Ch 36 Valve Disorders (Exam 2)

Question 1

Stenosis (2)

Answer 1

• constriction or narrowing of the valve opening

- results from rheumatic heart disease

Question 2

S/S of aortic stenosis (3)

Answer 2

• exertional dyspnea main s/s
• loud first heart sound and a low-pitched murmur
• hoarseness/hemoptysis (enlarged LA and pushes against vocal cords)

Question 3

Regurgitation

Answer 3

incomplete closure of the valve leaflets, resulting in the backward flow of blood

Question 4

What part of the heart regulates movement of mitral leaflets?

Answer 4

Chordae tendineae

Question 5

Regurgitation results from?

Answer 5

• ischemic papillary muscle dysfunction

- infective endocarditis (d/t vegetation)

Question 6

S/S of aortic regurgitation (4)

Answer 6

• thready peripheral pulses
• cool, clammy extremities
• new systolic murmur
• pulmonary edema: crackles on auscultation, SOB, low O2 sat

Question 7

What is infective endocarditis? Cause of IE?

Answer 7

• infection of the endocardial surface of the heart that affects the heart valves
• staphyloccocus aureus

Question 8

3 stages of infective endocarditis?

Answer 8

1. bacteremia
2. adhesion
3. vegetation

Question 9

What is vegetation?

Answer 9

adheres to the valve surface of the endocardium and can embolize to various organs and extremities, causing ischemia and infarction

Question 10

Clinical manifestations of infective endocarditis? (3)

Answer 10

• hemorrhages and petechiae (formation of lesions on toes and fingers)
• Roth spots: bleeding spots on the eyes
• Osler’s: painful, small spots on tips of fingers/toes
• Janeway’s: not painful

Question 11

Dx studies for infective endocarditis? (4)

Answer 11

• patient history: past dental procedures, OB/GYN procedures
• echocardiograms: vegetations
• (+) blood cultures
• elevated WBC

Question 12

Prophylactic treatment for infective endocarditis?

Answer 12

antibiotics given at the dentist to reduce risk of infective endocarditis

Question 13

Surgical intervention for infective endocarditis?

Answer 13

early valve replacement followed by prolonged (6 weeks or longer) drug therapy for patients with a fungal infection

Question 14

Nursing considerations for infective endocarditis (2)

Answer 14

• recognize s/s of complications of infective endocarditis (stroke, pulmonary edema, HF)
• fever (early sign that drug therapy is ineffective)

Question 15

2 types of valve replacement

Answer 15

mechanical (artificial) and biologic (tissue)

Question 16

Mechanical valve replacement

Answer 16

more durable, lasts longer, risk for thromboembolism, requires long-term anticoagulation

Question 17

Biologic valve replacement (3)

Answer 17

• bovine, porcine, and human
• no anticoagulation required
• less durable

Question 18

Cause of rheumatic fever

Answer 18

2-3 weeks post-streptococcal pharyngitis (unresolved strep throat)

Question 19

Major criteria manifestations of rheumatic fever (4)

Answer 19

• carditis: murmurs of the mitral or aortic regurgitation (mitral stenosis)
• monoarthritis or polyarthritis
• Sydenham’s chorea
• erythema marginatum lesions

Question 20

Minor criteria manifestations of rheumatic fever (3)

Answer 20

• fever
• polyarthalgia
• lab findings of increased erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)

Question 21

Treatment goal of rheumatic fever (5)

Answer 21

• control and treat infection w antibiotics
• relieve joint pain
• treat fever with antipyretics
• rest
• steroids

Question 22

Treat pharyngitis with ______

Answer 22

antibiotics (penicillin), requires strict adherence to full course of antibiotic therapy to avoid recurrence

Question 23

What is pericarditis? Causes of pericarditis? 2 syndromes of pericarditis are?

Answer 23

• inflammation of the pericardium sac with fluid accumulation
• idiopathic or caused by viral/bacterial infection (tuberculosis)
• acute pericarditis and Dressler syndrome

Question 24

What is acute pericarditis vs Dressler syndrome?

Answer 24

• acute pericarditis: first 48-72 hours after an MI

- Dressler syndrome: 4-6 weeks after an MI

Question 25

Clinical manifestations of pericarditis? (3)

Answer 25

• progressive and severe, sharp chest pain @ the shoulder and upper back, worse with deep inspiration and when lying supine
• pain is relieved by sitting up and leaning forward
• hallmark finding: pericardiac friction rub

Question 26

Management for pericarditis (3)

Answer 26

• focus on pain and anxiety
• HOB elevated at 45 degrees, overbed table for support
• anti-inflammatory drugs

Question 27

Cardiac tamponade (2)

Answer 27

• a complication associated with pericarditis

- treatment: pericardiocentesis (pericardial window)

Question 28

Post cardiac cath lab assessment (7)

Answer 28

• assess baseline: vitals, pulse ox, heart/lung sounds
• neurovascular assessment: peripheral pulses, color
• observe insertion site for hematoma/bleeding q15 mins for first hr
• monitor ECG for dysrhythmias
• monitor chest pain
• maintain IV and oral fluid intake and urine output
• teaching: s/s to report (chest pain), activity restrictions

Question 29

Interventions for nursing dx: decreased activity intolerance (2)

Answer 29

• monitor response to cardiac medications

- encourage activity and rest periods to avoid fatigue and increase activity tolerance

Question 30

Interventions for nursing dx: knowledge deficit (4)

Answer 30

• medication teaching to promote compliance
• cardiac risk modifications (smoking cessation, diet, exercise) to increase control of illness
• self-care of pain (nitroglycerin use)
• exercise regimen (endurance)