2023\/ 2024 Update) Multidimensional Care
III\/ MDC 3 Exam| Complete Guide with
Questions and Verified Answers| 100%
Correct – Rasmussen
QUESTION
Valvular Heart disease<\/em>
Answer:
-caused by structural abnormalities
-causes 3 main problems: stenosis, regurgitation, and prolapse.
QUESTION
Most common valvular disease<\/em>
Answer:
MITRAL valve (left atria to left ventricle) and AORTIC valve (left ventricle to aorta)<\/em>
QUESTION
stenosis is<\/em>
Answer:
stiffening due to calcification or thickening<\/em> causes narrowing and prevents normal flow<\/em>
QUESTION
regurgitation is<\/em>
Answer:<\/p>\n\n\n\n
incomplete valve closure caused by fibrotic changes or calcification and causes back flow<\/em> Answer: Answer: Responsibility of the Heart Cardiovascular disease is the Anatomy of the heart Blood flow steps of the heart<\/p>\n\n\n\n Age related changes How do the cardiac valves change with increased age? How does the conduction system change with increased age? How does the left ventricle change with age? How does the aorta and large arteries change with age? How do the baroreceptors work? How do the baroreceptors change in age? Remember that systole is _ and distole is ___<\/em><\/strong> Cycle of the heart Cardiac output = Normal CO range (cardiac output) Stroke volume is stroke volume (preload) stroke volume (afterload) Stroke volume (contractility) Blood pressure is Systolic BP Diastolic BP HEART FAILURE IS 3 major types of heart failure Left sided heart failure Right sided heart failure High output failure These systems try to compensate for heart failure initially being helpful but eventually causing more damage: Risk factors for left sided heart failure Risk factors for right sided heart failure S\/S of Left sided heart failure S\/S of right sided heart failure If the cough in left sided heart failure is pink or tinged it means Diagnostic testing for heart failure Treatment for heart failure Echocardiagram what can an echocardiogram identify Lab tests consist of: Electrolyte panel for heart failure H&H (hemoglobin and hematocrit) B-type natriuretic peptide (BNP) Urinalysis for detecting heart failure ECG tests can identify Medications include meds that improve stroke volume Nutrition therapy When monitoring weight it is important to remember surgical measures for HF What is a main psychosocial factor to help encourage with patients experiencing heart failure? Nursing interventions Prevention of pulmonary edema in a patient with HF Interventions for patient possibly experiencing pulmonary edema When preparing for discharge of a patient with HF Valvular Heart disease Most common valvular disease stenosis is regurgitation is prolapse is Remember the 3 main parts of valvular heart disease Mitral stenosis Mitral stenosis causes this series of problems Risk factors for mitral stenosis S\/S of Mitral Stenosis early and late -Late symptoms (associated with HF): hemoptysis (blood in cough), hepatomegaly (enlargement of liver), neck vein distention, pitting edema. What is a main sign of late stage mitral stenosis Mitral valvular STENOSIS heart disease goes with heart failure while mitral valvular REGURGITATION heart disease goes with<\/em> heart failure Valvular Heart disease Mitral REGURGITATION Risk factors for Valvular heart disease mitral regurgitation S\/S of valvular heart disease mitral regurgitation When right sided heart failure begins from Mitral regurgitation you will see What is the main sigh of mitral regurgitation that is leading to right sided heart failure valvular disease mitral prolapse Risk factors of Valvular heart disease mitral PROLAPSE S\/S of valvular mitral prolapse Main sign of mitral PROLAPSE Valvular disease aortic stenosis Valvular aortic stenosis Risk factors for Aortic Stenosis Main prevention for Aortic Stenosis Signs and symptoms of Aortic Stenosis Main sign of aortic stenosis Valvular disease Aortic Regurgitation Risk factors of Aortic Regurgitation S\/S of Aortic regurgitation main sign of aortic regurgitation ALL OF THE DIFFERENT AUSCULTATION SOUNDS Diagnostic testing for valvular disease Treatment of valvular disease meds Noninvasive heart valve procedures Invasive surgeries for valvular heart disease when a patient is taking coumadin (warfarin) watch for\/educate what preoperatively of heart surgery check for what Infective endocarditis https:\/\/www.youtube.com\/watch?v=wYZbMoWjLEg infective endocarditis prevalence Risk factors of infective endocarditis prevention