Infectious and Inflammatory Heart Disorders
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Questions and Answers

What is a common complication of untreated rheumatic fever?

  • Acute kidney injury
  • Pneumonia
  • Rheumatic carditis (correct)
  • Sepsis

Which assessment finding is least likely to be present in rheumatic carditis?

  • Fever
  • Heart murmur
  • Splinter hemorrhages (correct)
  • Rapid heart rate

Which diagnostic finding would most directly indicate inflammation in a patient suspected of having rheumatic fever?

  • Decreased C-reactive protein
  • Normal white blood cell count
  • ECG abnormalities
  • Elevated ESR (correct)

What is the primary medical management for a client diagnosed with infective endocarditis?

<p>Intravenous antibiotics (C)</p> Signup and view all the answers

Which of the following factors is a significant risk for developing infective endocarditis?

<p>Prolonged intravenous therapy (A)</p> Signup and view all the answers

Which symptoms are characteristic of infective endocarditis?

<p>Petechiae and Osler nodes (D)</p> Signup and view all the answers

When managing a client with rheumatic fever, which nursing intervention is essential?

<p>Administer prescribed drug therapy (A)</p> Signup and view all the answers

What potential outcome is linked to prolonged pericarditis if left untreated?

<p>Constrictive pericarditis (A)</p> Signup and view all the answers

What is a key characteristic of myocarditis that differs from myocardial infarction?

<p>Pain relief when sitting up (A)</p> Signup and view all the answers

Which diagnostic finding is essential in diagnosing pericarditis?

<p>Elevated ST segment on ECG (A)</p> Signup and view all the answers

What is a primary medical management intervention for cardiomyopathy?

<p>Cardiotonic drugs (C)</p> Signup and view all the answers

In which scenario is pericardiocentesis indicated?

<p>Acute cardiac tamponade (D)</p> Signup and view all the answers

What type of cardiomyopathy is characterized by leg swelling and dyspnea on exertion when lying down?

<p>Dilated cardiomyopathy (D)</p> Signup and view all the answers

Which assessment finding in pericarditis is commonly associated with altered blood pressure?

<p>Pulsus paradoxus (B)</p> Signup and view all the answers

What symptom is typically reported in patients with restrictive cardiomyopathy?

<p>Cyanotic skin (A)</p> Signup and view all the answers

Which laboratory test is crucial for evaluating the inflammatory process associated with myocarditis?

<p>C-reactive protein levels (C)</p> Signup and view all the answers

What is a common side effect of aggressive IV antibiotic therapy in management of heart infections?

<p>Dysrhythmias (D)</p> Signup and view all the answers

What lifestyle change is often recommended for patients with cardiomyopathy?

<p>Sodium-restricted diet (D)</p> Signup and view all the answers

What is the primary rationale for covering the site of pericardiocentesis with a sterile dressing?

<p>To protect compromised skin from microorganisms (D)</p> Signup and view all the answers

Which of the following assessment findings is most commonly associated with pericarditis?

<p>Friction rubs (C)</p> Signup and view all the answers

Which set of symptoms is least likely to be associated with thrombophlebitis?

<p>Cold and numb extremities (D)</p> Signup and view all the answers

What is the significance of Virchow's triad in relation to thrombus formation?

<p>It identifies three major factors contributing to clot formation (C)</p> Signup and view all the answers

Which of the following is NOT a common management strategy for thromboangiitis obliterans?

<p>Caloric supplementation (A)</p> Signup and view all the answers

Which symptom pair best describes intermittent claudication as it relates to Buerger disease?

<p>Cramps after exercise and pain at rest (A)</p> Signup and view all the answers

In assessing a patient with signs of venous thromboembolism, which diagnostic tool is most appropriate for evaluating venous structures?

<p>Doppler ultrasound (A)</p> Signup and view all the answers

Which symptom is characteristic of a significant complication associated with untreated pericarditis?

<p>Arrhythmias (B)</p> Signup and view all the answers

When providing care for a patient with pericarditis, which of the following findings suggests a management strategy has been successful?

<p>Stabilization of vital signs (A)</p> Signup and view all the answers

What is a key characteristic of rheumatic fever that distinguishes it from rheumatic carditis?

