Cardio - valves, infection, surgery Flashcards
(146 cards)
1
Q
myocarditis - also called - AND are men or women most at risk? (mei likes men)
A
Inflammatory cardiomyopathy, men most at risk.
2
Q
myocarditis - what is the most frequent virus that causes it? (Mei has herpes) - what symptoms will you have?
A
most frequent virus. toxins also can cause it. if virus causes it, then you’ll have a fever.
3
Q
most common cause of dilated cardiomyopathy/myocarditis (mei has covid)
(mei and brad appeared after Lupe had a transplant)
A
Lupus (SLE), hypersensitivity reactions, transplant rejection
COVID 19 and other viruses including influenza
4
Q
S & S of cardiomyopathy/myocarditis (mei has symptoms in her PECCS)
A
Palpitations, SOB, chest pain, edema, CHF.
5
Q
treatment of cardiomyopathy/myocarditis (Mei can sometimes solve her own problems)
A
Identify and treat cause, manage symptoms. sometimes resolves on its own. Can even do heart transplant if it’s bad.
6
Q
nursing care cardiomyopathy - how to assess it, and assess for what? (monitor brad)
A
Cardiac monitor, assess for CHF
7
Q
myocarditis patho (mei has direct damage, then secondary)
A
myocardium is damaged directly, then immune response causes secondary damage. usually entire myocaridum is affected.
8
Q
myocarditis - what labs are used to diagnose it?
A
check inflammatory stuff - c-reactive protein, BNP, proteins, troponins
9
Q
myocarditis complications (Mei is an athlete)
A
cardiomyopathy and dsyrrhymias that lead to death (usually the cause in young athletes)
10
Q
myocarditis - should be on constant (my telemetry)
A
telemetry
11
Q
myocarditis - lung assessement (the usual)
A
check for crackles and edema. jugular vein distention, weight gain, urine output. kidney function.
12
Q
myocarditis - activities?
A
restrict activities
13
Q
endocarditis
A
Inflammation/infection of the inside of the heart (inner most layer)
14
Q
endocarditis - patho (Tjan has veggies and leaves)
A
Infection forms vegetations/thrombi inside the heart that break off from the valve leaflet; emboli disseminate
15
Q
endocarditis - Destruction of valves, walls, chordae tendinae cause (Tjan loses his vents in Co)
A
loss of function and impaired ventricular filling (decreased CO)
16
Q
endocarditis - Back up of blood causes
A
lung congestion
17
Q
endocarditis - causes (think of the case study) (rheumy causes the end)
A
age,
Rheumatic heart disease, history of previous endocarditis
Prosthetic valve
IVDU
Contaminated invasive devices
Hemodialysis
Immunosuppression
Dental caries or gum disease
18
Q
endocarditis - IV drug users usually have what side heart failure?
A
right-sided
19
Q
endocarditis risk factors
A
hemodialysis, anyone with tons of IVs, biopsies
20
Q
endocarditis patho (Tjan is turbulent)
A
turbulent blood flow usually affects heart valves, platelets and fibrin deposit on injury, the vegetations form and cause more damage.
21
Q
endocarditis - clinical manifestions - what about a murmur? (think case study)
A
red pads of fingers and toes, painless spots on soles of feet (janyway) splinters under nails (blood clots) usually a new heart murmur, and HF, night sweats, weight loss. fever, confusion.
22
Q
endocarditis - how to diagnose (tjan gets 2 blood tests and an ECG)
A
blood tests from 2 different sites. echo cardiogram, CBC
23
Q
endocarditis treatment
A
IV antibiotics, usually 4 - 6 weeks or longer. repeat blood cultures until they test negative.
24
Q
endocarditis - nursing care - monitor for what?
A
Monitor for organ failure, emboli (vegetatian breaks off 50% of the time), serial blood cultures, progressive exercise, education and rehabilitation
25
endocarditis - assessment (lungs, heart, etc) (tjan gets the same assessment)
check for crackles and edema. jugular vein distention, weight gain, urine output, decreased cap refill
26
pericarditis - acute or chronic?
can be acute or chronic.
