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37 Cards in this Set
- Front
- Back
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Pericardium?
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Sac surrounds heart
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Endocardium?
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innermost layer of heart muscle
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Rheumatic Fever (Rh Fever)?
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-autoimmune inflammatory disease
- can involve any layer of heart - a complication of untreated upper respiratory infections- seen only in 3% of infections |
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Rheumatic Fever may develop 2-3 wks after_____
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- Group A Strep Throat
- or Scarlet Fever |
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Rh fever is most common in _____
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- school age children 5-15 yrs old
- a disease of childhood, but effects seen in adulthood |
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Rheumatic Carditis aka ____
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Rheumatic Endocarditis
- inflammation is in all heart layers - 40% of Rheumatic Fever episodes end up with Rheumatic Carditis |
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Most of damage is in ___ layer with inflammation of the heart____
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endocardium; valves
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Pathologic hallmark or Rheumatic Endocarditis is formation of ______
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Aschoff's bodies: small painless nodules in myocardium replaced w scar tissue.
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Rheumatic Pericarditis?
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outer layer of heart (pericardium) becomes thickened and covered w fibrous exudate that can lead to pericardial effusion
- it's called Pancarditis if all 3 layers are involved |
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A preceding case of strep throat is key to dx of _____
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Rheumatic Fever
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Modified Jones Criteria?
CANCER |
- Carditis- most serious symptom of Rh fever
- arthritis - Nodules - Chorea - involuntary jerky movements of face & limbs - E.R. (Erythema Marginatum)-long lasting rash begins in arms and trunk - painless |
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Dx tests for Rh fever?
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-labs
- CXR - shows HF, enlarged heart - EKG- shows prolonged PR interval - Echo- shows valve insufficiency, any pericardial fluid, or thickening of heart wall - TEE Transesophageal Echo - shows valve disease - cardiac cath - |
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Pts who had Rh fever are more susceptible for subsequent episodes; therefore put on preventive therapy and the best is______
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penicillin therapy
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Name 3 nursing diagnoses for Rh Fever?
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- Knowledge Deficit
- Activity intolerance r/t joint pain - Dec cardiac output r/t valve dysfunction |
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Myocarditis? What causes it?
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- Uncommon inflammation of myocardium
- Most common cause is Cox-Sackie virus (GI bug) |
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How dx myocarditis?
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no gold std for dx; often done by exclusion
- one dx method is endomyocardium biopsy - only done for sickest pts since it's invasive |
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symptoms of myocarditis?
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- flu-like symptoms
- HF symptoms (SOB, JVD, edema) - can progress to HF or dilated myodcarditis |
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Meds for myocarditis?
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steroids, antivirals, immunoglobulins
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Enfective Endocarditis?
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- infection of heart's inner lining and/or heart valves;
- occurs when bacteria in blood lodge onto abnormal heart valve - common after many invasive procedures due to infection - males & females equally effected - mortality is as high as 25% |
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What 2 types of bacteria cause infective endocarditis?
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- Staph
- Strep |
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What predisposes you to infective endocarditis?
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- valve abnormalities ie, heart valves scarred by rheumatic fever
- IV drug abusers - pts w artificial valves |
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How does the staph & strep enter body to cause Infective endocarditis?
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- oral cavity
- skin rashes - surgery/invasive procedures - IV line placement including central line |
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Vegetation forms on heart with infective endocarditis. What is the vegetation made of?
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- Fibrin, leukocytes, platelets, microorganisms
- easily friable, can break off leading to DVT or PE - these vegetative fragments can travel to other organs causing embolisms in those organs - remember infective endocarditis = embolization |
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What are key features of infective endocarditis?
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- fever, chills,
- malaise, fatigue - Osler Nodes - small tender nodular cutaneous lesions in the pads of fingers or toes - Petichiae- pin-point red spots - Splinter hemorrhages - black or red on finger nails - Janeway lesions- flat painless small red spots seen oon palms & soles - Roth spots- round white spots on retina surrounded by hemorrhage |
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Pts at high risk for infective endocarditis?
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- IV drug abusers
- Central lines in too long - bad teeth |
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More than 90% of pts with infective endocarditis develop ____
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murmurs
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what is most common complication of infective endocarditis?
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Heart failure; so assess for
- RHF- (peripheral edema, JVD, wt gain) - LHF - (fatigue, SOB, crackles on lungs) |
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Nursing dx for infective endocarditis?
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- low cardiac output r/t valve damage
- altered body temp r/t infection |
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Most reliabel dx for infective endocarditis?
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- Positive blood culture: obtain ASAP to identify bacteria
others dx: - echocardiogram - TEE - allows visualization of cardiac structures |
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According to AHA, moderate risk & high risk pts need antibiotic prohylaxis before general surgery, dental procedures, etc T or F
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T
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Pericarditis?
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inflammation of pericardium - sac in which heart lies; has 2 layers
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2 types of pericarditis? infectious & non infectious. Define infectious?
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Infectious
- bacterial pericarditis - requires Ab, sometimes must drain sac - Acute viral pericarditis: commonly follows resp infection |
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Define non-infectious pericarditis?
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-caused by malignant disease which is non-infectious, and treated by radiation, chemo
- if it progresses to renal failure, called uremic pericarditis; treated with hemodialysis |
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Signs & symptoms of pericarditis?
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- characteristic chest pain felt below sternum
- breathing causes heart to move against irritated pericardium and so it worsens pain - pain may worsen when pt lies down & improves when sitting up and leaning forward |
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pericardial friction rub is sign of pericarditis and is heard w stethoscope. T or F
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T
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What are 2 complications of pericarditis?
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- PERICARDIAL EFFUSION: occurs when space between parietal and visceral layers of pericardium fills with fluids. This puts pt at risk for cardiac tamponade
- CARDIAC TAMPONADE: excessive fluid within pericardial cavity; occurs in 15% of pts |
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What is danger of cardiac tamponade?
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- can restrict the ventricles from filling (during diastole); this dec stroke vol & cardiac output,
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