<p>It occurs after group A streptococcal infection. (A)</p> Signup and view all the answers

Which assessment finding would likely indicate rheumatic carditis in a patient?

<p>Rapid heart rate and abnormal rhythm. (A)</p> Signup and view all the answers

What is the primary infectious risk factor associated with the development of infective endocarditis?

<p>Prolonged use of catheters. (C)</p> Signup and view all the answers

Which symptom is least likely to be associated with infective endocarditis?

<p>Streptococcal sore throat. (B)</p> Signup and view all the answers

Which of the following nursing interventions is essential for a patient diagnosed with rheumatic fever?

<p>Administering prophylactic antibiotics as prescribed. (A)</p> Signup and view all the answers

Which laboratory finding is most directly related to active inflammation in patients with rheumatic fever?

<p>Elevated C-reactive protein levels. (D)</p> Signup and view all the answers

What primary risk factor for infective endocarditis involves the use of medical devices?

<p>Insertion of cardiac pacemakers. (C)</p> Signup and view all the answers

What finding on a patient with rheumatic fever might suggest the presence of a heart murmur?

<p>Irregular heart rhythm. (A)</p> Signup and view all the answers

What are some common assessment findings in a patient with thrombophlebitis?

<p>Calf pain with dorsiflexion (A)</p> Signup and view all the answers

What is the primary non-surgical management approach for a patient diagnosed with thromboangiitis obliterans?

<p>Buerger-Allen exercises (D)</p> Signup and view all the answers

Which clinical sign is most characteristic of pericarditis?

<p>Friction rub (B)</p> Signup and view all the answers

In assessing a patient with potential Buerger disease, what symptom would be least likely to be present?

<p>Increased hair growth on extremities (C)</p> Signup and view all the answers

Which combination of symptoms is commonly associated with acute pericarditis?

<p>Fever and tachycardia (A)</p> Signup and view all the answers

What underlying factors contribute to the development of thrombophlebitis as described by Virchow's triad?

<p>Altered blood coagulation, trauma, and venous stasis (B)</p> Signup and view all the answers

When managing a client with pericarditis, which symptom would indicate that the condition has worsened?

<p>Sudden onset of dyspnea (C)</p> Signup and view all the answers

Which of the following findings must be monitored closely in a patient receiving anticoagulant therapy for thrombophlebitis?

<p>Signs of bleeding (C)</p> Signup and view all the answers

What is a common indicator for the necessity of Doppler ultrasound in a patient suspected of having venous thromboembolism?

<p>Calf swelling or pain (D)</p> Signup and view all the answers

What complication should be considered for a patient with untreated pericarditis?

<p>Cardiac tamponade (D)</p> Signup and view all the answers

What is a key symptom of myocarditis that distinguishes it from myocardial infarction?

<p>Chest pain alleviated by sitting up (A)</p> Signup and view all the answers

Which diagnostic test is essential for assessing cardiomyopathy?

<p>Cardiac MRI (D)</p> Signup and view all the answers

Which of the following is a hallmark finding of pericarditis during auscultation?

<p>Pericardial friction rub (D)</p> Signup and view all the answers

What surgical intervention is often required for severe cases of cardiomyopathy?

<p>Ventriculomyomectomy (A)</p> Signup and view all the answers

Which medication class is NOT typically used in the management of myocarditis?

<p>Antipsychotics (B)</p> Signup and view all the answers

What finding would be suggestive of cardiac tamponade?

<p>Increased heart rate with hypotension (B)</p> Signup and view all the answers

In cases of suspected myocarditis, which viral agents are commonly associated?

<p>Coxsackie virus A and B (D)</p> Signup and view all the answers

What is a significant dietary recommendation for patients with heart inflammatory disorders?

<p>Sodium restriction (B)</p> Signup and view all the answers

Which assessment finding is crucial in diagnosing pericarditis?

<p>Elevation of ST segments on ECG (B)</p> Signup and view all the answers

What is typically the primary management for a patient diagnosed with pericarditis?

<p>Administration of NSAIDs and corticosteroids (C)</p> Signup and view all the answers

What is the pathophysiological basis for rheumatic carditis?

