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74 Cards in this Set
- Front
- Back
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Pericarditis and main causes
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Inflammation of the pericardium. Constricts the heart causing compression (cx pain). Causes are mostly idiopathic, viral and post MI.
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Assessment of pericarditis s/s and labs
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Chest pain is grating and aggravated by breathing (paritcularly inspiration) coughing and swallowing. Pain is worse when supine. Relieved by leaning forward. Auscultation of heart is pericardial friction rub, scratchy, high-pitched sound, produced by rubbing of inflamed pericardial layers. Fever, chills, fatigue, and malaise may occur. Elevated WBC, ST elevation.
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Intervention of pericarditis |
Assess nature of pain, position in high-fowlers, or upright and leaning forward. Cx pain: NSAIDs for inflammation. Auscultate for pericardial friction rub. Check blood cultures, adminster antibiotics for bacterial infection. Monitor for complications: Signs of cardiac tamponade. |
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Myocarditis |
Inflammation of the myocardium as a result of pericarditis, systemic infection. Causes are viruses, bacteria, fungi or radiation. |
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Myocarditis Assessment |
Fever. Auscultation of heart: Murmur that sounds like fluid passing an obstruction. Pulsus alternans. Fatigue, dyspnea, tachycardia, and cx pain. Also s/s of pericarditis. |
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Myocarditis Nursing Interventions
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Assist client to position of comfort: Sitting up and leaning forward. Admin. analgesics, salicylates and NSAIDs. Admin O2. Provide rest. Admin antidysrhythmics and antibiotics. Monitor for complications: HF, thrombus and cardiomyopathy.
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Endocarditis what is it when does it commonly occur/causes
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Inflammation of the innermost lining of heart and valves. Occurs primiarily in drug abuse, pts w/ cardiac valve replacement and elderly. Caused by microorganisms enter body through oral cavity and infections of GI/GU.
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Assessment of Endocarditis causes and s/s
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Fever, anorexia, wt loss, fatigue, cardiac murmurs, and HF. Embolic complications from vegetation fragments of valves. Petechiae. Splinter hemorrhages. Osler's nodes. Janeway lesion. Roth's spots. Splenomegaly. Clubbing of fingers
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Osler's nodes |
Painful, red, tender, or purple pea sized lesions on fingertips or toes. |
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Janeway Lesions |
Flat, painless, small red spots on palms and soles |
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Roth's Spots |
Hemorrhagic retinal lesions |
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Nursing Interventions for Endocarditis |
Prevent thrombus formation: rest, antiembolism stockings. Monitor for emboli: Pulmonary (pleuritic cx pain, dyspnea, and cough), CNS (confusion, asphasia, and dysphagia) splenic (acute abd pain) and renal (acute flank pain). Assess for splinter hemorrhages, Janeway lesions and Oslers nodes. Evaluate blood cultures, admin IV antibiotics. |
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Inflammatory and Structural Heart Disorders Dx Studies: ecg, echo, tee, cardiac cath
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ECG: Dysrhythmias, If systemic infection suspected draw two blood cultures 30 minutes apart from two different sites. ECHO: Valuable workup to detect vegetation on valves. TEE: Vegetation of valves. Cardiac Cath: Evaluate valve functioning and status of coronary arteries.
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Pericardial Effusion: what is it, s/s
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Build up of fluid in pericardium, can occur rapid or slow. Can cause cough, dyspnea, tachycardia. Heart sounds are distant. May compress adjoining structures. Compression may cause cough, dyspnea, and tachypnea.
