Endocarditis & Iron deficiency Anemia Flashcards by brooke posey

an inflammation of the endocardium (inner lining of the heart) from a pathogen that has damaged endocardial tissue

endocarditis

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What are the types of inflammatory diseases of the heart?

 Infective Endocarditis (endocardium)
 Rheumatic Endocarditis
◦A unique form of Infective Endocarditis
 Myocarditis (myocardium)
 Pericarditis (pericardium)

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How can infective endocarditis be classified?

as an acute or subacute infection

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How is acute infective endocarditis caused? Which organism is involved?

Caused by a new infection

* Organism - frequently staphylococci

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How is subacute infective endocarditis caused? Which organism is involved?

Occurs in an already defective heart valve

* Organism – often streptococci or E.coli

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What is infective endocarditis?

 Microbial infection of the endocardium

 Deformity or injury of endocardium

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What can occur as a result of infective endocarditis?

 Results in clot formation on endocardium

 Infective organisms invade clot &; form lesion

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What do the lesions (vegatations) form and become as a result of the infective organisms invading and forming a clot?

thromboemboli

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What are some examples of infective organisms?: (usually bacteria)

◦ Staphylococci, Enterococci or Pneumococci, Streptococci
◦ E.coli
◦ Rickettsia
◦ Fungi – Candida, Aspergillus
◦ Chlamydiae

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What can cause the progression of infective endocarditis?

◦ Tears in endocardium
◦ Deformities of valve leaflets
◦ Dehiscence of prosthetic valves
◦ Deformity of the chordae tendineae
◦ Abscesses

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What do the signs & symptoms of endocarditis develop due to?

 Toxic effect of the infection
 Destruction of the heart valves
 Embolization of fragments of vegetative growths

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What are the signs & symptoms of endocarditis?

*fever and new heart murmur 
 Petechiae- skin small pinpoint hemorrhages
 Splinter hemorrhages of nails
◦ Black lines or red streaks on nails
 Roth Spots
 Janeway Lesions
 Osler’s Nodes

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What are roth spots?

◦ White spots seen on retina

◦ Round or oval

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What are janeway lesions?

◦ Painless, hemorrhagic lesions

◦ Palms, soles, nose, ear

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what are osler’s nodes?

◦ Small painful nodules
◦ Tender, red lesions, white centers
◦ On fingers & toes

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What are the risk factors for endocarditis?

 Frequent introduction of pathogens
 Valvular heart disease-Valve replacement or repair
 IV drug abuse
 Indwelling IV catheters-esp if IV tip lies near heart
 Recent dental work
 Compromised immune system
 Previous endocarditis
 Recent body piercing or tatooing

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What are the labs and diagnostics done for endocarditis?

 Inflammatory process:
 Echocardiogram
 Kidney damage
◦ Anemia - low hemoglobin
 Infection:
◦ Positive blood culture-definitive diagnosis
◦ ASO Titer (Antistreptplysion O titer)
 Blood test to measure antibodies produced by
the groups A-Streptococcus bacteria
 A-strep can cause Bacterial Endocarditis

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The inflammatory process involves what labs?

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◦ WBC count, ESR are elevated

What does the endocardiogram lab test for?

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◦ Identify diseased valves
◦ Vegetations-lesions on valves
◦ Ventricular hypertrophy
◦ Heart failure

What are the interventions for endocarditis?

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 Prevention = best plan
 AHA guidelines for high-risk patient
◦ Prophylactic antibiotics before invasive
procedures
◦ Such as-invasive dental, GI &amp; GU procedure
 Strict aseptic technique
◦ Health care procedures
◦ Invasive lines
◦ Invasive procedures
 Proper hand washing Long-term IV antibiotics
◦ May need long-term IV catheter
◦ Central line or PICC
Monitor labs
◦ Monitor therapeutic antibiotic levels
◦ Effectiveness of medication (temp, WBC)
Discharge referrals –follow up care
Patient education
◦ Home with IV therapy
◦ Home anticoagulant therapy
Monitor for worsening of condition
Monitor for emboli

What are the surgical interventions for endocarditis?

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Defective valves:
 Surgical debridement
 Surgical repair
 Value replacement
◦ Damaged valve replaced with mechanical
(prosthetic) or biological valve (bovine,
porcine, cadaver)
*Valvuloplasty
*Annuloplasty
*Chordoplasty

What is valvuloplasty?

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 Balloon-tipped catheter inserted via peripheral
vessel into heart
 Balloon inflated in valve to increase valve diameter
 Then balloon removed

What is an annuloplasty?

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 Sternal incision made remove stenotic tissue at valve
 “O” ring is placed in valve leaflets
 Prevents regurgitation

What is chordoplasty?

