Chapter 23

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lngray82
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259174
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Chapter 23
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2014-01-29 21:10:30
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inflammatory disorders heart blood vessels
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chap 23
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  1. A syststemic inflammatory disease that sometimes follows Group A streptococcal infection.
    Rheumatic Fever
  2. What structures are affected with rheumatic carditis?
    layers affected are endocarditis, myocarditis, and pericarditis, also heart valves are, most commonly MITRAL
  3. When WBC's migrate to the endocardium causing inflammatory debris to accumulate around the leaflets which cause fibrous tissue to fuse of thicken and shorten (chordae tendinea)
    vegetations (valves loose abilityto open fully or close tightly)
  4. rheumatic fever is a complication of which infections?
    streptococcal infections.
  5. who usually gets rheumatic fever?
    in children 2 to 3 weeks
  6. Inflammation of the layers of the heart is called?
    carditis
  7. inflammation of more then one joint is called?
    polyarthritis
  8. involuntary grimacing and an inability to use skeletal muscles in a coordinated manner is called?
    chorea
  9. fever for several weeks, heart rate is rapid,or abnormal, erythema marginatum (red spotty rash)polyarthritis, poss nodules, chorea are symptoms of what?
    Rheumatic fever
  10. what does a heart murmur suggest?
    valve damage
  11. which diagnostic findings help diagnose rheumatic fever?
    no specific lab avail.....instead they can do a antistreptolysin o titrate, sed rate, CRP to check inflammation response. EKG and echo may show cardiac changes/damage.
  12. name 3 meds used to treat rheumatic fever
    • 1. PCN drug of choice
    • 2. azithromycin-if allergy to pcn
    • 3.vancomyocin if allergy to pcn
    • there are others so drugs may vary. most important is Penicillin
  13. describe the nursing management for a patient with rheumatic fever
    Administer drug therapy, monitor for therapeutic an adverse effects, encourage rest or reduce activities, do cardiac assessment, nutrition considerations
  14. Inflammation of the inner layer of the heart tissue as a result of an infectious microorganism is called?
    infective endocarditis
  15. Name 2 bacteria that most frequently causes bacterial endocarditis
    streptococcus viridans and staphylococcus aureus
  16. Who are at risk for getting infective endocarditis?
    pts with hx of rheumatic carditis, pts who have nonrheumatic valve disease or artificial heart valves, repaired congential heart defects, a prolapsed mitral valve or cardiomyopathy. IV drug users, immunosuppressed or pt with central lines
  17. How do vegetations adversely affect the heart?
    the microorganisms bury themselves in the vegetative mass making them difficult to destroy.
  18. which valve is mostly affected with vegetations?
    Mitral
  19. what would happen if vegetations break off?
    causes an emboli that then may occlude small vessels and interfere with an organs blood supply
  20. Name the symptoms of infective endocarditis
    fever,chills, muscle aches, joint pain, headache, malaise fatique, sleep disturbances, osler nodes, spinter hemorrhages, SM janeway lesions, Roths spots enlarged spleen, murmur,petechial, weakness
  21. Black longitudinal lines are called?
    splinter hemorrhages
  22. a non tender sm erythematous or haemorrhagic macular or nodule lesion on palms or soles are?
    Janeway lesions
  23. retinal hemorrhages with white or pale center composed of coagulated fibrin is called?
    Roth spots
  24. What are the common diagnostic findings with patients with infective endocarditis?
    Anemia/slight leukocytes. blood cultures x 3, TEE can reveal vegatations, EKG's
  25. how to you treat infective endocarditis?
    high doses of iv abx for 2-6 wks, bedrest, poss valve replacement
  26. nursing care for infective endocarditis includes
    limit activity, assess wt, HR, rythym, note and address any changes. Administer drugs around the clock, educate pt on periodic abx therapy that it is life long
  27. Inflammation of the heart muscle is called?
    myocarditis
  28. what causes myocarditis?
    • viral, bacterial, fungal, or parasitic infection.
    • Viral coxsackie a/b
    • influenza a/b
    • measles, mumps, adenovirus, rubella, Epstein barr, cytomegalovirus.
    • Also those who are bulemic
  29. what are the diagnostic findings for myocarditis?
    abnormal electrolyte and thyroid levels, elevated WBC's, CRP,troponin. abnormal EKG,abnormal reading from echo showing structural damage, heart muscle is thickened. Radionuclide studies, bx is done for confirmation
  30. WHat are the symptoms of myocarditis?
    sharp stabbing or squeezing chest discomfort that resembles MI, low grade fever, tachycardia, dysrhythmias, dyspnea, anorexia, pale skin or cyanotic, ascites, peripheral edema, crackles in lungs, s3 gallop
  31. treatment for myocarditis include
    treating underlying cause, ABx bedrest, low salt diet, cardiotonic drugs, poss heart transplant
  32. a chronic condition characterized by structural changes in the heart muscle is called?
    • cardiomyopathy
    • 3types......dilated cardiomyopathy, hypertonic cardiomyopathy and restrictive cardiomyopathy
  33. 3 causes of cardiomyopathy are?
    myocarditis, connective tissue disorders and alcoholism
  34. What happens to the heart muscle when the pt has myocardiopathy?
    the heart muscle loses its ability to pump efficiently
  35. a type of cardiomyopathy that is accompanied by dyspnea on exertion and when lying down. Person may feel fatigued, legs swollen and pt experience heart palpitations and chest pain
    dilated cardiopathy
  36. cardiopathy that is least common in the US but common in tropical regions, Africa ,India, south central America, Asia. they get dyspnea, dependent edema, ascites, and hepatomegaly
    restrictive cardiomyopathy (restrictive regions)
  37. cardiomyopathy that is associated with syncope and fatigue, sob, cp, ill after exercise many are asystomatic
    hypertrophic cardiomyopathy
  38. what heart sound is made for cardiomyopathy?
    murmur, also forceful contractions may be palpated over left chest wall
  39. treatment for cardiomyopathy
    diuretics, cardiac glycosides, antihypertensives, antidysrrythmias, anticoagualnts, anti inflammatory agents, low NA diet, poss surg.
  40. inflammation of the pericardium
    pericarditis
  41. pericarditis is secondary to what?
    endocarditis, myocarditis, chest trauma, MI others include TB, malignant tumors, uremia, CT disorders
  42. when pericardial fluid accumulates and causes acute compression of the heart is called?
    cadiac tamponade (heart needs a tampon!)
  43. s/s of pericarditis
    fever, malaise, dyspnea, chest heaviness, precardial pain, fluid muffle heart sound, hypotension
  44. aspiration of fluid in-between the visceral and parietal layers of the pericardium is called?
    paracardiocentesis
  45. an inflammation of a vein accompanied by a clot or thrombus formation is called?
    thrombophlebitis
  46. what factors predispose a patient to thrombophlebitis?
    venous stasis, altered blood coagulation, trauma, reduced cardiac output, inactivity, compression of the veins

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