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PN2 NUR2571 Exam 2 study guide
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PN2 NUR2571 Exam 2 study guidePN2 Exam 2 study guide
Chapter 25
Heart Failure and Inflammatory Dysfunction
Terms:
Hypertrophy – abnormal enlargement; increase in size and mass of a body part or organ.
Contractility – capability of muscle fibers to shrink
Cardiomyopathy – heart muscle disease
Carditis – inflammation of heart muscle
Prophylactic – preventing or contributing to prevention of disease
Idiopathic – disease state that arises from unknown cause
Endocarditis – inflammation of endocardium (inner heart muscle layer)
Myocarditis – inflammation of myocardium (middle heart muscle layer)
Pericarditis – inflammation of pericardium (thin membrane surrounding whole heart)
Inner to outermost – Endo myo pericardium
Myectomy – removal of offending muscle
Sequla – any abnormality resulting from disease
Valvular regurgitation –backward flow of blood through heart valve
Valvular stenosis – narrowing or constricting of the diameter of a bodily passage or orifice
Petechiae – small pin point hemorrhages
Valvuloplasty –plastic surgery performed to repair a valve in
body Mitral facies – florid appearance with cyanosed cheeks
Heart Failure – when the heart cannot pump enough blood effectively throughout the body.
Two categories – systolic & diastolic.
Systolic – inability of ventricles to contract and pump blood adequate. Diastolic-
decrease in ventricular filling and impaired diastolic filling of left ventricle. Both
lead to decreased amount of blood being circulated to the body.
Most common in 40-75 yo males. Affects both genders equally after 75 yo
Assessment & findings – health history and physical exam focusing on cardio
and
pulmonary system. Hh findings - patient needing increased number of pillows to sleep,
paroxysmal nocturnal dyspnea (wake up at night from shortness of breath d/t fluid in lungs), ask
about shortness of breath and what makes symptoms worse and better?, ask about coping and
family dynamics. Assessment findings – possible increase in bp and rapid hr, auscultated s3,
decreased level of consciousness, extremities cool, pale, cyanotic, edema and poor healing
wounds. R sided HF: swelling of feet and ankles, frequent nocturnal urination, pronounced neck
veins, palpitations, irregular or rapid hr, fatigue, weakness, faintness, palpable dysrhythmias,
weight gain, distended neck vein, enlarged liver, ankle edema. L sided HF: sob, paroxysmal
nocturnal dyspnea, palpitations, tachycardia, cough with frothy blood tinged mucus, fatigue,
weakness, syncope, weight gain, oliguria, fluid retention, heart murmur, extra heart sounds,
dysrhythmic heart rate, lung crackles, decreased basilar lung sounds.
, PN2 NUR2571 Exam 2 study guide
Diagnostic tests – ECG, chest xray, stress tests (exercise test), cbc, Potassium, sodium
and calcium imbalances, fluids and electrolyte levels, cardiac catheterization to see degree of
HF, MRI
Nursing diagnosis – activity intolerance, risk for ineffective breathing pattern, anxiety
Interventions – control volume overload by monitoring sodium and fluid intake, restrict
salt intake and fluids if needed, rx: morphine, diuretics, respiratory support: oxygen in
nonrebreather mas, PEEP intubation and mechanical ventilation, monitor oxygen and ABGs,
position patient for maximum cardio function (dangle legs and elevate head of bed, reassure
patient to reduce anxiety and extra workload on heart. Nurse needs to motivate pt toward healthy
behaviors by reflective listening, expressing acceptance and affirmation, monitor pt readiness to
change, ensure not jumping ahead of pt.
Rx- ACE inhibitors to decrease the pressure of the heart (captopril, enalapril),
ARBs reduce pressure and work overload (bisoprolol, carvedilol), vasodilators,
nitrates, beta blockers, diuretics (furosemide, torsemide), hormones, digitalis, and
aspirin.
Surgery for severe heart failure – heart valve replacement, implant of cardiac
defibrillator, coronary artery bypass grafting. Done under general anesthesia.
Dilated cardiomyopathy – heart muscle results in dilated heart chamber. Leads to weakened,
thin heart muscle wall that is unable to pump blood efficiently throughout body causing HF.
Assessment findings – monitor pt for sob, tiredness, palpitations, syncope, chest pain.
Nursing diagnosis – activity intolerance, risk for ineffective breathing pattern, pain.
Interventions – assess pt family and support, anxiety and depression.
Rx- ace inhibitors, beta blockers, diuretics, anticoagulants, antiarrhythmics.
Surgery – cardioversion, heart transplantation, pacemaker, implant defibrillator.
Hypertrophic cardiomyopathy – increase in size and thickness of heart muscle. Genetic and/or
idiopathic.
Assessment findings – sob, chest pain, palpitations, light headedness, black outs, physical
exam reveals palpable forceful apical pulse and heart murmur. Abnormal ECG
Nursing diagnosis – activity intolerance, risk for ineffective breathing pattern, pain
Interventions – educate pt about physical activity recommendations, weight reduction for
obese pt, moderate alcohol intake, flu vaccine recommended. Avoid overexertion, acute loss of
body fluid volume, fainting situations, hot showers, rx that drop bp quick. Report sudden loss of
consciousness, rapid palpitation, chest pain, sob.
Rx – calcium channel blockers to reduce stiffness of myocardium. Receive
antibiotic prophylaxis before dental procedure.
Surgery – myectomy (removing muscle), heart transplantation.
Arrhythmogenic right ventricular cardiomyopathy – disease where heart muscle is replaced
by fibrous scar and fatty tissue. Genetic link.
Assessment – palpitations, light headedness, fatigue, fainting, syncope. ECG test.