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Cardiac Tamponade |
As pericardial effusion increases, heart becomes compressed. |
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Cardiac Tamponade S/S |
Cx pain, confusion, anxiety and restless. heart sounds are muffled. Narrowing pulse pressure. Tachypnea, tachycardia, and decreased CO. Pulsus paradoxus, and decrease in SBP w/ inspiration, and JVD |
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Nursing Interventions for Cardiac Tamponade |
In a critical care setting, administer fluids IV to manage decreased CO, prepare pt for chest x-ray or echo. Prepare pt for pericardiocentesis to withdraw pericardial fluids. |
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Dx studies for pericardial effusion and cardiac tamponade |
CXR may show cardiomegaly, ECHO may show presence of either, Doppler imaging to assess diastolic function and dx constrictive pericarditis, and CT/MRI visualizes the pericardium and pericardial space. |
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Labs for pericardial effusion and cardiac tamponade |
Leukocytosis, CRP/ESR/Troponin elevated in pts w/ ST segment elevation. |
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Rheumatic Fever |
Complication that presents 2-3 weeks following an untreated or partially treated group A streptococcal pharyngitis. |
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Most serious complication of rheumatic fever |
Rheumatic heart disease |
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What does rheumatic fever affect? |
Connective tissue of heart, joints, skin of the heart, joints, skin, blood vessels and CNS. |
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Jones Criteria |
Rheumatic fever: Presence of Two major criteria OR one major and two minor |
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Major Criteria for Rheumatic Fever |
Carditis, arthalgia, chorea, erythema marginatum and subcutaneous nodules. |
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Minor criteria of rheumatic fever |
Fever, elevated sedimentation rate or CRP level positie, and prolonged P-R interval |
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Evidence of group A streptococcal infection |
Fever, increased antistreptolysis-O titer, positive throat cultures, and elevated sedmentation rate, and elevated CRP level. |
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Clinical Manifestations of Rheumatic Fever |
Chorea, fever, carditis, erythema marginatum, polyarthritis, abdominal pain and subcutaneous nodules. |
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Chorea |
Involuntary movements of extremeties and face affects speech. |
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Erythema marginatum |
Red skin lesions starting on the trunk and spreading peripherally. |
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Complications of Rheumatic Fever |
Chornic rheumatic carditis, rheumatic endocarditis can result in in fibrous tissue growth in valve leaflets and chordae tendineae w/ scarring and contractures, mitral valve frequently involved. |
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Dx Studies for Rheumatic Fever |
No single dx test: May include echo (show valve insufficiency and pericardial fluid or thickening) and CXR may show an enlarged heart if HF is present |
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Care for Rheumatic fever |
Bed rest, antibiotics, NSAIDs, salicylates, and corticosteroids. Chorea (seizure precautions in place) |
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Nursing Implementation of rheumatic fever teaching
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Prevention: Early detection and immedate treatment of group a streptococcal pharyngitis. Treated w/ oral peniccilin or amoxicillin for 10 days. Prior hx of RF makes pts more susceptible to get it again. Pt w/ RF w/out carditis should receive prophylaxis until 20 y/o for a min of 5 years. Pt w/ rheumatic carditis need treatment for a longer period of time. (Sometimes life long) Pt teaching is good nutrition, hygiene, and rest
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What are the valves in the heart? |
Heart contains atrioventricular valves (mitral and tricuspid) and two semilunar vales (aortic and pulmonic) which control unidirection blood flow |
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How is valvular defined as? |
Stenosis or regurgitation |
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Stenosis |
Constricting or narrowing, opening is smaller, forward flow of blood is impaired. |
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Regurgitation |
Incomplete closure of the valve leaflets results in the backward flow of blood |
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Mitral Stenosis |
"Fish mouth". The stenosed valve is unable to open sufficiently during left atrial systole, inhibiting left ventricular filling. Most cases of adults occurrence result from rheumatic heart disease. |
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Mitral valve regurgitation s/s
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Weakness, fatigue and exertional dyspnea. Acute onset: Pulmonary edema (crackles), and S3
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Aortic Valve Stenosis |
Valvular tissue thickens and narrows the valve opening, preventing blood from flowing from the left ventricle into the aorta. The effect is left ventricular hypertrophy. |
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As aortic valve stenosis progresses what happens?
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Decreased CO, decreased tissue perfusion, pulmonary hypertension, and HF.