27
causes of chronic pericarditis (C. Perry has uremia, TB, radiation, trauma and cancer)
TB, radiation exposure, trauma, uremia, metastatic cancer
28
causes of acute pericarditis (C. cute Perry also has TB, radiation, trauma and cancer)
trauma, viral infections (flu), uremia, post cardiac surgery, MI, raditation, neoplasms (tumors),
29
pericarditis - most common symptom (Peri is mostly causing me pain bc he rubs me the wrong way)
90% pleuritic chest pain. also will hear classic friction rub with pericarditis.
30
how to tell when pleuritic chest pain is an MI or pericarditis? (Peri feels better when he sits up)
with pericarditis, pain will be relieved with patient sits up (fowlers)
31
how to diagnose pericarditis (peri's diagonosis is elevated) (the usual)
echo, ECG, chest xray, EKG - st elevation most common
32
pericarditis - lung exam? (Peri surprisingly has clear lungs) nothing is backing up in the lungs - think
lungs will be clear
33
pericarditisis treatment (peri's treatment depends on the cause)
Depends on cause
34
pericarditisis complications (peri can be complicated and effusive)
effusion
35
pericarditis - monitor ECG for what?
Assess & monitor VS, RRED, WBC, cardiac rhythm & ST segment for elevation
36
pericarditis - heart sounds (peri is muffled)
muffled from fluid
37
cardiac tamponade (tampon for peri)
blood or fluid have leaked into pericardial sac.
38
causes of cardiac tamponade (micro peri is the cause of tampons)
MVA (microvascular angina?), RV biopsy, pericarditis
39
cardiac tamponade - cardiac output and what about pressure? (the tampons are low in Co, but the pressure has increased)
decreased CO, increased CVP (central venous pressure)
40
nursing considerations for cardiac tamponade - drainage? and check what? (check tampon for drainage with jugular)
monitor mediastinal CT drain (if chest was cracked open to remove fluid in peri). drainage should gradually get less. check JVD w/ normal lung sounds.
41
Obstructive Shock - what direction of blood flow is obstructed? (There's an obstruction going forward)
Decreased outflow of blood from the heart or great vessels = low or no cardiac output
NO FORWARD FLOW OF BLOOD
42
Obstructive Shock treatment
relieve obstruction or pt will die
43
causes of obstructive shock (shocked by the TPP)
PE, tension pneumothorax, pericardial tamponade
44
Obstructive Shock - signs (I'm shocked you have no pulse)
decreased bp, pulsus paradoxus (bp decreases with inhalation), narrowing pulse pressure
45
cardiac surgery - invasive or no?
minimally invasive
46
complications of cardiac surgery - preload and afterload? Co?
ineffective CO, reduced preload, increased afterload, increased preload
47
complications of cardiac surgery - is angina normal? Peri? (surgery on gyna is not normal)
infection, pain management (sternotomy hurts), angina (this is a bad sign), neurological dysfunction, pericardial tamponade
48
nursing assessment - cardiac surgery - BP issues?
Hypotension
Hypertension
Bleeding
49
cardiac valve disease - more in men or women? (the valves have equal rights)
equal in men and women.
50
valve disease causes (val is caused by the CCIR cure)
infection, rheumatic fever caused by strep, congential, calcific atherosclerosis.
51
valve disease types
stenosis
prolapse
52
valve disease - most common (art is popular valve)
aortic stenosis. least is tricuspid and pulmonic valve (right side less pressure)
53
first sign of valve disease (val has a murmur)
murmur
54
valve disease s & s - breathing?