Interventions – lifestyle advice, refrain from over exertion, and activities that increase
heart work overload, encourage and educate obese pt in weight loss, moderate alcohol intake, flu
vaccine. Report symptoms of palpitations, chest pain, changes in consciousness, sob.
, PN2 NUR2571 Exam 2 study guide
Rx – antiarrhythmics, ace inhibitors, diuretics, antigoagulants, prophylactic
antibiotics for pt who have concomitant valvular disease
Surgery – cardioversion, ablation therapy, heart transplant, pacemaker,
defibrillator
Restrictive cardiomyopathy – disease of the ventricular heart muscle where becomes stiff.
Genetic link – have family tested.
Assessment – bibasilar lung crackles, JVD, dependent pitting edema, enlarged liver,
fatigue, sob. ECG test
Interventions –treat symptoms and sequel (abnormality resulting from disease), assess
family and support.
Carditis – inflammation of the heart or heart valves.
3 types: endocarditis, myocarditis, pericarditis.
Endocarditis – infection from bacteria of hearts inner lining (endocardium). Common cause of
sore throat – Group a strep can lead to rheumatic fever and lead to rheumatic heart disease
bacterial endocarditis get antibiotic treatment ASAP to prevent damage.
Assessment – malaise, anorexia, weight loss, cough, back pain, joint pain. Heart
murmurs, janeway lesions (flat, painless red to bluish on palms and soles), petechiae (small pin
point hemorrhages) in conjunctiva. Patient hx of new onset headaches or transient ischemic
attacks.
Diagnostic test – obtain serial blood culture, ECG.
Interventions – prevention FIRST, assess for heart murmurs, embolism, HF, increased
infection, assess effectiveness of antibiotic therapy, pt education and family coping.
Rx- antibiotic therapy long term IV therapy with periodic blood cultures
Surgery – surgical valve repair or replacement
Myocarditis – inflammation of the myocardium (middle muscle layer of heart).
Assessment – fatigue, dyspnea, palpitations, chest discomfort, abd discomfort, heart
murmurs, irregular heart rhythm
Interventions – prevention FIRST, maintain up to date record related to influenza and
hepatitis, reduce heart workload, treat symptoms and causing agent, assess and monitor pt for
heart murmurs and HF, pt educate and pt and family coping.
Pericarditis – inflammation of the pericardium (thin membrane that surrounds the heart).
Assessment – chest pain: sharp and stabbing, fever, dyspnea, abd pain, tachycardia,
febrile state, Beck triad (hypotension, elevated jugular pressure, muffled heart sounds), pulsus
paradoxus.
Diagnostic tests – cbc, erythrocyte sedimentation rate, crp, bun, creatinine, cardiac
enzymes, blood culture, ECG, MRI
Interventions – reduce chest pain, dyspnea and fever, assess vitals, pulse ox, skin color
and temp, pt report sob and weakness, fatigue, telemetry monitoring, AVOID nsaids and
corticosteroids.
, PN2 NUR2571 Exam 2 study guide
Mitral valve prolapse – mitral valve leaflets stretch into atria during systole causing uneffective
closing and blood being pumped back into left atrium. Higher risk in men over 50 but found
more in females over 45.
Assessment – fatigue, sob, light headed, dizzy, syncope, palpitations, chest pain, anxiety,
auscultate heart: will hear systolic click, use TEE for assessing
Interventions – treat symptoms and chest pain, avoid caffeine, alcohol, smoking,
ephedrine, epinephrine. Educate pt on symptoms to report, minimize palpitations, chest pain,
fatigue or autonomic dysfunction. Minimize anxiety, teach about antibiotic prophylaxis prior to
procedures. Exercise for mild MVP. Educate on lifestyle changes, weight loss for obese pt,
hypotensive pt increase salt and fluids. Focal neuro event pt avoid tobacco and oral
contraceptives.
Mitral regurgitation – disorder or mitral heart valve where blood flows from left ventricle into
left atrium during systole. Group Strep A and MI may be cause.
Assessment – fatigue, general weakness, dyspnea, palpitations, cough, systolic murmur,
irregular pulse rhythm.
Interventions – ECG, treat same as CHF
Surgery – mitral valve replacement or valvuloplasty (plastic surgery performed to
repair valve in body).
Mitral stenosis – narrowing or constriction of diameter of mitral valve opening. Caused by
rheumatic heart disease. May lead to pulmonary hypotension and death. Genetic and more
common in women.
Assessment – dyspnea on exertion, fatigue, cough with hemoptysis, chest pain, rheumatic
fever, dysphagia, wave in jugular venous pulse, edema, enlarged liver, ascites, mitral facies
(florid appearance with cyanosed cheeks), diastolic murmur and displaced apex beat, irregular
pulse rhythm.
Interventions – ECG, prevent recurrence, exacerbation and treat symptoms same as
CHF, assess and educate pt: decrease salt intake, avoid strenuous exercise, use antibiotic
prophylaxis of recurrence and prevent infection.
Surgery – valvuloplastly and valvular defusion
Aortic regurgitation – disorder of aortic heart valve where blood back flows through aortic
valve into left ventricle during diastole, of ventricular relaxation. More common in adults.
Genetic and common sequelar of rheumatic fever.
Assessment – increased dyspnea on exertion, fatigue, paroxysmal nocturnal dyspnea,
awareness of forceful pulsations in upper thorax and head, diastolic murmur, increased intensity
of carotid and temporal pulse, widened pulse pressure
Interventions – ECG, MRI, use prophylactic antibiotics to prevent recurrence and
exacerbation.
Surgery – valvuloplasty or valve replacement
Aortic stenosis – narrowing or constriction of the diameter of the orifice between left ventricle
and aorta. Most common valvular disease in men. Has characteristic harsh systolic murmur with
thrill along left sternal border radiating to neck.
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