and risk reduction of infective endocarditis s\/s of infective endocarditis diagnostics and testing for infective endocarditis Treatment for infective endocarditis other considerations for infective endocarditis pericarditis pericarditis is commonly associated with risk factors of pericarditis S\/S of pericarditis Treatment of pericarditis nursing care of pericarditis Cardiac tamponade is How do you assess for cardiac tamponade in relation to pericarditis? Rheumatic Carditis Because Rheumatic carditis causes inflammation in all parts of the heart it : To prevent rheumatic fever which leads to rheumatic carditis you should s\/s of rheumatic carditis diagnostics and testing for rheumatic carditis treatment for rheumatic carditis Nursing care for rheumatic carditis Cardiomyopathy Risk factors for Dilated cardiomyopathy Risk factors for hypertrophic cardiomyopathy Risk factors for restrictive cardiomyopathy Risk factors for Arrythmogenic right ventricular cardiomyopathy S\/s of dilated cardiomyopathy s\/s of hypertrophic cardiomyopathy s\/s of restrictive cardiomyopathy diagnostic testing for cardiomyopathy Treatment of cardiomyopathy surgery for cardiomyopathy nursing care for a patient with cardiomyopathy post op care for patient who underwent surgery for cardiomyopathy What is the most major cause of death post transplant Hypertension what is part of the autonomic nervouse system involved in maintaing BP, along with hormones Types of hypertensions (3) Risk factors of hypertension Untreated hypertension can lead to When to treat high BP according to age S\/S of hypertension Diagnostic testing for hypertension Treatment for hypertension diet education to stop hypertension (DASH) other education for hypertension herbal supplements you MUST discuss with provider Arthersclerosis thrombosis unstable plaque ruptures risk factors for artherosclerosis hyperlipidemia think of HDL as HAPPY CHOLESTEROL and LDL as LOWSY CHOLESTEROL<\/p>\n\n\n\n Remember less cardiac output less oxygen to the body<\/p>\n\n\n\n
QUESTION
prolapse is<\/em>
Answer:
enlarges valve leaflets result in protrusion into the atria during systole<\/em>
QUESTION
Remember the 3 main parts of valvular heart disease<\/em>
Answer:
stenosis, regurgitation, prolapse<\/em>
QUESTION
Mitral stenosis<\/em>
Answer:
-The valve thickens by fibrosis and calcification
-valve prevents normal flow of blood from the left atrium to the left ventricle
QUESTION
Mitral stenosis causes this series of problems<\/em>
Answer:
-increased left arterial pressure
-back flow pressure into the pulmonary arteries eventually into the right ventricle
–the right ventricle hypertrophies and right sided heart failure occurs<\/em>
QUESTION
Risk factors for mitral stenosis<\/em><\/p>\n\n\n\n
-Rheumatic carditis (inflammation of the heart muscle)
-Rheumatic fever (disease from inadequately treated strep throat or scarlet fever)
-Congenital abnormalities
QUESTION
S\/S of Mitral Stenosis early and late
Answer:
-early: dyspnea, orthopnea, paroxysmal nocturnal dyspnea, palpitations (afib), dry cough,
fatigue.
-Late symptoms (associated with HF): hemoptysis (blood in cough), hepatomegaly (enlargement
of liver), neck vein distention, pitting edema.
Rumbling, apical diastolic murmur<\/em>
QUESTION
*What is a main sign of late stage mitral stenosis *
Answer:
Rumbling, apical diastolic murmur<\/em>
QUESTION
Mitral valvular STENOSIS heart disease goes with heart failure while mitral valvular
REGURGITATION heart disease goes with heart failure<\/em>
Answer:
right sided<\/em>
left sided then right<\/em>
QUESTION
Valvular Heart disease Mitral REGURGITATION<\/em><\/p>\n\n\n\n
-fibrotic and calcification changes prevent the mitral valve from closing completely during
systole, causing backflow of blood from ventricle to the atria during contraction because of the
backflow the heart has to compensate by increasing volume and pressure THIS ICNREASED
DEMAND CAUSES VENTRICULAR DILATION AND HYPERTROPHY CAUSING LEFT SIDED HEART FAILURE<\/em>
-overtime it eventually leads to right as well
QUESTION
Risk factors for Valvular heart disease mitral regurgitation<\/em>
Answer:
-mitral prolapse
-rheumatic heart disease
-affects women more than men
-infective endocarditis
-Papillary muscle dysfunction
QUESTION
S\/S of valvular heart disease mitral regurgitation<\/em>
Answer:
S\/S progress slowly and may be assymptomatic for decades<\/em>
-Early signs: fatigue, chronic weakness, anxiety, atypical chest pain, palpitations.