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 Surgical repair made-shapes chordate tendinease

to prevent regurgitation

What is the goal of care for endocarditis?

 Endocarditis can be prevented ◦ Goal of initial treatment is avoiding the infection  Goal of care- if the patient does develop endocarditis: ◦ Curing the infection ◦ NO residual damage to heart or valves

What are the priority nursing diagnosis for endocarditis?

 Activity intolerance  Cardiac Output, Decreased  Tissue Perfusion, Decreased  Knowledge Deficit

 Blood loss due to bleeding disorders  Acute / chronic blood loss ◦ Surgical, traumatic ◦ GI bleed

anemia

What is hypoproliferative anemia?

◦Decreased or defective production of RBCs

What are the signs & symptoms of anemia?

``` Affected by the following issues  Based on the severity  Speed at which it developed  Metabolic needs of the patient  Presence of other problems ```

```  Most common type of anemia  Causes: either due to ◦ Blood loss ◦ Hypoproliferative: caused by Decreased RBC Defective RBC ```

Iron deficiency anemia

What are the signs & symptoms for iron deficiency anemia?

``` Primary S & S  Weakness  Fatigue  Pallor  Pica – patients craving ice, starch, dirt ```

What are the signs & symptoms for prolonged iron deficiency?

* Tongue soreness * Brittle and ridged nails * Ulceration in corner of mouth

Physiologic Compensation for IDA | Results in these S & S:

```  Tachycardia  Palpitations  Dyspnea  Dizziness  Development of heart failure ```

What are the risk for IDA (iron deficiency)?

 Blood loss  Dietary deficiency  Inability to absorb iron  Pregnancy

What are the labs and diagnostics for iron deficiency anemia? Are the labs increased or decreased with this disease?

 Ferritin levels (decreased)  Hemoglobin levels (decreased)  Serum iron levels (decreased)  Total Iron Binding Capacity = TIBC (decreased)  Hematocrit (decreased)  RBC count (decreased)  Mean Corpuscular Volume (MCV) (decreased)

What are the nursing diagnosis for iron deficiency anemia?

``` Fatigue R/T :  Decreased oxygen carrying ability of blood ( Hgb) Altered nutrition:  Less than body requirements of iron Altered tissue perfusion R/T:   blood volume & H&H Noncompliance with prescribed therapy ```

What are the nursing interventions for iron deficiency anemia?

``` Prioritize activities ◦ Balance activity and rest – block care Healthy diet ◦ Limit alcohol ◦ Dietary supplements ◦ Risks for iron overload Monitor VS ◦ Pulse oximetry ◦ BP Promote medication compliance Monitor for & manage heart failure Patient education ```

What types of foods are recommended, that are high in iron, for iron deficiency anemia?

```  Beans ◦ Black, garbanzo, pinto  Nuts  Dried Fruit— prunes, raisins  Whole grains  Iron-fortified breads & cereals  Meats ◦ Especially red meat, beef & organ meats (liver)  Poultry  Fish & shellfish  Egg yolks  Dark green, leafy vegetables ```

What are the available medications available for iron deficiency?

 ferrous fumarate-po  ferrous gluconate-IV  iron sucrose-IV  ferrous sulfate – po (varied amounts of iron)

What patient teaching is important for the medication available for iron deficiency?

```  Timing with food  Best absorbed on an empty stomach  Eat iron rich foods with Vit C  Need for fiber-iron supp. cause constipation  Avoid staining of the teeth  Stool color change - dark ```

What are the parenteral supplements available for iron deficiency anemia?

Iron dextran or iron sucrose

What are the nursing considerations for the parenteral supplements available for iron deficiency anemia?

```  IM dose given via the Z-track  IV diluted  May cause a severe allergic reaction  Delayed reaction (1-2 days later) ◦ Flu-like symptoms may occur ```

What are the medication safety measures for iron deficiency anemia?

```  Iron unbound to transferrin is toxic  Accidental poisoning can occur  Safety measures:  Keep medications in a secure place  Keep meds in original containers  Keep meds tightly closed  Use childproof lids  Do not refer to medications/vitamins as“candy” ```

How is the care for iron deficiency anemia evaluated?

 Show improvement all cited nursing diagnoses  Maintain normal iron-deficiency related lab values  Symptoms may start to improve within a few days of treatment  Recovery is a slow process  Cause of the anemia is corrected  3-6 months for body’s iron stores to replenish  Cause may never be discovered or may not be correctable - lifetime treatment  Modifications in plan of care - if the patient is not improving

Endocarditis & Iron deficiency Anemia Flashcards

(44 cards)