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NUR 397-600 Adult I - Medsurg Exam 2 Study Guide.
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NUR 397-600 Adult I - Medsurg Exam 2 Study Guide/NUR 397-600 Adult I - Medsurg Exam 2 Study Guide.
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Inflammatory Heart Disease Endocardial Disease – infective organism invades endothelial lining of heart involving one or
more valves
Rheumatic endocarditis → infection of endocardium(inner layer of heart) secondary to strep
bacteria. Causes lesions in heart.
o s/s → fever, chest pain, tachy, SOB, systemic symptoms:rash on trunk, joint pain, muscle
spasms. PE: murmur, friction rub
Infective endocarditis → infection of endocardium secondary to strep or staph bacteria. Damage
to endothelial surface- attachment of infective organism to valves.
o s/s → flu-like symptoms. PE: murmur, petechiae, +blood clot
Myocarditis → inflammation of myocardium. Myocyte destruction and necrosis. Secondary to
viral, fungal, bacterial infection.
Pericarditis → outermost layer (heart encased in thin, fibrous layer)
o Need to r/o pleural effusion, tamponade- pericardiocentesis if that is the case
o Inflammation of pericardium → Both visceral(inner) & parietal(outer) layers -Viral
infection – Echovirus & coxsackievirus - s/p URI - Bacterial infection – Staph, Strep -2/2
MI – infarction pericarditis
o inc cardiac enzymes → blunt chest trauma s/s: chest pain/pressure “sharp or stabbing”
SOB
o PE: pericardial friction rub auscultated – scratchy sound. Pain relieved when sitting &
leaning forward Pericardial effusion: rub? Decreased heart sounds tamponade (Becks
Triad) *caution with a/c therapy
o Risk factors – common causes
Heart valve replacement, Intravenous drug abuse, Immunosuppression: HIV,
Cancer pt Rheumatic Fever, other infections. Malnutrition Overcrowded areas–
urban life Lower socioeconomic status
o Diagnostics/ Treatment → Dx: Lab Tests Blood cultures CBC w Diff, inc WBC– infection?
Cardiac enzymes – inc with pericarditis, ESR(erythrocyte sedimentation rate) how quickly
blood settles at the bottom of the test tube. Fast means inflammation. CRP (c-reactive
protein) (both are inflammatory markers) inc Throat. Cx: strep+? Can lead to RF Dx
Procedures EKG– heart block? ST changes Echo – inflamed heart layers Vegetation on
valve (bacterium), administer O2, administer abx, pain meds and antipyretics, encourage
rest-dec myocardial O2 demand and prevent further myocardial damage
o Tx for strep infections, prophylactic abx - HIGH RISK PTS, vaccine-up to date? Flu and
pneumonia vaccines, monitor for bleeding and cardiac tamponade
o Prophylactic antibiotic therapy: high risk patients.
o Complications from IE Infection of endocardium 2/2 strep or staph bacteria. Damage to
endothelial surface - attachment of infective organism to valves. Intravenous drug abuse.
Patients with cardiac malformation, S/S fever and flu like symptoms. PE murmur
petechiae + blood CX.
Aneurysms:
Risk factors→ advanced age, hx of HTN, smoking, atherosclerosis TEST QUESTION, connective
tissue disorders, diabetes, trauma
Common causes → congenital, mechanical, traumatic (pseudoaneurysms), inflammatory
(noninfectious), infectious (mycotic), pregnancy-related degenerative, anastomotic (post
arteriotomy)
Complications→
o aortic dissection- may be caused by sudden tear in aortic intima, opening way for blood
to enter aortic wall.
Pain- tearing, ripping, stabbing, excruciating; moves from point of origin- may be
located in the anterior chest, back, neck, throat, jaw
Circulation to any major artery can be impaired- neuro, renal, iliac, femoral
BP elevated unless tamponade or rupture
, o Complications of major arteries affected:
Dissection of carotid artery → neurologic symptoms
RN interventions → control the underlying dx/risk factors, prevent tissue damage, improve blood supply
o Position- avoid crossing legs, elevate legs to reduce swelling
o Warmth
o Exercise- builds collaterals
o Avoid vasoconstrictors → exposure to cold, avoid stress, caffeine, smoking
o Promote vasodilation → warm environment, insulated socks
o Meds → antiplatelet- reduce blood viscosity (ASA, clopidogrel (plavix)), statins
PVD → want legs elevated
o Damage or blockage in the blood vessels distant from the heart
(Arterial)
o Control the underlying disease/ risk factors
o Prevent tissue damage
o Improve blood supply
o Position – avoid crossing legs
o Avoid stress, caffeine, smoking
o Warm environment
o Insulated socks
o Lower legs (not elevate!)
(Venous) Venous obstruction= edema (from an embolus or incompitent valves)
o DVT
Rest, Warm compress, Do not massage limb, Compression stockings
Meds – AC – IV Heparin – SQ Heparin/ Lovenox → bridge to PO (Coumadin,
Pradaxa) *assess bleeding
o Venous insufficiency
Elevate legs / feet
Avoid crossing legs
Elastic compression stockings
o Varicose veins
Elastic stockings
APAP for pain
Care plans
o Antiplatelet – reduce blood viscosity
ASA
clopidogrel Plavix
o Statins
Simvastatin Zocor
Atorvastatin Lipitor
Complications
o Compartment syndrome
Medical emergency!
Tissue pressure within a confined body space restricts blood flow and results in
ischemia – can lead to irreversible tissue death!
Loosen dressings/ clothes
HTN:
Risk factors → atherosclerosis, HF, stroke, kidney failure, obesity.
, Normal fasting blood glucose → 70-110
Wbc → 5-10
RBC → 4-6
HgB → 12-14 (F) 14-18 (M)
Hct → 3x HgB
Platelets → 150,000-400,000
Na → 135-145
K → 3.5-5
Ca → 9.1 -10.9
Creatinine → 0.5-1.2
BUN → 10-20
Dysrhythmia management:
Electrical therapies:
Cardioversion- usually synched on pts R wave or counter shocked to pts underlying rhythm
o During ventricular depolarization
o Used during a-fib, a-flutter, v-tach with pulse
o Use a lot less jules (energy used when de-fibing) more beneficial and efficient to the
heart
Defibrillation-
o Use higher jules (200-300)
o V-fib, v-tach with no pulse
o Not synched
Defibrillation safety → call “all clear: and check that no one is in contact with bed or pt, re-assess
rhythm- assess pulse, resume CPR in between shocks, inspect skin under paddles for burns
Implantable cardioverter defibrillator (ICD) (last resort)→ background and uses: brady, VT
(pulseless), V-fib, shocks or paced beats, failed drug therapy, surgery, or catheter ablation.
Cardiac arrest? initiate CPR & ACLS protocols, Can externally defibrillate a client with an ICD as
long as the paddles aren’t placed directly over the pulse generator
Pacemakers → check EKG for proper sensing and capture, monitor for dysrhythmias, assess for
signs of decreased CO, prevent infection-site assessment
o Patient/family education
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