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



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)


How can infective endocarditis be classified?

as an acute or subacute infection


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

• Caused by a new infection
• Organism - frequently staphylococci


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

• Occurs in an already defective heart valve
• Organism – often streptococci or E.coli


What is infective endocarditis?

 Microbial infection of the endocardium
 Deformity or injury of endocardium


What can occur as a result of infective endocarditis?

 Results in clot formation on endocardium
 Infective organisms invade clot &; form lesion


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



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

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


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


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


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


What are roth spots?

◦ White spots seen on retina
◦ Round or oval


What are janeway lesions?

◦ Painless, hemorrhagic lesions
◦ Palms, soles, nose, ear


what are osler's nodes?

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


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


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


The inflammatory process involves what labs?

◦ WBC count, ESR are elevated


What does the endocardiogram lab test for?

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


What are the interventions for endocarditis?

 Prevention = best plan
 AHA guidelines for high-risk patient
◦ Prophylactic antibiotics before invasive
◦ Such as-invasive dental, GI & 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?

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


What is valvuloplasty?

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


What is an annuloplasty?

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


What is chordoplasty?

 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
 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



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