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MedSurge-HEART DISOR
MedSurge HEART DISORDERS review
| Question | Answer |
|---|---|
| Risk of infective endocarditis is increased by? | recent dental, urologic, surgical, GYN procedures, hx of IV drug abuse, heart disease, cardiac catherization, renal dialysis, infections |
| Acute left-sided infective endocarditis is? | a life-threatening form of infective endocarditis |
| S/S of acute left-sided infective endocarditis | abrupt onset of CNS complications resulting from embolization from infected valvular vegetations |
| Acute left-sided infective endocarditis diagnosis is best confirmed with? | blood cultures |
| Transesophageal echocardiograms can identify? | vegetations on valves and are used when blood cultures are negative |
| Splinter hemorrhages, manifestation of endocarditis? | black longitudinal streaks in nail beds |
| Janeway's lesions, manifestation of endocarditis? | flat, red, painless spots on the palms and soles of feet |
| Osler's nodes, manifestation of endocarditis? | painful red or purple lesions on fingers or toes |
| Roth's spots, manifestation of endocarditis? | hemorrhagic retinal lesions |
| Petechiae, manifestation of endocarditis? | small hemorrhages in conjunctiva, lips, and buccal mucosa |
| Pt. with prosthetic mitral valve develops left hemiparesis and visual changes, nurse expects management will be? | surgical replacement of valve |
| Usual S/S of pt. with aortic valve endocarditis in 80% of patients? | dyspnea, crackles in lungs, and restlessness |
| Vegetative embolization from the aortic valve occurs where in the body? | throughout the arterial system and may affect any organ |
| Pulmonary emboli occur in (left / right)-sided endocarditis? | right-sided |
| Prevention of endocarditis infection recurrence can be addressed by? | pt. obtaining prophylactic antibiotic therapy before invasive medical and dental procedures |
| To establish presence of a pericardial friction rub, nurse listens to pt. chest ...? | with diaphragm to auscultate a high-pitched continuous rumbling sound |
| When excess pericardial fluid compresses the heart and prevents adequate diastolic filing, S/S would be? | markedly distended jugular veins, ↓ BP, tachycardia, tachypnea, muffled heart sounds |
| Cardiac tamponade is? | pressure on the heart that occurs when blood or fluid builds up in the myocardium and pericardium |
| Chronic constrictive pericarditis is manifested by? | fibrin accumulation, a scarred and thickened pericardium and adherent pericardial membranes |
| Pulses paradoxus is? | drop in systolic pressure > 10 mm Hg with expiration |
| Acute pericarditis may be diagnosed with ECG showing? | diffuse ST segment elevation |
| Pt. with acute pericarditis should be positioned? | in Fowler's position with a padded over-the-bed table for patient to lean on |
| Medications to help control pericardial pain include? | anti-inflammatory medications, opioids are not usually indicated |
| Nurse should question pt. with myocarditis specifically about? | recent viral illness (e.g. fever and malaise) |
| Most common cause of myocarditis in the US? | viruses |
| The heart has increased sensitivity to the drug _____ in myocarditis. | digoxin; and it is rarely (if ever used) |
| Nursing role in prevention of rheumatic fever? | early diagnosis and immediate Tx of group-A streptococcal pharyngitis |
| Antibiotics (should / should not) be used to treat viral infections? | should not |
| Diagnosis of rheumatic fever is strongly supported in pt. with? | carditis, polyarthritis, erythema marginatum |
| Erythema marginatum is described as? | the presence of pink rings on the trunk and inner surfaces of the limbs which come and go for as long as several months |
| Antibiotics - use to treat rheumatic fever | eliminate residual group-A heolytic streptococci, prevent spread /recurrence of infection |
| Aspirin - use to treat rheumatic fever | anti-inflammatory and arthritic and joint manifestations |
| Corticosteriod - use to treat rheumatic fever | anti-inflammatory and severe carditis |
| NSAIDs - use to treat rheumatic fever | anti-inflammatory and joint manifestations |
