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NURS 3000 > Cardiovascular Complications > Flashcards

Cardiovascular Complications Flashcards

1
Q

Ineffective Endocarditis (IE)

A

Infection of heart valves or the endocardial surface, typically both become infected

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2
Q

Pathphys IE

A

infection leads to fibrin, leukocytes, platelets and microbes on the surface
then causes local heart tissue damage
can also cause embolisms to break off and affect other areas of the body

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3
Q

Etiology of IE

A

Community or healthcare
intracardiac and/or IV devices
Staphyloccus pneumonia, aureus or enteroccoci
gram +ve, fungi or virus
blood flow turbulence within the heart allows the organism to infect previously damaged valves

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4
Q

Risk Factors of IE

A 
previous history
prosthetic valves
rheumatic heart disease
IV drug use
scarlet fever
long hospital stays
recent dental, urological, surgical or gynecological procedures
poor dental health
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5
Q

CM of IE

A 
fever
murmurs in the mitral mid to late systolic
weakness
headaches
night sweats
weight loss
fatigue
coughing
arialgias
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6
Q

Sub Acute CM of IE

A

joint aches and pains for muscle and back
finger clubbing
splinter hemorrhage
blood in urine
Petechiae - pinpoint round red spots from bleeding in lips, buccal mucosa, palate ankle, feet and antecubital and popiteal areas
Osler’s Nodes/Janeway’s Lesions - tender purple pink nodules with pale center
Roth’s Spots - small blood shot eyes

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7
Q

Diagnostics of IE

A 
blood culture of two sets taken more than 60 mins apart or three sets taken less than 60 mins apart to be cultured for three weeks to test for organisms
CBC and electrolyte panel
ESR and CRP
Uranalysis
ECHO, ECG and CXR
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8
Q

Tx of IE

A

Prophylatic therapy with antibiotics
antibiotics IV 4-6 weeks with regular bloodwork
anti-inflammatories
antifever
light bed rest or complete bed rest if severe

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9
Q

Complications of IE

A

right sided can lead to embolisms in the lungs, limbs and brain
left sided can lead to embolisms in the kidneys, liver, spleen, limbs and brain

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10
Q

Pericarditis

A

inflammation of the pericardial sac/pericardium that’s typically a symptoms or complication of the disease, not a disease itself

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11
Q

Pericardium

A

inner serous layer of heart wall tissues that is closest to the epicardium

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12
Q

Pathophys of Pericarditis

A

inflammation of neutrophils, monocytes, and macrophages for to the hyperemic pericardium with an increased blood flow and fibrin deposits on the visceral pericardium

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13
Q

Etiology of Pericarditis

A

80-85% virus
within 48-72h post MI
Dressler’s syndrome
4-6 weeks post MI

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14
Q

CM of Pericarditis

A

sharp and pleuritic chest pain that gets worse with breathing in or lying down
radiate to traps and arms
pericardial friction rub that can be heard with stethoscope that can cause further damage
pulses paradoxes with inhalation
SOB
hyperventilation

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15
Q

Pericardium Friction Rub

A

complication of pericarditis that can be heard best in the left sternal boarder in time with the heart beat with scratching and grating noises
degenerate heart walls

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16
Q

Pericardial Effusion

A

complication of pericarditis

excess fluid in the pericardium related to inflammation response

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17
Q

Cardiac Tamponade

A

complication of pericarditis that is an increase in fluids in pericardial sac that can increase pressure in on the heart and vessels

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18
Q

Diagnostics for Pericarditis

A 
ECG with widened ST segment and elevation
CXR
ECHO
Pericardiocentesis
pericardial biposy
identify the cause
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19
Q

Tx of Pericarditis

A 
antibiotics to treat the bacteria
treat the cause
Colline and asteroids as a last resort
pain meds
pericardiocentesis to remove the excess fluids
elevate head of the bed
anti-inflammatories
monitor for complications
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20
Q

Myocarditis

A

focal or diffuse inflammation of the myocardium caused by virus, bacteria, fungi, radiation and/or pharmacological factors
causes cardiac dysfunction and has been linked to dilated cardiomyopathy

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21
Q

CM Early for Myocarditis

A 
fever
myalgia
SOB
vomiting and nausea
lymphadenopathy
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22
Q

Post-Infection CM of Myocarditis

A

appears within 7-10 days of onset with extra pleuretic chest pain and pericardial friction rub

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23
Q

Late CM of Myocarditis

A 
CHF with S3 sound
syncope episodes
peripheral edema
jugular vein distension
angina
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24
Q

Diagnostic for Myocarditis

A

ECG and ECHO

endomyocardial biopsy for blood culture

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25
Q

Tx of Myocarditis

A

inotropic and or vasopressor therapy
mechanical circulation support for increasing cardiac output
BB
ACE inhibitors
diuretics
immunosuppressants potentially, depending on the cause and severity of inflammatory response
bed rest or restricted activity with maintenance of activity tolerance

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26
Q

P Wave

A

atrial depolarization/contraction with a typical +ve deflection above the isometric line with an average of 0.06-0.12 sec