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Clinical Manifestations of Aortic Valve Stenosis |
Angina, syncope, dyspnea, HF, normal/soft S1, diminished/absent S2, systolic murmur and prominent S4. |
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Drug Alert for Aortic Stenosis |
Use nitro cautiously w/ pts w/ aortic stenosis as significiant reduction in BP may occur. Cx pain can worsen due to a dcrease in preload and drip in BP. |
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Aortic Valve Regurgitation |
Valve is incompetent and prevents complete closure during diastole. |
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Clinical Manifestations of Aortic Valve Regurgitation |
Profound dyspnea, cx pain and left ventricular failure. |
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Dx Studies for Valvular Disease |
Chest x-ray, echo, ECG, transesophageal echo and doppler, and cardiac cath. |
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Chest X-Ray Valvular Disease |
Heart size, altered pulmonary circulation, and valve calcification |
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What does a echo reveal r/t valvular heart disease? |
Valve structure, function and heart chamber size |
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What does a ECG reveal r/t valvular heart disease? |
HR, rhythm, and any ischemia or ventricular hypertrophy |
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What does transesophaegeal echo and doppler reveal r/t valvular heart disease? |
Color-flow imaging help dx and monitor valvular heart disease progression |
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What does a cardiac cath. reveal r/t valvular heart disease? |
Detects pressure changes in heart chambers, pressure gradients across valves |
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Prevention of rheumatic fever and endocarditis? |
HF is treated w/ vasodialators (ACE inhib, -pril), positive inotropes (Digoxin), beta blockers, diuretics, and low-sodium diet. Anticoagulation therapy prevents and treats systemic or pulmonary emboli, usually prophylactically in pts w/ a fib. |
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Percutaneous Transluminal Balloon Valvuloplasty |
Alternative treatment for some pts w/ valvular heart disease. Performed in cardiac cath lab. Balloon tipped cath threaded from femoral artery/vein to stenotic valve so balloon may be inflated in an attempt to seperate valve leaflets |
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Valvuloplasty |
Procedure to improve blood flow through a narrow valve. A catheter is threaded to the valve through a hole temporarily created in the septal wall and inflated. |
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Valve Repair |
Usually the surgical procedure of choice. It has a lower operative mortality rate than valve replacement and is often used in mitral or tricuspid valvular heart disease. |
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Mitral Valve Commissurotomy |
Surgical procedure to open a stenotic valve. Stenotic valve restricts the flow of blood. A scalpel incision widens the valve. |
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Mitral commisurotomy treatment of choice for what? |
Mitral stenosis |
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Valvuloplasty |
Repair of valves by suturing torn leaflets,, chordae tendinae, or papillary muscles. Primarily used to treat mitral or tricuspid regurgitation. Avoid risks of replacement but may not establish total valve competence. |
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Prosthetic Valves for what valves usually and what is it surgical tx of choice for
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Valvular replacement may be required for mitral, aortic, tricuspid, and occassionally pulmonic valvular disease. Surgical tx of choice for aortic stenosis and aortic regurgitation is valvular replacement.
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Mechanical prosthetic valves |
Manufactured, man made, more durable, last longer. Thromboembolism is a problem and lifetime anticoagulant therapy is required. Main complication is hemorrhage from use of long term anticoagulants. |
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Biological Valves |
Constructed from bovine (cow) porcine (pig) and human cadavers. Biologic valves do not require anticoagulation due to low thrombogenicity. Pts w/ a fib will require long-term anticoagulation therapy. |
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Cardiomyopathy |
Group of diseases that affect the structural and functional ability of the myocardium. Classified as primary CMP (idiopathic) or secondary (known cause) |
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Dilated Cardiomyopathy |
Most common type. Fibrosis of myocardium and endocardium, dilated chambers. |
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Causes of dilated cardiomyopathy |
Cardiotoxic agents (alcohol, cocaine), CAD |
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S/S of dilated cardiomyopathy |
Fatigue, weakness, HF |
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Tx of dilated cardiomyopathy |
HF, vasodilators, control dysrhythmias, heart transplant |
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Hypertropic Cardiomyopathy |
Characterized by massive ventricular hypertrophy, small chambers |
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Causes of hypertropic cardiomyopathy |
Aortic stenosis, htn |
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S/S of hypertropic cardiomyopathy |
Dyspnea, fatigue, angina, syncope, palpitations. |
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Tx of hypertrophic cardiomyopathy |
Symptomatic: meds, may need surgery |
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Restrictive cardiomyopathy |
Restrictive filling of ventricles: least common. |
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Causes of restrictive cardiomyopathy |
Amyloidosis, endomyocardial fibrosis |
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S/S of restrictive cardiomyopathy |
Dyspnea, HF, fatigue, |
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Tx of restrictive cardiomyopathy |
Symptomatic: meds |
