med surg cardiac

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What would the nurse assess for as a causative agent in patient who presents to the clinic with Rheumatic Heart Disease?

pharyngeal infection by Lancefield Group A beta-hemolytic Strep

In a patient with Rheumatic Heart Disease, how long does it for the symptoms to develop?

Several weeks after the initial respiratory infection occurs. (1-6 weeks)

What is a unique symptom of Rheumatic Heart Disease?

Erythema marginatum (red raised rash); usually on chest, back, or abdomen

What will the nurse assess for on the EKG of a patient with Rheumatic Heart Disease?

Prolonged P-R interval

A patient presents to the ER with pain in the left chest that radiates to the L shoulder, neck and back.What disorder would the nurse suspect the patient to have?

Pericarditis

How is pericarditis pain different from Myocardial pain?

It increases with inspiration, cough, movement of the trunk, and deep breathing. It is worse when lying flat and better when sitting up leaning forward.

What will the nurse assess for on the EKG of a patient with Pericarditis?

PR interval depression; tachycardia; bradycardia; Atrial Fibrillation

With a patient diagnosed with pericarditis who is having chest pain, what would the nurse assess for on the EKG?

ST segment elevation; T wave inversion without Q wave changes - these changes can remain for weeks to months

The nurse is listening to the heart sounds of a patient diagnosed as having a Pericardial Friction Rub. What is the KEY diagnostic tool in assessing for this disorder?

Heart sounds described as grating, scraping, squeaking, or crunching; the sounds are a result of friction between the roughened inflamed areas of the pericardium

What assessment tool would the nurse use to distinguish between a pericardial and pleural friction rub?

Have the patient hold his/her breath for a few seconds. If it continues, it's a pericardial rub not pleural.

The nurse knows that if the onset of Pericardial Effusion is rapid, an 80mL increase of fluid may cause enough compression of the heart to cause?

Shock and death

The nurse knows what three things are included in the "Beck's Triad" of Cardiac Tamponade?

decreased b/p, jugular vein distention, muffled heart sounds

When assessing a patient with Cardiac Tamponade, the nurse notices that the patient has developed Pulsus paradoxus. The nurse knows that this means?

It is a 10mmHg decrease of systolic b/p on inspiration as a result of pericardial swelling.

What are bacterial antibiotics and TB drugs used for in Cardiac Tamponade?

Used to treat the causative organism

The nurse knows that in a patient with myocarditis, the inflammation can affect what key function of the heart?

Affects the heart's ability to pump; can present as an emergency

What will the nurse assess for on the EKG of a patient diagnosed with Myocarditis?

Diffuse ST segment abnormalities, T wave changes, dysrhythmias and heart block

What are classification of drugs are used as part of immunosuppressive therapy of Myocarditis?

steroids; to reduce cardiac damage if autoimmune factors are present

What would antimicrobials be used for in a patient with Myocarditis?

If the myocarditis developed from a bacterial infection

What are classification of drugs are used in Myocarditis to prevent thrombi on heart walls?

Anticoagulants

What classification of drugs are used as needed in Myocarditis?

Anti-arrhythmics

What classifications of drugs are used in patients with Myocarditis with CHF?

ACE inhibitors, Beta blockers, Dig, Diuretics

A nurse is taking care of a patient who recently had a prosthetic heart valve procedure from having Infective Endocarditis. The nurse knows that the patient can still develop an infection up to how many days and more post op?

Up to more than 60 days post op

The nurse knows that the most common skin bacteria causing Infective Endocarditis is?

Staph aureus

What classifications of drugs are used as IV antibiotic therapy for patients with Infective Endocarditis?

penicillins, cephalosporins, antitubercular drugs or if fungal organism - may require a combination of drugs

The nurse knows that after how many days, a patient with Infective Endocarditis who has no response to antibiotic therapy will need a valve replacement?

7-10 days

What is the blood culture procedure for a patient with Infective Endocarditis?

Blood cultures obtained from different sites 2x or 3x over a 24 hour period and may be incubated over 3 weeks.

What is important for the nurse to remember regarding cultures and antibiotics?

The nurse should always do cultures before administering antibiotics.

The nurse knows that a patient with Infective Endocarditis who is having a tracheo-esophageal echocardiogram (TEE) should be NPO before the procedure for how long?

6 hrs because conscious sedation is used; also observe pt for return of gag reflexes

What is the medical management for a patient with a nursing diagnosis of: Ineffective Tissue Perfusion r/t emboli formation, dislodging of a vegetative growth?

Administer anti-coagulants and monitor for therapuetic levels to keep emboli from forming throughout the body

What is the medical management for a patient with a nursing diagnosis of: Decreased Cardiac Output r/t action of diseased valve, increased body demands 2nd to infection, and 2nd to CHF?

Administer diuretics, inotropic agents, and Na diet to decrease fluid retention

What is the medical management for a patient with a nursing diagnosis of: Hyperthermia r/t the response to the cardiovascular disease process?

Administer antibiotics and anti-pyretic as necessary to treat the causative organism.

The nurse knows that a unique clinical manifestation of Aortic Valve Regurgitation is?

Musset's sign: head bobbing with each heartbeat

What does the nurse know when listening for heart sounds of a patient with Tricuspid Valve Disease?

Murmurs heard become louder with inspiration

The nurse knows that a patient who recieves a biological valve replacement does not usually require what classification of drugs?

Anticoagulants

The nurse knows that a patient on anticoagulant therapy should avoid?

ASA or anti-inflammatory drugs, foods high in vitamin K (green leafy vegetables, brocolli, asparagus, brussel sprouts, cabbage)

What should the nurse teach the patient on anticoagulant therapy about dental procedures?

The need to take antibiotics prior to invasive dental work to prevent endocarditis

Why are anticoagulants used in patients with Dilated Cardiomyopathy?

to prevent emboli

Why are diuretics used in patients with Dilated Cardiomyopathy?

to decrease fluid overload

Why are beta blockers and ACE inhibitors used in patients with Dilated Cardiomyopathy?

They may be able to slow or stop heart muscle damage

Why are antiarrythmics used in patients with Dilated Cardiomyopathy?

Control muscle irritability

Why is Dig used in patients with Dilated Cardiomyopathy?

For symptoms of HF

What classifications of drugs are used in patients with Hypertrophic Obstructive Cardiomyopathy to decrease obstruction and hypercontractility?

Negative inotropic meds (beta-blocking agents, calcium antagonist)

What classifications of drugs are used in patients with Hypertrophic Obstructive Cardiomyopathy and also have atrial fib?

Anticoagulants and Antiarrhythmic agents to prevent sudden cardiac death

What classifications of drugs are used in patients with Restrictive Cardiomyopathy?

antiarrhythmics, diuretics, beta or calcium channel blockers, anticoagulants

What classifications of drugs are used in patients with Arrhythmogenic Right Ventricular Cardiomyopathy?

beta blockers, antiarrythmics

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