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27
Q

QRS Complex

A

beginning to end of ventricle depolarization that is slower, 0.6-0.12sec
shorter complexes means slower depolarization
longer time means cardiac dysfunction

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28
Q

T Wave

A

ventricle repolarization

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29
Q

PR Segment

A

flat line between the P and Q sections that sets the isometric line and represents conduction through the AV node
represents times taken from impulse to spread through the atria, AV node, bundle of His or bundle branches

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30
Q

QT Interval

A

full period of time for heart to contract and relax ventricle with inverse relationship with HR
typically 0.34 to 0.43sec
disturbances are from drugs, electrolyte imbalances, and changes in HR

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31
Q

ST Segment

A

measured from S to T wave that represents the time in-between the ventricle depolarization and repolarization that should be flat
disturbances are typically ischemia, MI or stroke

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32
Q

T Wave

A

time for ventricle repolarization, upright

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33
Q

S1 Sound

A

beginning of R wave and systole, typically together but the valves closing can rarely be heard separately

34
Q

S2 Sound

A

closing of semilunar valves, splitting is normal when you can hear arteriole or peripheral sphincters close to create the sound

35
Q

Atuomacitity

A

ability to initiate an impulse spontaneously and continuously

36
Q

Conductivity

A

Ability to transmit an impulse along a membrane in an orderly fashion

37
Q

Excitability

A

ability to be electrically stimulated

38
Q

ECG

A

graphic tracing of an electrical impulse produced by the heart through the movements of charged ions for K+ and low NaCl

39
Q

Tele Monitoring

A

46 lead over prolonged period of time to diagnosed and monitor arrhythmias

40
Q

Artifact

A

disortion of the baseline and waveforms on the ECG, can be form the machine dysfunction or the actual heart problems

41
Q

Ventricular Contraction

A

count R wave for 6 sec x10 and compare for seeing if the rhythm is regular
typical is 60-100

42
Q

Atrial Rate

A

counting P waves within a 6 sec period and x10

43
Q

Etiology of Arrhythmias

A 
electrolyte imbalance
drugs
MI
HF
Myocardial cell degeneration
conduction defects
hypertrophy of cardiac muscle
acid-base imbalance
alcohol
caffeine
emotional crisis
connective tissue disorders
electrical shock
hypoxia
shock
metabolic conditions
near drowning
physical deficits and defects
44
Q

CM of Arrhythmias

A 
Chest, shoulder, neck and or arm pain
cold clammy skin
decreased BP
tachy or brady
low O2 sat
syncope
SOB
extreme restlessness
pallor
weakness
fatigue
45
Q

Normal Atrioventricular Impulse Transmission

A

conduction is delayed in ventricle which is prolonged R wave

46
Q

Pre-Excititation

A

the accessory pathway between atria and ventricles where it bypasses the AV node

47
Q

ST Segment Elevation

A

commonly seen in pt with MI or ischemia

48
Q

ST Segment Depression

A

pt with hypokalemia, cardiac ischemia, or and digitalis toxicity

49
Q

Sinus Arrhythmias

A

rhythm varies with breathing that is typically found in children that drops with exhalation and increases with inhalation

50
Q

Premature Beat

A

isolated and too early beat that can occur regularly or every 3-4 beats

51
Q

Pulse Deficit

A

weak contraction of the ventricles, occurs at atrial fibrillation, premature beats and HF

52
Q

Sinus Bradycardia

A

low HR but regular ECG with prolonged beats

can occur with carotid massage, hypothermia, increased ICP, increased vagal tone and parasympathomimetic drug

53
Q

Sinus Tachycardia

A

normal sinus and ECG showing, just really fast

can come from increased vagal inhibition, physical or mental stress, or sympathetic stimulation

54
Q

Premature Atrial Contraction

A

contraction form somewhere other than the atria or sinus node that travels across a broad pathway
ECG downward deflection, hidden in preceding T wave, and shorter PR interval
indicator of more serious arrhythmia

55
Q

Paraoxysmal Supraventricular Tachy

A

dysrhythmia from ectopic focus above the bifurcation of the Bundle of His from re-entrant phenomenon

56
Q

Atrial Flutter

A

SEE SAW between QRS complex from an ectopic focus that typically cannot originate from a healthy heart
250-350 atrial rate with a 2:1 conduction regularly with a ventricle rate of 150
PR interval is funky and AV delays signals

57
Q

Atrial Fibrilation

A

total disorganization of atrial electricity from multiple ectopic foci which indicates a total loss of effective atrial conduction
atrial rate is fucked lol
ventricle rate is 50-180
erratic P waves
If Jackson Pollock had an ECG and someone said be free

58
Q

Pulselessness Electrical Activity

A

electrical ECG but not mechanical activity of the ventricles with no pulse
oh no, out pt…. it’s broken

59
Q

Sudden Cardiac Death

A

heart really said well fuck me up the ass and call me bob, I’m DONE

60
Q

Heart Murmurs

A

blowing swooshing sounds that occurs with turbulent blood flow in the heart or great vessels that can be heard, posture can affect it where leaning over can accentuate it
defined by loudness, location, and how frequent

