the heart does the infection tend to do the most damage? | heart valves |
| What does Friable mean and how does it relate to endocarditis? | It means "easily broken off" When the infection, with it's protective coat, breaks away from it original location and then travels in the bloodstream to other parts of the body |
| What can happen when friable pieces become lodged in blood vessels? | They can cause hemorrhages, infarcts or abscesses |
| Name 5 S/S of infective endocarditis. | Temp over 101.5, SOB, cough, joint pain., with acute staph endocarditis the pt may have a heart mummer |
| Name 5 S/S of peripheral circulation with infective endocarditis. | 1)petechiae on the trunk, conjunctiva and mucous membranes, 2)Splinter hemorrhages under fingers and toenails. 3)Small purple lesions on the palms, hands and soles of the feet. |
| Name 2 complications of infective endocarditis? | heart failure, infarctions of other organs (lungs, brain, kidneys or bowel) |
| What three tests are performed when infective endocarditis is suspected? | CBC, blood cultures, ECG |
| How is infective endocarditis prevented? | antibiotic prophylaxis prior to high risk procedures for pts with preexisting heart disease. |
| How does infective endocarditis damage heart valves? | The infection settles on the heart valves and changes their size and shape. The valves can no longer close correctly. |
| Why is surgery performed on certain pts with infective endocarditis? | Valvular damage is extreme and causes regurgitation and left side heart failure. |
Created by:
3perfectcats
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