| Activity is restricted for pt. with rheumatic heart disease with carditis for how long? | until symptoms of heart failure are controlled; confined to bed |
| Valvular stenosis leads to? | ↓blood flood and hypertrophy of preceding chamber |
| Valvular stenosis causes? | a pressure gradient difference across an open valve |
| Heart valve most commonly affected by stenosis or regurgitation? | mitral valve |
| Most common valvular disease in the US is? | mitral valve collapse |
| Mitral stenosis, characteristics? | dyspnea, embolization may result from chronic atrial fibrillation |
| Acute mitral regurgitation hypertension, characteristics? | rapid development of pulmonary edema and cardiogenic shock; rapid onset prevents left chamber dilation |
| Cardiogenic shock occurs when? | the heart has been damaged so much that it is unable to supply enough blood to the organs of the body |
| Chronic mitral regurgitation, characteristics? | loud pansystolic or holosystolic murmur; brisk carotid pulses present |
| Mitral valve prolapse, characteristics? | ballooning of valve into left atrium during ventricular systole |
| Aortic stenosis, characteristics? | characteristic systolic crescendo-decrescendo murmur; angina and syncope result from ↓ CO |
| Acute aortic regurgitation, characteristics? | sudden onset of cardiovascular collapse |
| Chronic aortic regurgitation, characteristics? | water-hammer pulses |
| Tricuspid valve disease, characteristics? | may be caused by pulmonary HTN; major symptoms related to systemic venous pressures |
| Drugs most often prescribed for pts. with mechanical valve placement? | anticoagulants; due to risk of thrombus formation |
| Drugs contraindicated for pts. with aortic stenosis? | nitrates; because an adequate preload is necessary to open stiffened aortic valve |
| Dysrhythmias frequently cause what S/S? | palpitations, lightheadedness, dizziness > falls risk |
| Hypervolemia and paroxysmal nocturnal dyspnea would be apparent in pt. with? | heart failure |
| Percutaneous transluminal balloon valvuloplasty is indicated for? | older patients with stenosis of any valve |
| The operative mortality rate is (higher / lower) in valve repair than replacement? | lower in valve repair |
| Open valve repair is (less / more) precise than closed? | more and requires cardiopulmonary bypass during surgery |
| Mechanical prosthetic valves require long-term anticoagulation, and is contraindicated in? | women of childbearing age, pts. at risk for hemorrhage, non-compliant w/anticoagulant therapy |
| The greatest risk to a patient who has an artificial valve is the development of? | endocarditis |
| The hyperdynamic systolic function creates a diastolic failure in? | hypertropic cardiomyopathy |
| Systemic embolization may occur because of stasis of blood in the ventricles in? | dilated cardiomyopathy |
| The most uncommon type of cardiomyopathy? | restrictive cardiomyopathy |
| Heart transplant is often required in? | dilated cardiomyopathy |
| About 1/2 of the cases of _____ _____ have a genetic basis. | hypertropic cardiomyopathy |
| No ventricular hypertrophy is found in? | dilated cardiomyopathy |
| ECG reveals cardiomegaly with thin venricular walls in? | dilated cardiomyopathy |
| Syncope during increased activity resulting from an obstructed aortic valve outflow occurs in? | hypertropic cardiomyopathy |
| Infective myocarditis or exposure to toxins or drugs is often follows? | dilated cardiomyopathy |
| Surgery to remove myocardial tissue may be indicated for symptoms refractory to treatment in? | hypertropic cardiomyopathy |
| Ventricular stiffness is characteristic of? | restrictive cardiomyopathy |
| Massive thickening of intraventricular septum and ventricular wall is characteristic of? | hypertropic cardiomyopathy |
| Hypertrophic cardiomyopathy is? | a condition in which the heart muscle becomes thick. Often, only one part of the heart is thicker than the other parts |
| Restrictive cardiomyopathy refers to ? | changes in and weakening of the heart muscle, which causes the heart to fill poorly, squeeze poorly, or both |
| Dilated cardiomyopathy is? | a condition in which the heart becomes weakened and enlarged. As a result, the heart cannot pump enough blood to the rest of the body |
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