<p>Infection following group A streptococcal infection (C)</p> Signup and view all the answers

Which assessment finding is characteristic of infective endocarditis?

<p>Enlarged spleen (A)</p> Signup and view all the answers

Which laboratory test is crucial for diagnosing inflammation associated with rheumatic fever?

<p>C-reactive protein test (D)</p> Signup and view all the answers

What is the primary treatment approach for rheumatic fever to prevent complications?

<p>Intravenous antibiotics and prophylactic measures (C)</p> Signup and view all the answers

Which microorganism is commonly associated with causing infective endocarditis?

<p>Staphylococcus aureus (A)</p> Signup and view all the answers

Which clinical manifestation would be consistent with rheumatic fever?

<p>Spotty rash that quickly disappears (B)</p> Signup and view all the answers

Which of the following risks is most associated with the development of infective endocarditis?

<p>Invasive procedures like cardiac catheterization (D)</p> Signup and view all the answers

Which of the following nursing interventions is critical for a patient diagnosed with infective endocarditis?

<p>Monitoring vital signs, especially for signs of systemic infection (D)</p> Signup and view all the answers

Which of the following symptoms is NOT typically associated with acute pericarditis?

<p>Cold extremities (C)</p> Signup and view all the answers

What is the primary rationale for immediate intervention in a patient with thrombophlebitis?

<p>To prevent potential embolism (A)</p> Signup and view all the answers

Which finding is commonly associated with myocarditis and is characterized by sharp chest pain that is relieved by sitting up?

<p>Sharp stabbing or squeezing chest discomfort (D)</p> Signup and view all the answers

When assessing a patient for Buerger disease, which finding would be least expected?

<p>Thickened nails (A)</p> Signup and view all the answers

What is the primary pathological change in cardiomyopathy?

<p>Loss of ability to pump blood efficiently (A)</p> Signup and view all the answers

Which treatment strategy is generally recommended for managing thromboangiitis obliterans?

<p>Tobacco cessation (A)</p> Signup and view all the answers

In assessing a client with potential pericarditis, which combination of assessment findings is crucial?

<p>Chest pain and friction rubs (B)</p> Signup and view all the answers

Which finding is indicative of pericarditis during auscultation?

<p>Pericardial friction rub (D)</p> Signup and view all the answers

What is a common non-surgical management strategy used in both myocarditis and pericarditis?

<p>Rest and analgesics (D)</p> Signup and view all the answers

What is a critical nursing management concern for a client with thrombophlebitis?

<p>Monitoring for signs of infection (B)</p> Signup and view all the answers

Which of the following is a specific symptom of restrictive cardiomyopathy?

<p>Exertional dyspnea (B)</p> Signup and view all the answers

Which assessment finding typically indicates worsening severity in patients with thrombophlebitis?

<p>Increased calf size (D)</p> Signup and view all the answers

What is the role of echocardiography in diagnosing infectious and inflammatory disorders of the heart?

<p>Detecting structural abnormalities (C)</p> Signup and view all the answers

In the context of diagnosing Buerger disease, which symptom signifies chronic ischemia?

<p>Intermittent claudication (A)</p> Signup and view all the answers

Which diagnostic method is least commonly utilized for detecting thromboangiitis obliterans?

<p>Anticoagulant therapy response (C)</p> Signup and view all the answers

Which symptom may suggest advanced cardiac tamponade linked to pericarditis?

<p>Neck vein distention (D)</p> Signup and view all the answers

What would be a significant nursing intervention for managing a patient with acute pericarditis?

<p>Implementing a sterile dressing on the pericardiocentesis site (B)</p> Signup and view all the answers

During nursing management of a patient with myocarditis, which intervention is priority?

<p>Limiting activity and monitoring vital signs (D)</p> Signup and view all the answers

Which laboratory marker is typically elevated in cases of pericarditis due to inflammation?

<p>C-reactive protein (C)</p> Signup and view all the answers

What's an accurate assessment finding linked to hypertrophic cardiomyopathy?

<p>Syncope and chest pain (A)</p> Signup and view all the answers

Flashcards

Rheumatic Fever

An inflammatory condition following a group A streptococcal infection, affects the heart.