SOB, dyspnea, orthopnea
55
causes of cardiac valve dysfunction (valves can stop working inside, outside, or it's mechanical)
inside - heart muscle valves
outside - pericardium
mechanical - faulty valves
56
valves most likely to be stenotic (2 of them)
aortic and mitral
57
valves most likely for regurgitation (just one)
mitral
58
cardiac valve - signs of right-sided HF - liver signs?
the tricuspid, and you'll get signs of right sided heart failure. (Edema of abdomen, feet and ankles
Fatigue
Weakness
Decreased u/o
Jaundice
Ascites)
59
cardiac valve - if it's the left side, it will be (and what about murmur)
pulmonic (signs and symptoms S & S
SOB, cyanosis
Poor weight gain in babies
Syncope
Murmur
Chest pain
Fatigue)
60
cardiac valve - mitral symptoms (mite you be tachy and tired, you SOB) and esp what?
signs of left ventricular - SOB, especially orthopnea, dyspnea after exercise, coughing
CP, palpitations, tachycardia
Extreme fatigue
61
cardiac valve - Regurgitation - will happen fast or slow?
will happen slowly
62
mitral stenosis - causes (mite you be old with a fever)
aging, rheumatic fever, things get stiff
63
regurgitation - who gets it and what is the main cause? (men regurgitate bs)
men 30 - 60
64
stenosis main cause (calcium makes stan stiff)
calcification main cause
65
Transcatheter Aortic Valve Replacement (TAVR) - invasive or not? (trans is minimal)
minimally invasive, highly successful.
66
heart valve - non surgical - goals (goal for the valve is go to Co, stay steady, and take meds)
Maintain cardiac output
Treat arrhythmias
Prophylactic antibiotic therapy
67
heart valve - surgical (balloon for my valve)
Repair
Balloon valvuloplasty
Commisurotomy
Reconstruction
Replace`
Synthetic
Biologic
68
valve surgery - pre op care - (val is progressive)
Maintain cardiac output
Treat arrhythmias
FEN
Pulmonary function
Renal function*****
Pain anxiety management
Wound care
CT care
Monitored progressive activity
Self care education
SOB
daily weights
69
cardiomyopathy (myo is large)
heart muscle is enlarged and thick.
70
types of cardiomyopathy
Dilated:
Hypertrophic:
Restrictive:
71
cardiomyopathy - causes (Brad door)
Idiopathic, HTN, viral infections, post MI, thyroid disease
72
cardiomyopathy - cure?
none, just heart transplant, pacemaker
73
endocarditis - what type of bacteria usually?
due to bacteria - usually strep and staph. if you get it once, you're likely to get it again.
74
chronic pericarditis causes what to happen? (C, peri is getting stiff in his old age)
The chronic (constrictive) inflammation causes pericardial thickening, leading to stiffness.
75
acute pericarditis becomes what? (A cute peri becomes a tampon)
The acute condition leads to cardiac tamponade with pulseless electrical activity (PEA)
76
chronic pericarditis - what age is common? And mortality? (c, peri is young and lives forever)
more in young and middle aged ppl. high reoccurance rate. mortality is really low, like 1%.
77
acute pericarditis - causes - how long after surgery is the critical time? (a cute peri - 2 weeks was the morning)
10-14 days post op
78
endocarditis may lead to (In the end, Tjan was SSHD)
May lead to TIA’s (transischemic heart attack), CVA (stroke), shock, death
79
endocarditis - Rapid recognition and response (emergency tjan needs an ECG and o2)
VS, ECG monitor for dysrhythmias
Assess for symptoms of heart failure
Maintain gas exchange
Breath sounds, RRED, oxygen therapy to maintain saturation
80
endocarditis monitor labs (tjan in the lab shifts left with the bun)
Monitor labs
WBC shift left, anemia
BUN/Cr (long term ABX)
81
endocarditis - meds? (Tjan get meds in Hawaii for 4-6 weeks)
evaluate FEN status
Assess & maintain vascular access
CVC (central venous catheter)
ABX (antibiotics) 4-6 weeks on schedule with peak/trough
82
endocarditis - symptom management (tjan door)
HA (headache?), fever, anorexia, nausea, position of comfort, modify activity
83
endocarditis symptoms - feels like...(tjan and Jim hansen)
Vague flu like to heart failure with conduction defects
84
endocarditis treatment
IV antiobotics
85
percariditis patho (peri has white plates with fiber and fluid)
Collection of WBCs, platelets, fibrin and fluid (pericardial effusion) builds up in pericardial sac which restricts filling.