-later signs: dyspnea of exertion, orthopnea.
QUESTION
When right sided heart failure begins from Mitral regurgitation you will see<\/em>
Answer:
-Neck vein distention
-pitting edema
–HIGH PITCHED HOLOSYSTOLIC MURMUR<\/em>
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<\/a><\/figure>\n\n\n\n
-trasnports O2 and CO2
-transports nutrients & wastes
-transports hormones
-protects against disease & infections
-regulates body temp<\/p>\n\n\n\n
leading cause of death in the US<\/p>\n\n\n\n
fist size organ and pumps approx: 60ml with each beat and 5L every minute (can be increased when demand increases)<\/p>\n\n\n\n\n
-cardiac valves
-conduction system
-left ventricle
-aortic & other large arteries
-Baroreceptors<\/p>\n\n\n\n
-murmurs appear
-valvular abnormalities result in rhythm changes<\/p>\n\n\n\n
-Pacemaker cell decreases (the regulator of the heart)
-Fibrous tissue & SA node increase (the heart gets thicker)
-Decrease muscle fibers in atrial myocardium and bundle of His
-Conduction time increases (bradycardia possible)<\/p>\n\n\n\n
-size increases (cardiomyopathy)
-walls s tiffen (stroke volume and ejection fraction decrease)
-Fibrotic changes happen (filling speed is decreased and less able to increase cardiac output activity)<\/p>\n\n\n\n
walls thicken and stiffen (main responsibility of hypertension in older adults)<\/p>\n\n\n\n
They have a set point that the blood pressure should be at and make changes to the heart rate to change the blood pressure.<\/p>\n\n\n\n
they become less sensitive bc they are responsible for knowing when to increase or decrease the flow of blood based on the increase or decrease of movement they are responsible for orthostatic changes which lead to increased dizziness and fainting<\/p>\n\n\n\n
-systole is CARDIAC CONTRACTION
-distole is CARDIAC FILLING<\/p>\n\n\n\n
-passive filling of ventricles & atria (diastole)
-Atrial contraction (artial systole) P wave
-Ventricular ejection (ventricular systole)<\/p>\n\n\n\n
heart rate x stroke volume<\/p>\n\n\n\n
4-7 L\/min<\/p>\n\n\n\n
the amount of blood ejected during each contraction impacted by preload, afterload, contractility, and HR<\/p>\n\n\n\n
how much the myocardial ventricle STRETCHES (impacted by volume returning)<\/p>\n\n\n\n
how much RESISTANCE the ventricle must overcome to pump directly related to arterial blood pressure & diameter of blood vessels<\/p>\n\n\n\n
how well the heart can constrict or relax to ensure appropriate FORCE of contraction<\/p>\n\n\n\n
the force of blood exerted against the vessel wall<\/p>\n\n\n\n
the amount of pressure during ventricular systole<\/p>\n\n\n\n
the amount of pressure remaining in the system during diastole<\/p>\n\n\n\n
PUMP FAILURE<\/p>\n\n\n\n
-Left sided heart failure
-Right sided heart failure
-High output heart failure (least common)<\/p>\n\n\n\n
most common
-ineffective left ventricular contraction causing back up to the pulmonary system causing pulmonary congestion<\/p>\n\n\n\n
-results from ineffective right ventricular contraction causing back up to the periphery causing peripheral edema<\/p>\n\n\n\n
-not as common
-cause by conditions that increase metabolic needs (septicemia, anemia, hyperthyroid)<\/p>\n\n\n\n
-sympathetic nervous system: increased HR and BP
-Renin-angiotensin system activation: angiotensin II contributes to ventricular remodeling causing progressive contractile dysfunction
-Myocardial hypertropy: the walls thicken to provide more muscle mass however too much growth can lead to less oxygenated muscles.<\/p>\n\n\n\n
-african americans
-hypertension
