Inflammatory cardiac disorders & Acute decompensated HF

NURS 4060

What are key cues of pericarditis (inflammation around heart)

pain & friction rub

What are key cues for myocarditis (inflammation of muscle)

weak contraction/pump + rhythm issues

What are key cues for Endocarditis (inner lining & valves)

Infection, murmur, emboli

The following hallmark cues describe what inflammatory cardiac disorder?

• Sharp, pleuritic chest pain

• Worse lying flat

• Better sitting up/ leaning foward

• Friction rub

Pericarditis

What is a major concern with pericarditis?

tamponade

The following s/s describe worsening of which inflammatory cardiac disorder?

• hypotension + JVD + Muffled heart sounds

• worsening dyspnea

• tachycardia/ anxiety

Pericarditis

For which cardiac disorder should you think in this way?

• sharp positional pain + friction rub → watch for tamponade

Pericarditis

The following nursing priorities are related to which cardiac disorder?

• Assess vitals, pain, lung sounds, heart sounds

• Notify provider/RR for signs of instability

Pericarditis

The following s/s describe which inflammatory cardiac disorder?

• Recent viral illness/ flu-like symptoms

• Fatigue, dyspnea, chest discomfort

• Palpitations or syncope

Myocarditis

In myocarditis, the muscle is inflamed so the heart may not contract well. If the heart isn’t contracting well, there is — , —, and —

decreased cardiac output, heart failure signs, and dysrhythmias

The following nursing priorities are related to which cardiac disorder?

• Assess VS, respiratory, and perfusion

• Continuous rhythm monitoring, strict I/O, DW

• Activity limitation until cleared

Myocarditis

For which cardiac disorder should you think this way?

• inflamed heart muscle → weak pump + dysrhythmias

Myocarditis

The following cues describe which cardiac disorder?

• fever, chills, night sweats

• new or changing murmur

• Petechiae, splinter hemorrhages, Osler nodes

• Janeway lesions, Roth spots

• HF signs: sob/edema

Endocarditis

What is a splinter hemorrhage

tiny red/brown linear streaks under fingernails/toenails

What is “osler nodes”

painful/tender, small red/purple on pads of fingers/toes

What is janeway lesions

painless, flat red spots typically on palms & soles

What are roth spots?

retinal hemorrhages

The following priority nursing actions relate to which cardiac disorder?

• monitor temp, heart sounds, embolic complications, & HF

• Obtain blood cultures BEFORE abx when ordered

endocarditis

Which cardiac disorder should you think like this?

• infection on valves → emboli + valve damage

Endocarditis

pericarditis → CLUE → WATCH FOR

sharp pain better leaning forward → tamponade

myocarditis → CLUE → WATCH FOR

viral symptoms + weak pump cues → dysrhythmias/ HF

endocarditis → CLUE → WATCH FOR

fever, murmur, embolic signs → stroke, emboli, valve damage

Which cardiac disorder is most associated with embolization?

Endocarditis → vegetations can embolize & travel to brain, lungs, kidneys, or extremities

What are the two main symptoms of acute decompensated heart failure?

fluid overload & poor tissue perfusion

The following nursing priorities are related to which cardiac disorder?

• assess congestion & perfusion

• Look for respiratory distress & signs of low CO

Acute decompensated heart failure

Congestion in ADHF shows fluid overload. What are the common cues of congestion?

dyspnea, orthopnea, PND, crackles, JVD, edema, weight gain, low O2 or increased WOB

Low perfusion in ADHF means organs aren’t receiving enough forward blood flow. What are low-perfusion cues in ADHF?

hypotension, cool clammy skin, confusion/restlessness, decreased urine output

What are the major red flags for ADHF

dyspnea, PND, hypoxia, hypotension, confusion, cool clammy skin, & low urine output

If the nurse notices respiratory distress or low perfusion, what should the nurse then do?

priority assessment & notify provider

In order, what are the nursing priorities for ADHF?

sit upright, oxygen, cardiac/VS monitoring, IV access and labs, diuretics

How do diuretics or vasodilators help in the event of ADHF?

reduce workload of heart

After the nursing priorities for ADHF have been completed, what things should the nurse monitor?

BP, urine output, electrolytes, kidney fxn, mental status, & worsening resp distress

68 yo pt w hx of HF reports w worsening SOB. They are sitting upright, anxious, & using accessory muscles.

• FINDINGS: O2 88% on RA, crackles bilaterally, BP 92/58, cool clammy skin, urine output decreased

What condition is most concerning?

Name 2 congestion cues

Name 2 low-perfusion cues

What are your first three nursing actions?

ADHF w/ hypoxia & low perfusion; crackles, O2 88%; BP 92/58, cool clammy skin, urine output; Prioritize breathing, perfusion, & rapid communication

Which cardiac disorder does the following statement most closely relate to?

• sharp chest pain that improves when leaning forward; friction rub heard

Pericarditis

Which cardiac disorder does the following statement most closely relate to?

• Fever, new murmur, & splinter hemorrhages after recent dental infeciton

Endocarditis

Which cardiac disorder does the following statement most closely relate to?

• Recent viral illness followed by fatigue, dyspnea, palpitations, & low EF

Myocarditis

Sharp positional pain + friction rub → watch for tamponade

Pericarditis

Inflamed muscle → weak pump, dysrhythmias, HF signs

Myocarditis

Infection on valves → emboli & valve damage

Endocarditis

Assess congestion + perfusion, then prioritize oxygenation & stablility

ADHF

Recognize — and respond to —

pattern, deterioration