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From Flashcardlet > Inflammatory-Infective HD > Flashcards

Inflammatory-Infective HD Flashcards

1
Q

What is infective endocarditis?

A

Inflammation of the lining of the heart

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2
Q

What is the cause of infective endocarditis?

A

invasion of microorganisms and/or abnormal immunological reaction

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3
Q

Where is the inflammation usually confined in infective endocarditis?

A

the covering of a valve and possibly the membrane lining the chambers

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4
Q

What is the course of infective endocarditis?

A

acute vs. subacute

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5
Q

What is acute endocarditis?

A

Endocarditis that begins abruptly and progresses rapidly.

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6
Q

What is the cause of acute endocarditis?

A

usually caused by organisms such as staphylococci or streptoccoci (but strep more in subacute)

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7
Q

What is the breakdown of how acute endocarditis works?

A
  • Shorter Course
  • Rapid Onset
  • More Toxic
  • Virulent Organism
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8
Q

How are the symptoms described for acute endocarditis?

A

may be nonspecific involving multiple organ systems

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9
Q

How are multiple organs affected in acute endocarditis?

A

microemboli can cause organ infarction

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10
Q

Clinical manifestations of acute endocarditis

A

fever, bacteremia, chills, weakness, malaise, fatigue, anorexia

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11
Q

What is subacute endocarditis?

A

A condition usually caused by colonization of the Streptococcus viridians group in an abnormal heart or in valves damaged previously by rheumatic fever

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12
Q

What is the breakdown of how subacute endocarditis works?

A

Longer clinical course with lifelong impact, insidious onset, less virulent causative organism

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13
Q

Clinical manifestations of subacute manifestations

A

arthralgias, myalgias, back pain, abdominal discomfort, weight loss, headache, clubbing of fingers

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14
Q

What are vascular manifestations of subacute endocarditis?

A

New murmur, splinter hemorrhages (in fingernails), petechiae, osler nodes, janeway lesions, roth’s spots

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15
Q

What are complications of endocarditis?

A

primary lesions, local spread, and embolization sites

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16
Q

What are the complications with primary lesions?

A

vegetations and they migrate and cause emboli in right and left side

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17
Q

What happens if there is local spread of endocarditis?

A
  • incompetent valves
  • invasion of myocardium and CHF
  • Sepsis
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18
Q

Where are embolization sites of endocarditis?

A

spleen, kidney, brain, lungs, peripheral blood vessels

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19
Q

What diagnostic studies are done for endocarditis?

A

health history, blood cultures, elevated WBC, ESR >30, echocardiogram, ECG, and cardiac catheterization

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20
Q

What kind of health history is important to find out for endocarditis?

A

heart disease, recent dental, gynecological, or urological surgery

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21
Q

What needs to be considered for the blood cultures for endocarditis?

A

May be negative for up to 3 weeks and they should be drawn prior to initiation of antibiotics

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22
Q

non-surgical management of endocarditis

A
  • identification of the infecting organism

- treatment with appropriate antibiotics

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23
Q

How long will antibiotics more than likely need to be taken for endocarditis?

A

4-6 weeks

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24
Q

What needs to be taught to the patients about their antibiotics for endocarditis?

A

Take all medication when they are ordered, and don’t save some for the end.

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25
Q

When would surgical management of endocarditis be needed?

A

if antibiotic therapy is ineffective

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26
Q

What surgery is performed for endocarditis?

A

Replacement of infected valve, repair/remove congenital shunts, repair injured valve/chordae tendineae, and drain abscesses if present

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27
Q

What education should be provided to a patient with endocarditis?

A

avoid persons with infection, report cold and flu symptoms, avoid excessive fatigue, good dental care

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28
Q

Who receives prophylactic treatment for endocarditis?

A

Patients with abnormalities of the heart or great vessels are at increased risk to develop endocarditis

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29
Q

When is antibiotic prophylactic treatment recommended?

A

patients with mitral valve prolapse, prosthetic cardiac valves, congenital cardiac malformations or rheumatic fever

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30
Q

What is pericarditis?

A

inflammation of the pericardium

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31
Q

What are the types of pericarditis?

A

acute and chronic, constrictive

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32
Q

What is the etiology of pericarditis?

A

may be caused by TB, mycoses, infection, collagen disease, uremia, MI, neoplasms, or trauma

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33
Q

What are the 3 functions of the pericardium?