-coronary artery disease
-valvular disease
-cardiomyopathy
-substance abuse
-congenital defects
-cardiac infections
-dysrhythmias
-diabetes
-smoking
-family history
-obesity
-severe lung disease*
-sleep apnea
-metabolic disorders hyperthyroidism*<\/p>\n\n\n\n
-left sided heart failure
-MI on the right side
-Pulmonary hypertension
-severe lung disease*<\/p>\n\n\n\n
-Nocturnal cough
-fatigue
-reduced activity tolerance
-chest discomfort\/ angina
-palpitations or tachycardia
-dyspnea\/ orthopnea
-crackles in lungs
-paroxysmal nocturnal dyspnea
-confusion\/restlessness
-weak peripheral pulses\/ cool extremities<\/p>\n\n\n\n
-peripheral edema
-nausea & anorexia
-jugular vein distention
-enlarged liver\/ spleen
-polyuria at night
-weight gain
-BP changes
-progressive edema from periphery inward<\/p>\n\n\n\n
disease has progressed<\/p>\n\n\n\n
-echocardiogram
-lab tests
-CXR (chest xray)
-ECG<\/p>\n\n\n\n
-medications
-fluid & sodium restrictions
-CPAP
-Surgery (heart transplant or VAD)<\/p>\n\n\n\n
used to determine how well the heart is pumping and is best tool for HR non invasive<\/p>\n\n\n\n
-EF (ejection fraction) (normal 55-70%)
-Can identify valvular changes
-can identify pericardial effusions
-can identify chamber enlargement or ventricular hypertrophy<\/p>\n\n\n\n
-electrolyte panel
-H&H (hematocrit and hemoglobin)
-BNP
-Urinalysis
-ABG<\/p>\n\n\n\n
-sodium
-potassium
-magnesium
-calcium
-chloride
-renal panel<\/p>\n\n\n\n
-identify anemia issues early which can a cause of RIGHT sided HF<\/p>\n\n\n\n
used for diagnosing HF<\/p>\n\n\n\n
proteinuria and specific gravity<\/p>\n\n\n\n
-dysrhythmias
-MI
-Ischemia
-Ventricular hypertrophy<\/p>\n\n\n\n
-ACE & ARBS (reduce afterload)
-Human B-Type Natriuretic Peptides (treat acute HF)
-Diuretics
-Venous vasodilators
-Nitrites
-Digoxin
-Beta blockers
-Inotropic drugs<\/p>\n\n\n\n
-reducing sodium
-Fluid restriction
-monitor I & O
-Daily weight (1 kg = 1 L of fluid)<\/p>\n\n\n\n
-same scale
-in the morning before breakfast
-can be delegated<\/p>\n\n\n\n
-CPAP (helps a person with sleep apnea sleep better)
-CRT (cardiac resynchronization therapy)
-CardioMems (implanted monitoring system)
-Gene therapy
-VAD (ventricular assist devices) an implanted mechanical pump
-heart transplant is most ideal but not available to everyone<\/p>\n\n\n\n
hope the more hopeful they are usually the better outcome<\/p>\n\n\n\n
-anticipate decreasing fatigue
-Monitor for pulmonary edema<\/p>\n\n\n\n
-Monitor for s\/s: crackles, dyspnea, confusion, tachycardia, BP changes, pink tinged sputum, dysrhythmias, anxiety, lethargy<\/p>\n\n\n\n
-sit patient up
-provide oxygen to maintain saturations >90% consider CPAP (machine to breath easier)
-provide Nitro if BP allows
-Lasix or bumex IV<\/p>\n\n\n\n
-diet, activity, meds, weight monitoring
-what to do if symptoms worsen
-smoking cessation
-see provider within 7 days
-ensure ACE or ARB in left ventricular HF
-identify home health needs<\/p>\n\n\n\n
-caused by structural abnormalities
-causes 3 main problems: stenosis, regurgitation, and prolapse.<\/p>\n\n\n\n
MITRAL valve (left atria to left ventricle) and AORTIC valve (left ventricle to aorta)<\/p>\n\n\n\n
stiffening due to calcification or thickening causes narrowing and prevents normal flow<\/p>\n\n\n\n
incomplete valve closure caused by fibrotic changes or calcification and causes back flow<\/p>\n\n\n\n
enlarges valve leaflets result in protrusion into the atria during systole<\/p>\n\n\n\n
stenosis, regurgitation, prolapse<\/p>\n\n\n\n
-The valve thickens by fibrosis and calcification