Rheumatic Carditis

Inflammation of the heart caused by rheumatic fever.

Infective Endocarditis

Inflammation of the inner lining of the heart, caused by microorganisms.

Bacterial Endocarditis Risk Factor

Previous strep throat infection is a risk factor as streptococcus bacteria can lead to endocarditis.

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Infective Endocarditis Assessment

Fever, chills, muscle aches, joint pain, specific skin lesions (Osler nodes, etc.), enlarged spleen, a heart murmur.

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Rheumatic Fever Assessment

Mild fever, rapidly beating heart, abnormal rhythm, spots on skin, that disappear quickly and leave circles on the skin, swollen warm, red, and painful joints. Heart murmur, pericardial friction rub.

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Endocarditis Diagnostic Tests

Tests like ESR, ECG, and C-reactive protein, to assess inflammation and infection.

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Bacterial Endocarditis Causes

Prolonged IV therapy, cardiac pacemakers, and catheterizations, Foley catheters can increase the risk of the development of infective endocarditis.

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Myocarditis

Inflammation of the heart muscle.

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Cardiomyopathy Types

Three types: Dilated (heart stretches), Hypertrophic (thicker heart muscle), Restrictive (stiff heart muscle).

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Pericarditis

Inflammation of the pericardium (sac around the heart).

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Cardiac Tamponade

Acute compression of the heart, often due to fluid buildup around it.

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Pulsus Paradoxus

Abnormal decrease in pulse pressure during inspiration.

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Diagnostic Finding for Myocarditis, Heart inflammation

Usually involves blood tests (WBC, CRP), ECG, echocardiography, and potentially chest X-rays.

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Myocarditis Assessment Findings

Sharp chest pain (resembles MI), fever, tachycardia, dyspnea, fatigue, cyanosis, and S3 heart sound.

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Pericarditis Assessment Findings

Fever, malaise, chest pain (better sitting/leaning forward), pericardial friction rub and severe hypotension.

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Cardiomyopathy Diagnostic Tests

Chest x-rays, ECG, echocardiogram, cardiac MRI, and cardiac catheterization are often needed.

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Pericarditis Diagnostic Tests

ECG (especially elevated ST segment), chest X-rays, echocardiogram, white blood count (WBC), and erythrocyte sedimentation rate (ESR).

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Pericardiocentesis dressing care

Monitor dressing for bleeding or fluid leaks after pericardiocentesis, a procedure to relieve pericardial fluid.

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Pericarditis assessment

Common signs of pericarditis include chest pain, friction rubs (a scratching sound), and sometimes elevated cardiac enzymes.

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Thrombophlebitis

Inflammation of a vein with a clot (thrombus).

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Virchow triad

Factors contributing to thrombophlebitis: venous stasis, altered blood clotting, and vein damage.

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Thrombophlebitis assessment

Look for discomfort and swelling, heat, redness, or decreased capillary refill in an affected extremity. Monitor signs of a possible pulmonary embolism (PE).

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Buerger disease

Inflammation of blood vessels, causes clotting and tissue damage.

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Buerger disease symptoms

Symptoms include cold, numbness, burning, and tingling, leg cramps (claudication), and skin changes.

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Buerger disease treatment

Treatment focuses on stopping smoking, exercises, pain relief, and in some cases surgery.

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Thrombophlebitis diagnostic tools

Tools to diagnose include Doppler ultrasound, venography, and impedance plethysmography.

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Thrombophlebitis management

Management includes medication like anticoagulants, compression bandages, and potentially surgical options.

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Rheumatic Fever Cause

Rheumatic fever develops after a group A streptococcal infection, usually strep throat.

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Infective Endocarditis Cause

Infective endocarditis is inflammation of the heart lining caused by microorganisms like bacteria, fungi, or viruses. It can occur after procedures like IV therapy or catheterizations.

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Infective Endocarditis Signs

Signs include fever, chills, muscle aches, joint pain, specific skin lesions (Osler nodes, splinter hemorrhages, Janeway lesions, Roth spots, petechiae), enlarged spleen, and a heart murmur.

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Rheumatic Carditis Assessment

Look for mild fever, rapid heartbeat, irregular rhythm, skin rash, and swollen, painful joints. You may also hear a heart murmur or pericardial friction rub.