A

anchors, lubricates, and prevents

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34
Q

How does the pericardium anchor?

A

by extending to the great vessels, sternum & vertebral column

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35
Q

What does the pericardium lubricate?

A

surfaces of pericardium: to protect contacting surfaces when heart pumps

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36
Q

What does the pericardium prevent?

A

excessive dilation during diastole

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37
Q

What are clinical manifestations of acute pericarditis?

A

Chest pain (different from angina), dypsnea, pericardial friction rub

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38
Q

What is acute pericarditis commonly associated with?

A

malignant neoplasms, idiopathic causes, infective organisms, post MI (Dressler’s), post pericardiotomy syndrome, systemic connective tissue disease, renal failure

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39
Q

What are complications of acute pericarditis?

A

pericardial effusion, cardiac tamponade, pulsus paradoxus (narrowing of systolic and diastolic BP)

40
Q

What are signs of tamponade?

A

Low voltage ECG, peripheral cyanosis, decreased pulse pressure, muffled heart sounds, distended neck veins.

41
Q

What diagnostic studies are done for acute pericarditis?

A

Serial ECGs, CXR, echocardiogram, positive pericardial fluid cultures, slight increase in CK-MB, Increase SED rate, WBC

42
Q

What needs to be watched for with a ECG in acute pericarditis?

A

ST segment and/or T wave changes

43
Q

Therapeutic management of acute pericarditis

A
  • identify and treat underlying cause
  • antibiotics
  • corticosteroids
  • NSAIDS
44
Q

What is the nursing management for acute pericarditis?

A
  • Manage pain and anxiety
  • Differentiate between pericardial and anginal pain
  • bed rest with HOB elevated
  • Patient education
45
Q

What is the patient education for acute pericarditis?

A
  • the importance of taking prescribed meds and purposes

- recurring symptoms to report

46
Q

Manifestations of constrictive pericarditis

A
  • occur slowly - chronic condition
  • mimic CHF and Cor Pulmonale
  • may be pericardial knock
47
Q

What is the most prominent finding of constrictive pericarditis?

A

elevated jugular venous pressure

48
Q

Diagnostic studies for constrictive pericarditis

A

ECG, CXR, Cardiac Cath, CT, MRI

49
Q

Management of constrictive pericarditis

A

pericardiectomy and pericardial window

50
Q

What is a pericardiectomy?

A

excision of pericardium

51
Q

What is pericardial window?

A

opening to allow for continuous drainage of pericardial fluid

52
Q

What is rheumatic carditis?

A

Heart damage from group A beta-hemolytic streptococci or “rheumatic fever” and is called rheumatic heart disease

53
Q

What is rheumatic fever?

A

-inflammatory disease that affects all layers of the heart

54
Q

What percentage of rheumatic fever is a complication of upper respiratory infections?

A

3%

55
Q

Etiology of rheumatic carditis

A

The onset follows a preceding infection with a strain of group A strep, usually begins as ‘sore throat’

56
Q

What age group does rheumatic carditis usually occur?

A

between 5 and 15, but can occur at any age

57
Q

How does the rheumatic fever affect the heart?

A

It is believed to be an autoimmune response in which immune complexes (antibodies and complement) damage the heart valves or heart muscle

58
Q

What are the complications of rheumatic carditis?

A
  • Heart damage to valves (commissures, chordea tendineae, papillary muscle fibrosis), stenosis and regurgitation
  • Extracardiac Lesions
59
Q

Clinical manifestations of rheumatic carditis

A

murmurs, cardiac enlargement (cardiomegaly) and heart failure, pericarditis, dysrhythmias, polyarthritis, chorea (syndenhams chorea), erythema marginatum

60
Q

Diagnostic studies for rheumatic carditis

A

ASO Titer, ESR, C-Reactive Protein, ECG changes, and Echocardiogram, increase WBC and SED rate, increase cardiac enzymes, pos throat cultures,

61
Q

Therapeutic management of rheumatic carditis

A
  • antibiotics
  • ASA and Steroids
  • Bedrest
  • possible commissurotomy
  • valvuloplasty or valve replacement
62
Q

How are vegetations on the heart made?

