complex care exam 2

Question 1

if the tricuspid valve is infected, what should you look for? right side

Answer 1

symptoms similar to a pulmonary embolism

Question 2

mitral valve infected, what could happen left side

Answer 2

something could break off and go to the brain, spleen, kidneys, brain, and extremities

Question 3

duration of antibiotics

Answer 3

4-8 weeks

Question 4

what bloodwork will you get for aminoglycosides

Answer 4

creatinine, BUN, peak and through, b/c they can be nephrotoxic and ototoxic

Question 5

what is the most vulnerable time for embolic events?

Answer 5

2-4 weeks after initiation of therapy

Question 6

when is S3?

Answer 6

early diastole – the blood is hitting a stiff or non-compliant ventricle

Question 7

what are s/s of Pulmonary embolism

Answer 7

chest pain, SOB, feeling of doom, death

Question 8

tx for endocarditis

Answer 8

central line, 4-8 weeks of IV antibiotics based on blood cultures, monitor Cr, BUN, blood cultures

Question 9

what does refractory heart failure mean?

Answer 9

we have tx the heart failure to the best of our knowledge but you still have HF

Question 10

home teaching for infective endocarditis

Answer 10

brush your teeth, antibiotic stewardship (prophylaxis if you have had infective endocardidits), floss, s/s of stroke, PE, etc, weekly PIC line dressing changes and looking for infection

Question 11

what is pericarditis?

Answer 11

decrease in cardiac output because there is inflammation in the enclosed space
s/s: a friction rub (at the apical site)

Question 12

cardiac tamponade what will you find?

Answer 12

• tachycardia
• hypotension
• narrow pulse pressure
• tachypnea
• JVD b/c the blood of the jugular cannot get into the heart
• muffled heart tones

Question 13

is acute pericarditis often bacterial or viral?

Answer 13

most often idiopathic with a viral cause
–> means our treatment will be supportive

Question 14

what is pulsus paradoxus?

Answer 14

an inspiratory drop in systolic BP by greater than 10mm Hg

Question 15

what is the number one biggest concern in pericarditis?

Answer 15

cardiac tamponade

Question 16

when does it become cardiac tamponade?

Answer 16

narrowing pulse pressure, hypotension, tachycardia

Question 17

when the heart is filling (DIASTOLE), which valves are open?

Answer 17

mitral & tricuspid are OPEN
aortic & pulmonic are CLOSED

Question 18

what are the clinical manifestations of mitral valve regurgitation/prolapse?

Answer 18

systolic murmur

Question 19

what are clinical manifestations of mitral valve stenosis?

Answer 19

diastolic murmur

Question 20

Aortic Valve stenosis – where will the problem be?

Answer 20

during systole when the blood is pushing out
(resistance during systole)
– (the aortic valve is closed during diastole)

Question 21

when you have aortic valve stenosis –> what is protective and what does the ventricle do?

Answer 21

• the mitral valve is protective, (protecting the pulmonary bed from systolic overloading and from aortic stenosis and regurgitation)
• the right ventricle gets bigger in order to push the blood through the stenosed valve

Question 22

aortic stenosis clinical manifestation

Answer 22

systolic murmur
narrow blood pressure

Question 23

aortic regurgitation manifestation

Answer 23

• the murmur that is produced is from the blood going from the aorta back to the ventricle
• wide pulse pressure (systolic normal, diastolic low)d