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41 Cards in this Set
- Front
- Back
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mvp
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- mitral valve prolapse - balooning of mitral valve during systole
- gnerally asymptomatic - may have fatigue, sob, lightheaded, palpitations, chest pain, anxiety |
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mvp treatment
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- although mvp is largely asymptomatic, those presenting with symp can be treated
- avoid alcohol, smoking, caffeine - vulnerable to endocarditis - avoid infections, hygiene |
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stenosis
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- stiff valves let less blood through
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patho and symptoms of mitral stenosis
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- reduction of flow through mitral valve causes backup of blood into lungs - pulm venous htn --> dyspnea, hemoptysis, orthopnea, resp infection
- dec CO --> fatigue - blood backs up into pulm arter, so R ventr fails - enlarged l. atrium pushes on bronchi --> dry cough, wheezing |
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how to diagnose mitral stenosis
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- doppler echocardiography to diagnose
- also - assessment findings: atrial fibrillation causes weak pulse - atrial dysrhythmias |
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patho of HF
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- when heart cannot generate a sufficient CO
- pooling of blood either in lungs or rest of body also - RAAS activated and vasoconstriction to improve CO - hypertrophy of affected side of heart |
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right sided heart failure
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- Right, rest of body
- blood backs up in rest of body - hepatomegaly - ascites - nausea, weakness - weight gain, anorexia |
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left sided heart failure
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- left, lungs
- ineffective left vent contrc leads to backup in lungs - pulm congestion - dyspnea, cough, crackles, impaired oxygen exchange |
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mitral click
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- click during systole
- sign of mitral prolapse |
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- usual cause of mitral stenosis
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- rheumatic endocarditis
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risk factors for valve disorders
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- infective endocarditis
- rheumatic fever - lupus - congenital malformations - marfan syndrome - cardiomyopathy - ishemic heart disease |
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marfan syndrome
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- connective tissue disorder
- said to be unusually tall with long limbs and fingers |
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patho of cardiomyopathy
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- cardiac dysfunction that leads to dec CO
- any disease of heart muscle that leads to CO - dec SV activates SNS and RAAS --> HF - ie hypertrophic cardiomyopathy - heart muscle increases in size and mass, reducing cavities, little ventricular filling, dec CO common cause of HF |
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possible nursing diagnoses for cardiomyopathy
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- dec CO r/t structural disorders caused by cardiomyophthy
- ineffective tissue perfu r/t dec peripheral blood flow - imparied gas exchange r/t pulm congestion - activity intolerance r/t dec CO |
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hypertrophic cardiomyopathy
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- rare autosomal dominant disorder
- may cause cardiac arrest in athletes - heart msucle asymmetrically increases in sze and mass - longer time to relax - smaller cavities, difficult ventr filling |
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nursing interventions hypertrophic cardiomyopathy
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impt to maintain hyrdation
- avoid diuretics - anticipation urination q4h - drink more when urine deep yello - digoxin - may worsen l. ventricular outflow track obstruction |
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digoxin and HCM
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- digoxin may worsen left ventricular outflow track obstruction
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infective endocarditis
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microbial infection of endothelium of heart
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those at risk for infective endocarditis
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- structural cardiac defects - ie congenital disorders, valv disorders, HCM
- prosthetic heart valves - invasive procedures |
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patho of infective endocarditis
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- deformity/injury of endocardium creates a clot
- bacteremia invade clot - clot expands, protecting bacteria from immune defenses - infection erodes into endocardium - distruction of heart valves |
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clinical manifestations of infective endocarditis
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- fever and murmur primarily
- vegetationsfrom clot may cause petechial lesions: osler odes janeway lesions roth spots splinter hemorrhages |
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osler nodes vs janeway vs roth vs splinter
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osler nodes - small painful nodules in pads of fingers/toes
janeway lesions - painless red flat macules roth spots - hemorrhage with pale centers in fundi of eyes splinter hemorrhages - reddish brown lines and streaks under nails |
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itp
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- idiopathic thrombocytopenia purpura
- easy bruising, hevy menses, petechiae on extrem and trunk |
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patho itp
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- autoantibodies against platelets
- macrophages ingest platelets - body responds by increasing platelet count |
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cause of itp
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- past virus infection in children
- sulfa drugs - lupus - pregnancy |
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DIC patho
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- sepsis, shock, or other condition triggers inflammatory response
- supressed fibronolytic system --> small amounts of tiny clots form microcirculation - excessive clotting leads to to bleeding because all platelets used up - clots also causes organ failure |
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blood administration for blood loss
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whole blood
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blood administration for anemia
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packed rbc
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blood administration for chronic renal failure
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packed RBC
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blood administration for coagulation factor disorders
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fresh frozen plasma
ffp |
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blood administration for thrombocytopenia
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platelets
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if you are administering a blood transfusion, and you suspect a reaction, what should you do?
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1. stop the transfusion.
2. maintain the IV line with NS through new IV tubing at a slow rate. 3. assess pt. compare with baseline. 4. notify physician of findings. 5. notify blood bank. 6. send blood container and tubing to blood bank. |
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nurse suspects hemolytic or bacterial transfusion reaction. what to do?
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1. stop the transfusion.
2. maintain the IV line with NS through new IV tubing at a slow rate. 3. assess pt. compare with baseline. 4. notify physician of findings. 5. notify blood bank. 6. send blood container and tubing to blood bank. 7. obtain blood specimen from patient. 8. obtain urine sample asap to dectect hemoglobin (hemolysis) |
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nurse administering blood transfusion. pt. has chills and fever within 2 hrs
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= febrile nonhemolytic reaction
- caused by antibodies to donor leukocytes. non life thretening - treat by a leukocyte reduction filter - routine premedication for fever contraindicated since it may mask a reaction |
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febrile nonhemolytic reaction
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- caused by antibodies attacking donor leukocytes
- fever and chills within 2 hrs - can treat/prevent with a leukocyte filter - antipyretics contraindicated due to masking effect |
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nurse administering blood transfusion. pt. has immediate fever, chills, low back pain, nausea, dyspnea, chest tightness, anxiety
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= acute hemolytic reaction
- caused by incompatible blood - ABO/Rh (ABO much worse) - stop promplty - obtain blood and urine specimens - treat by giving fluids, O2, and managing inflammatory reaction/DIC |
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acute hemolytic reaction
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- caused by ABO/Rh incompatibilty, causing hemolysis of RBCs
- SS - immiediate - low back pain, nausea, chest tightness, dyspnea, anxiety, fever chills - stop infusion, take blood and urine samples - give fluids, O2, manage DIC |
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nurse administering blood transfusion. pt. has urticaria, itching, flushing
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= allergic reaction to plasma proteins
- rarely severe - treat with antihistamines, corticosteriods, epi, - washing to remove plasma proteins |
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nurse administering blood transfusion. pt. has dyspnea, orthopnea, JVD
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- circulatory overload - too much too fast
- slow rate, sit up with feet in dependent position (lower than plane of body) - if dyspnea severe, treat with O2 and morphine |
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TRALI
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= transfusion related acute lung injury
- unknown cause, and most common cause of transfusion death - most common with plasma SS - SOB, hypoxia, hypotension, fever, pulm edema - O2, intubation, fluid support MAY prevent death |
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nurse administering blood transfusion. pt. has SOB, hypoxia, hypotension, fever, p edema
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= transfusion related acute lung injury
- idiosyncratic, most common cause of transf death, most common from plasma - treat with supportive therapy - O2, fluids, intubate - may not prevent death |