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Bacterial Endocarditis Risk

Previous strep throat infection is a risk factor for bacterial endocarditis.

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Infective Endocarditis Management

Treatment typically involves IV antibiotics like penicillin, vancomycin, or Zithromax. In severe cases, surgery may be needed for heart valve repair or replacement.

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Rheumatic Fever Management

Treatment includes IV antibiotics to treat the infection and medications to prevent blood clots. Other measures include bed rest, diversion activities, and prophylactic antibiotics.

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What is Myocarditis?

Inflammation of the heart muscle, often caused by viral, bacterial, fungal, or parasitic infections.

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Cardiomyopathy

A condition where the heart muscle loses its ability to pump blood efficiently.

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Dilated Cardiomyopathy

A type of cardiomyopathy where the heart chambers become enlarged and weakened.

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Hypertrophic Cardiomyopathy

A type of cardiomyopathy where the heart muscle thickens abnormally.

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Restrictive Cardiomyopathy

A type of cardiomyopathy where the heart muscle becomes stiff and less flexible.

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Pericarditis Management

Managing Pericarditis involves treating the underlying cause (e.g., infection), providing pain relief, and addressing complications like cardiac tamponade.

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Buerger's Disease Risk Factor

Smoking is the primary risk factor for Buerger's Disease.

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Buerger's Disease Assessment

Look for telltale signs like cold extremities, numbness, burning, tingling, leg cramps (claudication), and skin changes.

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Buerger's Disease Management

Management focuses on quitting smoking, doing specific exercises, managing pain, and potentially surgical options.

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What are three types of Cardiomyopathy?

Dilated cardiomyopathy (heart stretches), Hypertrophic cardiomyopathy (heart muscle thickens), and Restrictive cardiomyopathy (heart muscle becomes stiff).

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What are some assessment findings of Myocarditis?

Sharp chest pain (resembles MI), fever, tachycardia, dyspnea, fatigue, cyanosis, and S3 heart sound.

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What is Pericarditis?

Inflammation of the pericardium (sac around the heart).

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What are some assessment findings of Pericarditis?

Fever, malaise, chest pain (better sitting/leaning forward), pericardial friction rub and severe hypotension.

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What is Cardiac Tamponade?

Acute compression of the heart, often due to fluid buildup around it.

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What is Pulsus Paradoxus?

Abnormal decrease in pulse pressure during inspiration.

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What are some diagnostic tests for Pericarditis?

ECG (especially elevated ST segment), chest X-rays, echocardiogram, white blood count (WBC), and erythrocyte sedimentation rate (ESR).

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What is the medical treatment for Pericarditis?

Rest, analgesics, antipyretics, NSAIDs, and corticosteroids may be used.

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What is the surgical treatment for Pericarditis?

Pericardiocentesis, pericardiostomy, pericardiectomy, and decortication may be performed.

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Study Notes

Infectious and Inflammatory Disorders of the Heart

  • Rheumatic Fever and Rheumatic Carditis

    • Pathophysiology: follows group A streptococcal infection
    • Rheumatic carditis: inflammatory cardiac manifestations of rheumatic fever
    • Assessment Findings: mild fever, rapid heart rate, abnormal rhythm, rash (red, spotty), swollen warm, red, and painful joints, heart murmur, pericardial friction rub
  • Infective Endocarditis

    • Pathology: inflammation of inner heart tissue (autoimmune response)
    • Microorganisms: bacteria, streptococci, staphylococci, fungi (see Table 23-1)
    • Causes: prolonged IV therapy, cardiac pacemaker/catheterization, Foley
    • Assessment Findings: fever, chills, muscle aches, joint pain, Osler nodes, splinter hemorrhages, Janeway lesions, Roth spots, petechiae, enlarged spleen, heart murmur
  • Myocarditis

    • Pathophysiology: inflammation of heart muscle layer
    • Causes: viral, bacterial, fungal, or parasitic infection (e.g. Coxsackie viruses A and B, influenza A and B, measles, mumps, Epstein-Barr virus, COVID-19)
    • Assessment Findings: sharp stabbing or squeezing chest discomfort (resembles MI), low-grade fever, tachycardia, dysrhythmias, dyspnea, fatigue, cyanotic skin, crackles, S3 galloping rhythm
  • Pericarditis