Fibrotic changes restrict filling and therefore decrease CO
86
cardiomyopathy assessment findings - left side (brad is not on the pulse anymore, he's 3rd or 4th)
Manifestations of decreased CO
Left sided HF symptoms – activity intolerance, weakness, narrow pulse pressure, decreased peripheral pulse strength, pre/syncope, angina, dyspnea, orthopnea, pulmonary congestion, dysrhythmias (PVCs, VT), murmurs, S3 & S4
87
cardiomyopathy treatment (think, can thickness be fixed?)
No cure, treat underlying cause
Treatment palliative (symptom management) or surgical (heart transplant, muscle resection, valve replacement)
Manage heart failure
Maximize CO, maintain gas exchange, modify activity to tolerance
medications
88
pericarditis - can cause tamponade? And what are the symptoms?
Observe for signs of pericardial tamponade (increase pressure, decreased filling, decreased CO)
89
pericarditis - JVD? And what are the heart sounds? (Peri's jugular)
Distant heart sounds, JVD
90
pericarditis - patient position? (Peri in pain leans forward)
Assess and manage pain
Patient position (Fowler’s forward leaning or side lying
Analgesic, anti inflammatory
91
valve disease - stenosis - (stenosis goes backwards)
chamber pressure increase causing backward effect
92
valve disease - prolapse
falls in on itself
93
symptoms of regurgitation - what is the big one? (men bathroom)
Palpitations, CP
Tachypnea, SOB, coughing
Fatigue is the big one
94
mitral stenosis - breathing and edema? (mite you need help exercising with your edema)
Orthopnea or trouble breathing after exercise
Pulmonary edema
Exertional CP, palpitations
Peripheral edema
95
stenosis s & s (stiff stan can't exercise)
Exercise intolerance
Syncope
Angina
96
cardiomyopathy - dilated (impairs what?)
Thick/enlarged ventricular walls
Dilation of chambers
Impairs systolic function (pumping)
97
cardiomyopathy - hypertrophic - is filling or ejecting affected?
Hypertrophic:
Ventricles enlarge and ventricular cavities reduce in size therefore filling is decreased
98
cardiomyopathy - restrictive (brad restricts amy after radiation)
d/t amyloidosis, XRT (radiation therapy)
Ventricles become rigid and fibrotic and filling is reduced
99
cardiomyopathy - causes (can't do cardio with brad if...)
diabetes, peripartum, alcoholism, anabolic steroid use
100
cardiomyopathy - causes (Brad bald plant)
chemotherapy, XRTe (radiation), connective tissue disorders
101
endocarditis - symptoms (Tjan has back pain)
back pain, and sometimes include symptoms from other organ systems depending on spread
102
endocarditis - symptoms (Tjan on junk)
Anorexia, weight loss, fever, chills, night sweats
103
endocarditis - murmur?
new murmur
104
endocarditis can develop into (think case study - just 2 - worst case scenario)
HF development, systemic embolization
105
endocarditis - late symptom (Oster is late to meet TJan)
Oster nodes (late)
106
endocarditis - early symptom (Jane comes first)
Janeways lesions (early)
107
endocarditis - spleen? (large spleen for 6 weeks)
> 6 weeks splenomegaly
108
endocarditis - nails? (tjan clubs)
clubbing
109
how to diagnose endocarditis?
