Unit 4C: Alterations In Perfusion

Front 1

Blood rapidly collects in pericardial sac, compresses myocardium b/c the pericardium does not stretch, and prevents heart from pumping effectively

Back 1

-Cardiac tamponade

Front 2

Describe s&s for a patient experiencing cardiac tamponade:

Back 2

-Muffled, distant heart sounds, hypotension, neck vein distention, increased central venous pressure

Front 3

Describe treatment for a patient experiencing cardiac tamponade:

Back 3

-Medical emergency
-pericardiocentesis with surgical repair as appropriate

Front 4

The blockage of pulmonary arteries by a thrombus, fat or air embolus, or tumor tissue resulting in perfusion obstruction
-it is one of the most common causes of preventable death in hospitalized patients

Back 4

-Pulmonary embolism

Front 5

Where do most pulmonary emboli arise from?

Back 5

-Deep veins of the legs (most lethal from the femoral or iliac veins)

**Other sites include right side of the heart (especially with a-fib), the upper extremities (rare), and the pelvic veins (especially after surgery or childbirth)

Front 6

What part of the lungs are most frequently affected by pulmonary emboli?

Back 6

-Lower lobes

**b/c they have a higher blood flow than the other lobes

Front 7

The most common risk factors for PE are:

Back 7

-immobilization
-surgery within the last 3 months
-stroke
-hx of DVT
-malignancy

Front 8

Describe s&s for a patient experiencing PE:

Back 8

-classic triad: dyspnea, chest pain, and hemoptysis (does not always occur)
-Most common: anxiety and sudden onset of dyspnea, tachypnea, or tachycardia
-Other: cough, pleuritic chest pain, hemoptysis, crackles, fever, accentuation of the pulmonic heart sound, and sudden change in mental status
-if massive emboli: pulse is rapid and weak, BP is low, ECG indicates right ventricular strain, acute cor pulmonale may result
-Medium emboli: pleuritic chest pain, dyspnea, slight fever, and productive cough with blood-streaked sputum, tachycardia, pleural friction rub

Front 9

Describe treatment for a patient experiencing PE:

Back 9

-supplemental O2, intubation may be necessary
-IV for meds and fluid replacement
-Continuous IV heparin (Lanoxin) for acute treatment
-Coumadin for long-term therapy
-Monitoring of aPTT and INR levels
-Bed rest
-Opioids for pain relief
-Inferior vena cava filter
-Thrombolytic agent may be considered
-Pulmonary embolectomy in life-threatening situations

Front 10

Previously known as bacterial endocarditis
-an infection of the endocardial surface of the heart, including cardiac valves
-comes in two forms: subacute and acute
-occurs when blood flow turbulence within the heart allows the causative organism to infect previously damaged valves or other endothelial surfaces

Back 10

-Infective endocarditis (IE)

Front 11

This form of IE typically affects those with preexisting valve disease and has a clinical course that may extend over months:

Back 11

-Subacute IE

Front 12

This form of IE typically affects those with healthy valves and presents as a rapidly progressive illness:

Back 12

-Acute IE

Front 13

What are the most common causative organisms of IE?

Back 13

-Staphylococcus aureus and Streptococcus viridans
*Both are bacterial

**Other possible pathogens include fungi and bacterial
**Resistant organisms include methicillin-resistant Staphylococcus aureus (MRSA)

Front 14

The principal risk factors for IE are:

Back 14

-prior endocarditis
-prosthetic valves
-acquired valvular disease
-cardiac lesions
-procedures that can allow large numbers of organisms to enter the bloodstream and initiate the infectious process

Front 15

The infection may spread locally to cause damage to the valves or to their supporting structures, this results in:

Back 15

-dysrhythmias
-valvular incompetence
-eventual invasion of the myocardium, leading to HF, sepsis, and heart block

Front 16

What are the most common causes of IE:

Back 16

1.) aging
2.) IVDA
3.) Use of prosthetic valves
4.) Proliferation of IV device placement, resulting in nosocomial infections
5.) Renal dialysis

Front 17

Left-sided endocarditis is more common in patients with:

Back 17

-bacterial infections

-underlying heart dz

Front 18

Right-sided endocarditis is more common in patient that:

Back 18

-IVDA

Front 19

A condition caused by inflammation of the pericardial sac (the pericardium), which may occur on an acute basis
-idiopathic or viral most common causes
-other: uremia, bacterial infection, acute MI, TB, neoplasm, and trauma
-inflammation is caused by an influx of neutrophils, increased pericardial vascularity, and eventually fibrin deposition on the visceral pericardium

Back 19

-Acute pericarditis

Front 20

Describe s&s for a patient experiencing acute pericarditis:

Back 20

-frequently severe chest pain that is sharp and pleuritic in nature
-pain is generally worse with deep inspiration and when lying supine
-relieved by sitting
-pain amy radiate to the neck, arms, or left shoulder
-pericardial friction rub (hallmark finding)

Front 21

A scratching, grating, high-pitched sound believed to arise from friction between the roughened pericardial and epicardial surface
-stethoscope diaphragm placed at the lower left sternal border of the chest

Back 21

-pericardial friction rub

Front 22

Results from scarring with consequent loss of elasticity of the pericardial sac
-usually begins with an initial episode of acute pericarditis
-characterized by fibrin deposition with a clinically undetected pericardial effusion

Back 22

-chronic constrictive pericarditis