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chpt 37 heart

inflammatory & structual disorders

QuestionAnswer
up to how many liters of O2 can you give? up to 6L, but past 4L, use a mask and not a nasal canula
what's the most important pt teaching for endocarditis? handwashing
subacute insidious, gradual onset, lasts longer, less virulent
acute last shorter, highest virulence, rapid onset, sickest
Endocarditis BACTERIAL; streptococcus viridans, pyogenes & pneumoniae, staph areus, fungi, chlamidiae, viruses
Endocarditis dx which you must not miss strep infection
what happens with certain endocarditis mormally blood flow through valves is smooth, but if damaged (rheumatic fever), bacteria grabs a hold
what's a vegetation lesion the "cauliflower-like appearance in the endocardium- white & patchy
Dx tool for vegetation & it's nursing intervention the TEE & echocardiogram- pt is to be NPO, chest x-ray to detect size
what do you do before fiving ASA or ANBX take pt blood
endocarditis diagnostic tests hx: invasive procedures, UTI, RTI, blood culture from 3 different venipuncture sites, 20 min intervals, cultures kept 3 weeks, mild leukocytosis,EKG to detect AV block, cardiac cath to detect fx
collaborative care for endocarditis prophylactic antbx for dental procedures (even cleaning)-- ONLY for those w/previous endocarditis, previous open heart surgery, congenital HF, and PROSTHETIC CARDIAC VALVES
long-term IV ANBX given @ home w/home health nurse
why does ANBX for tx endocarditis need to be long term (2-6weeks)? no blood supply to that region
poor outcome w/what type of endocarditis? fungal endocarditis, prosthetic valvular endocarditis (metal)--early valve replacement recommended
drug therapy for endocarditiis accurate ID of organism necessary-- but PENICILLAN is used
TX for endocarditis ANBX, rest periods, monitor labs :WBC, ROM and TED hose, bturn cough and breath Q2H pt can walk around if they don't have fever
peak and trough for endocarditis Peak levels drawn 30 minutes after end of infusion. Trough levels drawn immediately before the next dose. Levels drawn around 3rd/4th dose to reach steady-state.peak 4-12, trough <1.5
Acute pericarditis etiology & pathophysiology VIRAL-->inflammation of both layers, most often idiopathic but can be caused by MI (w/in 24 hours), TB neoplasm, trauma
Acute pericarditis S/S severe chest pain, coordinates w/breathing, worst when supine, rapid shallow breaths to avoid pain
halmmark finding pericarditis pericardia frx rub left sternal border, If pt has had MI- check for frx rub
pericarditis nursing intervention have pt lean forward
what drug given for endocarditis NSAIDS, not morphine, to relieve pain AND inflammatory (give w/food & milk)
2 complications from pericarditis cardiac tamponade(systolic & diastloic equalize), & pleural effusion (distant heart sounds & limits motion of the heart)
if too much fluid in pericardial sac- what is done? pericardial centesis (when SBP reduced by 30mmHg)
what procedure is done to check inflammation of pericarditis constant EKG to see if it's getting better
what do you tx for pericarditis underlying cause (MI, TB, infx), anxiety (talk to them)
what is avoided w/pericarditis? steroids
MI vs Pericarditis MI is not relieved by position change
pulsus paradoxis BP exaggeration of 10 mmHg- decreases during inhalation, increases w/exhalation- indicates pericarditis/cardiac tamponade
chronic constrictive pericarditis results from scarring, loss of elasticity, accumulation of fibrin & calcium, impaired stretch during diastole, less space
CT scan and MRI contraindication metal/pacemakers
myocarditis inflammation of myocardium caused by a VIRUS, bacteria, fungi, radiation
myocarditis s/s stabbing chest pain, palpitation, fever--accompanies pericarditis
myocarditis nursing intervention keep pt in a high fowlers position
rheumatic fever inflammatory dz of the heart involving all layers
most serious comlication of rheumatic fever rheumatic heart dz
rheumatic fever characterized by scarring and deformity of the heart valves resulting from rheumatic fever
rheumsatic fever dx that cannot be missed strep throat
Aute rheumatic fever is d/t? inflammation of all 3 layers of the heart occuring as a delayed sequela of GROUP A STREPTOCOCCAL INFX
Aute rheumatic fever effects what part of the body? heart, joints, skin, CNS
layers effected by acute rheumatic fever/dz 1. rheumatic endocarditis- found primarily in the valves (mitral/aortic)- regurgitation & stenosis 2. rheumatic myocardial damage: ASCHOFFS BODIES or nodules- cause scarring 3. rheumatic pericarditis: bot layers
rheumatic heart fever s/s similar to CHF--> murmurs, regurgitation/stenosis of valves, cardiac enlargement, pericarditis w/distant heart sounds, frx rub, signs of effusion, chorea (ataxia), pink map-like rash, SQ nodules on bony prominences
rheumatic fever complications chronic rheumatic carditis d/t valvular structure, valve stenosis, regurgitation, aortic dilation, arrythmia, ventricular dysfx, leading cause of MITRAL VALVE STENOSIS & REPLACEMENT
rheumatic fever shows what on an EKG prolonged QT interval
rheumatic fever drugs & tx bed rest, initial & prophylactic antbx, ASA, CORTICOSTEROIDS
biologic valves have what as a s/e calcification
rheumatic fever nursing mngmt rest, educate to prevent streptococcus infx by taking ANBX full course
what is contraindicated w/valvular heart dz nitroglycerin- preload needed to push blood through valves
what is mitral valve stenosis narrowing and constriction of heart d/t stuff sticking to it and sticking to it
major cause of mitral valve stenosis RHEUMATIC HEART DZ, other inflammatory causes: congenital, rheumatic arthritis, lupus
mitral valve shape "fish mouth"
mitral valve stenosis s/s similar to HF: dyspnea, A-fib, fatique, loud S1 and murmur
mitral valve regurgitation backwards flow into LA
mitral valve prolapse is what? buckling of leaflets into atrium during systole
mitral valve concers no caffeine & benign for most of their lives
Aortic valve stenosis etiology 1/3 of originial size for orofice, congenital, results from RHEUMATIC fever, increases w/age d/t fibrocalcific degeneration
Hallmark finding for aortic stenosis SYSTOLIC MURMUR
aortic valve prognosis poor- need valve replacement
Aortic valve stenosis s/s angina, HF, syncope--> nitroglycerin contraindicated
Aortic valve regurgitation LIFE THREATENING EMERGENCY d/t endocarditis, trauma, dissection, rheumatic heart da, syphilis, congenital bicuspid issues
Aortic valve regurgitation s/s hypotension, weakness, severe dyspnea, "WATER HAMMER PULSES,"rapid beat which declines rapidly, S3 S4 murmur
valve replacement teaching Coumadin for life w/prosthetic valves
pregnant women cannot have prosthetic valves b/c they cannot use coumadin
is valve surgery palliative or curative palliative
what lab values are checked w/valve replacement INR done monthly (2.5-3.5 okay)
older people have a better chance w/MI b/c... they have collateral circulation
Created by: arsho453
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