61
Q

Grade 1 Murmur

A

barely audible where it can only be heard in a dead silent room and stethoscope

62
Q

Grade 2 Murmur

A

audible in any room but is very faint

63
Q

Grade 3 Murmur

A

moderately loud with the stethoscope and easy to hear

64
Q

Grade 4 Murmur

A

loud and associated with thrill palpable in the chest wall

65
Q

Grade 5 Murmur

A

very loud, heard with the stethoscope having one side off the chest wall that is associated with a thrill

66
Q

Grade 6 Murmur

A

this heart is a death metal concert, don’t even need the stethoscope close to the wall of the chest

67
Q

Innocent Murmur

A

no valvular or probable cause, that’s typically only a grade 2 no thrill soft sounds mid-systolic, short, crescendo-decrescendo
typically goes away with posture correction

68
Q

Functional Murmur

A

due to the increase of blood flow in the heart with multiple presentations

69
Q

Defibrilation

A

terminating ventricular and pulseless VT by giving a jumper start t the heart with a DC shock throughout the heart that allows it to depolarize and have CPR to get mechanical flow to instigate the repolarization process

70
Q

Synchronized Cardioversion

A

therapy for hemodynamically unstable ventricular and supraventricular tachydysrhythmias, counter shock placed on the R wave while being sedated

71
Q

Implantable Cardioverter Defrubillator

A

sustained SCD, spontaneous sustained VT, syncope with includible VT or fibrillation during EPS and a high risk for future life threatening dysrhythmias
lead system SUBQ that shocks the heart back into normal rhythm

72
Q

Pacemaker

A

set to change the heart rhythm by placing leads on the myocardium for stimulating regular contractions with an internal power conductor

73
Q

Radiofrequency Ablation Therapy

A

low voltage high frequency shock to the heart to stim contractions

74
Q

The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a client with acute pericarditis. Which of the following actions is best for the nurse to implement?

  1. Force fluids to 3 000 mL/day to decrease fever and inflammation.
  2. Teach about deep, slow respirations to control the pain.
  3. Remind the client to ask for the opioid pain medication every 4 hours.
  4. Position the client in Fowler’s position, leaning forward on the overbed table.
A
  1. Position the client in Fowler’s position, leaning forward on the overbed table.
75
Q

Cardiac tamponade is suspected in a client who has acute pericarditis. Which of the following actions should the nurse implement to assess for the presence of pulsus paradoxus?

  1. Check the electrocardiogram (ECG) for variations in rate in relation to inspiration and expiration.
  2. Note when Korotkoff sounds are audible during both inspiration and expiration.
  3. Auscultate for a pericardial friction rub that increases in volume during inspiration.
  4. Subtract the diastolic blood pressure (DBP) from the systolic blood pressure (SBP)
A

2.Note when Korotkoff sounds are audible during both inspiration and expiration.

76
Q

Which of the following techniques should the nurse use to assess the client with pericarditis for the presence of a pericardial friction rub?

  1. Auscultate with the stethoscope diaphragm at the lower left sternal border.
  2. Listen for a rumbling, low-pitched, systolic sound over the left anterior chest.
  3. Feel the precordial area with the palm of the hand to detect vibration with cardiac contraction.
  4. Ask the client to stop breathing during auscultation to distinguish the sound from a pleural friction rub.
A
  1. Auscultate with the stethoscope diaphragm at the lower left sternal border.
77
Q

The nurse is admitting a client with possible acute pericarditis. Which of the following diagnostic assessments should the nurse plan to teach the client about?

  1. Electrolyte levels
  2. Echocardiography
  3. Daily blood cultures
  4. Cardiac catheterization
A
  1. Echocardiography
78
Q

The nurse is planning care for a client hospitalized with streptococcal infective endocarditis (IE). Which of the following interventions should the nurse include?

  1. Monitor laboratories for streptococcal antibodies.
  2. Arrange for insertion of a long-term IV catheter.
  3. Encourage the client to get regular aerobic exercise.
  4. Teach the importance of completing all oral antibiotics.
A
  1. Arrange for insertion of a long-term IV catheter.
79
Q

The nurse identifies the nursing diagnosis of decreased cardiac output related to valvular insufficiency for the client with infective endocarditis (IE). Which of the following findings support this diagnosis?

  1. Fever, chills, and diaphoresis
  2. Urine output less than 30 mL/hour
  3. Petechiae of the buccal mucosa and conjunctiva
  4. Increase in pulse rate of 15 beats/minute with activity
A
  1. Urine output less than 30 mL/hour
80
Q

The nurse is assessing a client with infective endocarditis (IE). Which of the following findings should the nurse expect to assess?

  1. A new regurgitant murmur
  2. A pruritic rash on the trunk
  3. Involuntary muscle movement
  4. Substernal chest pain and pressure
A
  1. A new regurgitant murmur
81
Q

The nurse is obtaining a health history from a client with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which of the following questions by the nurse is best?
“Have you been to the dentist lately?”
“Do you have a history of a heart attack?”
“Is there a family history of endocarditis?”
“Have you had any recent immunizations?”

A

“Have you been to the dentist lately?”

NURS 3000 (11 decks)

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