    • Pathophysiology: inflammation of pericardium, primary or secondary (with or without effusion)
    • Secondary to: endocarditis, myocarditis, chest trauma, MI, post-cardiac surgery
    • Cardiac tamponade: acute compression of the heart, pulsus paradoxus (see Nursing Guidelines 23-1)
    • Assessment Findings: fever, malaise, heaviness in chest, precordial pain, worsening pain with movement/breathing, relief with upright posture, pericardial friction rub, severe hypotension

Diagnostic Findings, Medical and Surgical, and Nursing Management (Infectious and Inflammatory Disorders of the Heart)

  • Diagnostic Findings: anemia, leukocytosis, blood cultures, transesophageal echocardiography, ECG
  • Medical and Surgical Management: high doses of IV antibiotic therapy, bed rest, valve replacement (see Drug Therapy Table 23-1)
  • Nursing Management: limit activity, assess for changes in weight, pulse rate, and rhythm, administer antibiotics, monitor cardiopulmonary status, VS, I&O, daily weights, LS, SpO2, maintain BR, O2

Inflammatory Disorders of the Peripheral Blood Vessels

  • Thrombophlebitis

    • Pathophysiology: inflammation of a vein with clot/thrombus formation (DVT, PE)
    • Inner vein is irritated or injured; platelets clump together
    • Virchow triad: venous stasis, altered blood coagulation, trauma to the vein (causes)
    • Assessment Findings: calf pain that increases with dorsiflexion (Homans sign), heat, redness, and swelling, capillary refill < 2 seconds, fever, malaise, fatigue, anorexia
  • Thromboangiitis Obliterans (Buerger Disease)

    • Pathophysiology: inflammation of blood vessels with clot formation and fibrosis of the blood vessel wall
    • Assessment Findings: cold, numbness, burning, and tingling in feet, intermittent claudication (leg cramps after exercise), pain at rest, cyanosis and redness of feet and legs, skin: mottled purplish-red, thin and shiny, sparse hair growth, black gangrenous areas on toes and heels
    • Medical Management: tobacco restriction, Buerger-Allen exercises, analgesics, sympathectomy
    • Nursing Management: history of pain (increased or decreased), examine extremities, nails, skin, temperature, peripheral pulses, capillary refill. See client and family teaching 23-4

Additional Information

  • Medical and Surgical Management (Inflammatory Disorders of Peripheral Blood Vessels): Doppler ultrasound, venography, impedance plethysmography (IPG), ambulation, compression bandaging, anticoagulant therapy
  • Medical and Surgical Management (Additional): diuretics, digitalis, antihypertensives, antidysrhythmic, anticoagulants, corticosteroids, dietary sodium restriction, pacemaker, defibrillator, ventriculomyomectomy, transplant
  • Nursing Management (Infectious and Inflammatory Disorders of the Heart): administer prescribed drug therapy, diversion activities, bed rest, prophylactic antibiotics. Limit activity, assess for changes in weight, pulse rate, and rhythm; administer antibiotics. Monitor cardiopulmonary status, VS, I&O, daily weights, SpO2, maintains BR, O2

Question #1

  • Correct Answer: B) Strep throat 4 weeks earlier
  • Rationale: Bacterial endocarditis is associated with upper respiratory infection caused by the Streptococcus bacteria.

Question #2

  • Correct Answer: E) All of the above
  • Rationale: The signs and symptoms of inflammatory disorders of the heart include diaphoresis, chest pain, friction rubs, and elevated cardiac enzymes.

Question #3

  • Correct Answer: C) The condition is associated with smoking.
  • Rationale: Buerger's disease is an inflammatory process affecting medium-sized arteries/veins of the legs, leading to occlusion of circulation. Smoking exacerbates the process.

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Test your knowledge on infectious and inflammatory disorders of the heart, including rheumatic fever, infective endocarditis, and myocarditis. This quiz covers pathophysiology, assessment findings, and key microorganisms involved in these conditions. Dive deep into heart diseases and enhance your understanding of cardiovascular health.

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