Diagnosed with blood cultures, echocardiogram
110
cardiomyopathy/myocarditis - (mei and brad are new)
new onset of arrhythmias or dysrthyrmias
111
cardiomyopathy - right side - symptoms (Brad hall)
JVD, peripheral edema, atrial dysrhythmias (AF, PACs),
112
medications for cardiomyopathy (Brad gets the same meds)
ACE inhibitors, afterload reducers, inotropes, calcium channel blockers, beta blockers, diuretics
113
pericarditis - HR and pulse
increased HR with hypotension, decreased pulse amplitude/strength
114
pericarditis - mental status? (Peri is out of it)
change in LOC and AMS (altered mental status)
115
valve disease - insufficiency/regurgitation
cusps no longer close completely, chamber pressure and filling is impaired
116
heart rhythm with regurgitation (Gab regurgitates)
aFib
117
mitral stenosis - cough?
dry cough
118
mitral stenosis (mite you have a hoarse, wet voice?)
Hoarse, wet sounding voice,
Fatigue
119
cardiomyopathy - right side - symptoms (what organs)
hepatomegaly, splenomegaly, abdominal distension, anorexia, nausea
120
cardiomyopathy - right side - bradycardia?
Bradycardia in restrictive due to heart blocks, conduction dysfunction
121
cardiomyopathy - right side - symptoms (pee RIGHT away at night)
orthopnea, PND, nocturia
122
devices for cardiomyopathy
Biventricular pacemaker
ICD
123
cardiac tamponade - shock (tampons cause shock)
pressure in all 4 chambers will be the same and will end up in shock, narrowed pulse pressure.
124
(3 lead) white on right
smoke over fire
125
(5 lead) chocolate over my heart
green goes last
126
pericarditis - blood tests (peri is tropin)
troponins, CBC (high white count) C-reactive
127
obstructive shock - signs
tachycardia tachypnea, pale cool clammy skin, decreased SpO2.
128
what tests to diagnose miocarditis? (only an echo can find mei)
ECG, usually always an echo to check the valves.
129
cardiac surgery - assessment - is surgery cold?
FEN imbalances
Hypothermia
130
cardiac surgery - assessment - what about kidneys? Wounds?
Renal dysfunction/ARF
Impaired wound healing
131
cardiac surgery assessment - GI?
GI dysfunction
Stress ulcer
Paralytic ileus
N, V
Nutritional deficits
132
cardiac tamponade - what happens with BP? (the tampon dropped my inspiration)
systolic will drop during inspiration
133
cardiac tamponade - heart sounds? (the tampon muffled me)
heart sounds muffled, distented neck veins
134
can cardiac surgery cause dysrhhthmias and pulmonary problems?
yes, dysrhtymia, pulmonary dysfuction
135
peri treatment if tamponade occurs?
Pericardiocentesis if tamponade
136
peri treatment if there is chronic fluid?
Surgical pericardectomy is indicated for chronic fluid accumulation (pericardial window)
137
peri - pain treatment?
treat pain - NSAIDs, steroids, antibiotics
138
valve disease - S & S - (Val at the door)
angina, syncope, weight gain
139
valve disease - signs and symptoms (Val TV)
edema, pale cool extremities.
140
cause of cardiac tamponade - (this surgery caused a tampon)
post operative hemmorhage in CABG (coronary artery bipass). post op.
141
cause of cardiac tamponade (tampon trauma)
air bags. chest trauma.
142
what is cardiac tamponade?
fluid builds up in the space between the heart muscle and the outer covering sac (pericardium) of the heart.
143
cardiomyopathy - can you get up and walk around? And what meds? (Brad needs bedrest and DVT meds)
BR (bed rest), no straining, DVT prophylaxis, progressive recovery, education
144
acute pericarditis - causes (a cute peri door)
MI, autoimmune (lupus, arthritis), rheumatic fever, hypothyrodism
145
regurgitiation - main cause (The cause is always the same)
main cause is diastolic HTN
146
endocarditis - lung symptoms (just cough basically)
pleuritic CP, cough
