ADVANCED MED SURG: WEEK 3

valvular regurgitation

leaking of blood backward through a valve that does not close tightly

valvular stenosis

a condition in which there is narrowing, stiffening, thickening, or blockage of one or more valves of the heart causing blood flow to decrease or stop

valve prolapse

the stretching of an atrioventricular valve leaflet into the atrium during diastole

nursing assessment for valvular disorders:

-monitor vitals (BP high or low etc.)

-assess heart sounds (are there murmurs?)

-monitor for signs of HF (syncope, dysrhythmias, etc.)

-monitor weight

-easily fatigued from movement?

patients with valve replacements may need anticoagulants for life. True or false?

true

what are 3 indicators of valve rejection? (in order)

1) fever

2) rash

3) malfunctioning of the tissue/valve (leads to signs of HF that have returned)

nursing management for valvular procedures:

-monitor for infections (top priority)

-prophylactic ABX

-monitor for signs of returning HF

-neuro. checks

-monitor all vitals

-educate patients to take full course of ABX, and to get prophylactic ABX before dental procedures etc.

-inform patient they may need anticoagulant therapy for life

-teach patient to come back for routine echocardiograms

Cardiomyopathy

WHAT: progressive events that lead to increasingly impaired cardiac output, which can lead to HF, dysrhythmias, or even sudden death

TYPES: dilated, hypertrophic, and restrictive

S/S: fatigue, dyspnea, palpitations, chest pain, syncope, JVD, weight gain, edema, and dry cough

INTERVENTIONS: (treatable NOT curable)

for acute phase--> rest, supplemental oxygen, medications for HF etc, low sodium, increase activity tolerance, and reduce anxiety

for post-acute phase--> decrease powerlessness and promote home-based care

Rheumatic endocarditis

WHAT: inflammation of the heart due to rheumatic fever (caused by streptococcus bacteria) (most often in school-aged children)

-the infection damages the heart valves (especially the mitral valve)

-can occur if strep throat goes untreated

S/S: a "whooshing" heart murmur, fever, SOB, fatigue, syncope, tachycardia, and chest pain

INTERVENTIONS: antibiotics and anti-inflammatory medications such as steroids

Infective endocarditis

WHAT: inflammation of the inner layer of heart tissue as a result of an infectious microorganism (usually from prosthetic heart valves or structural defects)

S/S: fever, murmurs, cardiomegaly, HF, tachycardia, fatigue, dyspnea, and syncope

INTERVENTIONS: IV ABX's, antipyretics for fever, and valve repair/manage symptoms of HF

Pericarditis

WHAT: Inflammation of the sac surrounding the heart (pericardium)

-can lead to pericardial effusion or cardiac tamponade

S/S: fever, SOB, syncope, HF, fatigue, and cardiomegaly

INTERVENTIONS: NSAIDS/steroids to reduce inflammation, pericardiocentesis if cardiac tamponade develops, ABX's if bacterial, and continue cardiac monitoring/manage symptoms

Prevention of Infectious Diseases of the Heart

-ABX prophylaxis

-oral hygiene

-if female patient has PID, advise them not to use IUDs

-immunizations

-meticulous care with catheters (have them removed as soon as they are no longer needed)

Pericardial effusion

WHAT: a collection of fluid between the pericardial sac and the myocardium

CAUSES: infections of the heart (pericarditis), post-cardiac surgery, and/or trauma/chest injury

S/S: chest feeling "full", dyspnea, muffled/distant heart sounds, cough or hiccups, and tachycardia

INTERVENTIONS: treat underlying cause (infection etc.), and pericardiocentesis to aspirate fluid

Cardiac tamponade

WHAT: acute compression/pressure of the heart caused by fluid accumulation in the pericardial cavity

CAUSES: progression of pericardial effusion, chest trauma, and/or rupture of heart wall after MI or surgery

S/S: "classic triad"--> hypotension, muffled heart sounds, and JVD

-also pulses paradoxus, weak/thready pulses, and tachycardia

INTERVENTIONS: pericardiocentesis, frequent vital monitoring and cardiac monitoring

the ________ system is the number one system involved with heart failure

RAAS

heart failure causes _________ and ________

fluid overload and inadequate tissue perfusion

signs/symptoms of right-sided heart failure

-peripheral edema

-JVD

-hepatomegaly

-weight gain

-ascites

signs/symptoms of left-sided heart failure

-pulmonary congestion/edema

-crackles

-low oxygen saturation

-dyspnea

-oliguria

-dry cough

-impairment of any organ not being perfused properly

medications for heart failure:

1) ACE inhibitors (vasodilator, and decrease after load)

2) ARBS (work better than ACEs for people of color)

3) hydralazine and isosorbide (alternative to ACEs/ARBs)

4) beta-blockers (decrease HR/BP)

5) diuretics (decrease fluid volume)

6) digoxin (improves contractility)

7) IV meds such as dobutamine and milrinone (for acute HF)

Pulmonary edema

WHAT: accumulation of fluid in the lungs

S/S: restlessness, anxiety, SOB, cool/clammy skin, cyanosis, weak pulses, lung congestion/edema, sputum production, and decreased LOC

INTERVENTIONS: decrease exertion/stress on body, deliver oxygen, give diuretics, monitor lung sounds/I'd and O's, and upright positioning

Cardiogenic shock

WHAT: Shock caused by inadequate function of the heart, or pump failure (decreased perfusion/CO)

S/S: symptoms of HF and hypoxia

INTERVENTIONS: correct underlying cause (HF etc.), decrease preload and after load, and improve oxygenation

pulmonary embolism

WHAT: A blood clot that breaks off from a large vein and travels to the blood vessels of the lung, causing obstruction of blood flow

S/S: dyspnea, chest pain, tachypnea, and cough

INTERVENTIONS: anticoagulant therapy