A

Infections cause platelets and fibrin to aggregate on the valve tissue and engulf circulating bacteria or fungi. They form wart-like vegetative growths on the heart valves, endocardial lining of a heart chamber or endothelium of a blood vesse.

63
Q

What do vegetations cause?

A

cover the surface of the valves and cause ulcerations and necrosis

64
Q

What else can vegetations involve?

A

chordae tendineae

65
Q

Who is at risk for infective endocarditis?

A 
Implanted valves
 drug user
Males
Indwelling central catheters (PA lines)
Cardiac surgery
66
Q

signs of splenic infarction from endocarditis

A

– LUQ pain rading to L shoulder

67
Q

signs of renal infarction from endocarditis

A

hematuria, pyuria, flank pain, decreased UOP

68
Q

signs of cerebral infarction from endocarditis

A

hemiparesis, aphasia, other neurologic deficits

69
Q

signs of pulmonary infarction from endocarditis

A

cough, pleuritic pain, pleural friction rub, dyspnea, and hemoptysis

70
Q

signs of peripheral vascular occlusion from endocarditis

A

numbness and tingling in arm leg, finger, or toe

71
Q

possible causes of acute endocarditis

A

Septic thrombophletitis, opeon heart surgery involving valves, prosthetic volves, or skin, bone & pulmonary infections.

72
Q

What diseases may sub-acute endocarditis be acquired from?

A 
Rheumatic valve disease, 
Congenital heart disease
Acquired valvular/congenital lesions
mitral valve prolapse
AS
73
Q

What procedures may subcute endocarditis follow?

A

dental, GU, GYN, and GI procedures

74
Q

What type of drug users may acquire subacute endocarditis?

A

IV drug users

75
Q

What percentage of people with endocarditis have no underlying heart disease?

A

40%

76
Q

What are some nursing considerations for endocarditis since they tire easily and are more prone to getting sick?

A

Cluster care
Make sure their immunizations are up to date
good dental care
O2 therapy

77
Q

What are the different forms pericarditis may be?

A

May be fibrinous or effusive (purulent, serous or hemorrhagic)

78
Q

During pericarditis, what does the damage release?

A

chemical mediators of inflammation (prostaglandin, histamine, bradykinins and serotonin)

79
Q

What drugs can cause pericarditis?

A

procainamin and hydralazine

80
Q

What happens after the chemical mediators are released in pericarditis?

A

friction occurs and you may hear pericardial friction rub

81
Q

In pericarditis, what increases 2nd to histamine?

A

vessel permeability

82
Q

What begins phagocytosis in pericarditis?

A

macrophages

83
Q

After phagocytosis occurs in pericarditis, what may occur?

A

pericardial effusion or tamponade

84
Q

What is pericardial effusion?

A

increased fluid after trauma

85
Q

What are the two types of pericardial effusion?

A

purulent or hemorrhagic

86
Q

What is pulsus paradoxus, parodoxical pulse, or Kussmaul’s pulse?

A
  • A pulse that is more or less suppressed at the close of each full inspiration, frequently noted in pericarditis. It is thought to be the compression of the great vessels by inflammatory adhesions which are stretched during act of inspiration.
87
Q

What is tamponade?

A

excessive fluid in pericardial sac causing compression of the myocardium

88
Q

How is tamponade detected?

A

with pulsus paradoxus

89
Q

What may assessment reveal with tamponade?

A

Assessment may reveal a weak or absent peripheral pulse and weak point of maximum impulse [PMI], distended neck veins, decreased blood pressure and a narrowing pulse pressure.

90
Q

What is chorea?

A

irregular involuntary movements, sometimes from rheumatic fever

91
Q

what is polyarthritis?

A

multiple joint pain with redness, heat, swelling

that can be from rheumatic fever

92
Q

What is erythema marginatum in rheumatic fever?

A

trunk rash (macules); may fade in center and be mistaken for ringworm. Darken with heat.

93
Q

What systems and parts of the body does rheumatic fever affect?

A

Joint, skin, nervous system & heart affected

94
Q

What is the percentage of cardiac involvement in rheumatic carditis?

A

50%

95
Q

nursing interventions for rheumatic carditis

A 
Check allergies
Bed rest 
Position upright
Analgesics
Complete antibiotics
Teach s/s heart failure
**  Prophylacatic antibiotics prior to invasive procedures

From Flashcardlet (107 decks)

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