-valve prevents normal flow of blood from the left atrium to the left ventricle<\/p>\n\n\n\n
-increased left arterial pressure
-back flow pressure into the pulmonary arteries eventually into the right ventricle
-the right ventricle hypertrophies and right sided heart failure occurs<\/p>\n\n\n\n
-Rheumatic carditis (inflammation of the heart muscle)
-Rheumatic fever (disease from inadequately treated strep throat or scarlet fever)
-Congenital abnormalities<\/p>\n\n\n\n
-early: dyspnea, orthopnea, paroxysmal nocturnal dyspnea, palpitations (afib), dry cough, fatigue.<\/p>\n\n\n\n
Rumbling, apical diastolic murmur<\/p>\n\n\n\n
Rumbling, apical diastolic murmur<\/p>\n\n\n\n
right sided
left sided then right<\/p>\n\n\n\n
-fibrotic and calcification changes prevent the mitral valve from closing completely during systole, causing backflow of blood from ventricle to the atria during contraction because of the backflow the heart has to compensate by increasing volume and pressure THIS ICNREASED DEMAND CAUSES VENTRICULAR DILATION AND HYPERTROPHY CAUSING LEFT SIDED HEART FAILURE
-overtime it eventually leads to right as well<\/p>\n\n\n\n
-mitral prolapse
-rheumatic heart disease
-affects women more than men
-infective endocarditis
-Papillary muscle dysfunction<\/p>\n\n\n\n
S\/S progress slowly and may be assymptomatic for decades
-Early signs: fatigue, chronic weakness, anxiety, atypical chest pain, palpitations.
-later signs: dyspnea of exertion, orthopnea.<\/p>\n\n\n\n
-Neck vein distention
-pitting edema
-HIGH PITCHED HOLOSYSTOLIC MURMUR<\/p>\n\n\n\n
high pitched holosystolic murmur<\/p>\n\n\n\n
-valve LEAFLETS enlarge and prolapse into the right atrium during sytole and may progress into mitral regurgitation and left sided heart failure<\/p>\n\n\n\n
-marfan syndrome (an inherited disorder that affects connective tissue)
-congenital cardiac defects
-genetics<\/p>\n\n\n\n
-atypical chest pain
-palpitations
-exercise intolerance
-atrial or ventricular dysrhythmias usually the cause of: dizziness or syncope
systolic click<\/p>\n\n\n\n
systolic click<\/p>\n\n\n\n
-considered a disease of wear and tear
-the CO cannot be increased to meet the body’s demands
-stenosis causes symptoms then progresses to left sided heart failure and eventually right<\/p>\n\n\n\n
is the most common dysfunction<\/p>\n\n\n\n
-congenital bicupsid or unicupsid aortic valves
-rheumatic disease
-arthersoclerosis
-degnerative calcification<\/p>\n\n\n\n
arthersclerotic disease<\/p>\n\n\n\n
-classic: dyspnea, angina, syncope of exertion.
-Late stage: fatigue, peripheral cyanosis, orthopnea, paroxysmal nocturnal dyspnea, narrow pulse pressure.
harsh systolic crescendo-decresendo murmur<\/p>\n\n\n\n
harsh, systolic crescendo-decrescendo murmur<\/p>\n\n\n\n
the aortic valves leaflets do not close properly and leads to LEFT then right heart sided heart failure<\/p>\n\n\n\n
-non rheumatic conditions
-infective endocarditis
-congenital abnormalities
-hypertension
-marfan syndrome<\/p>\n\n\n\n
-major symptoms: exertional dyspnea, orthopnea, paraxysmal nocturnal dyspnea, fatigue.
-In late disease: palpitations, nocturnal angina with diaphoresis.
Blowing, decrescendo diastolic murmur<\/p>\n\n\n\n
blowing, decrescendo diastolic murmur<\/p>\n\n\n\n
-Mitral stenosis (diastolic murmur): Rumbling, apical diastolic murmur
-Mitral regurgitation (systolic murmur): high pitched holosystolic murmur
-Mitral Prolapse: systolic click
-Aortic stenosis (sytolic murmur): *harsh systolic crescendo-decrescendo murmur (diamond shaped murmur)
-Aortic regurgitation (diastolic murmur): blowing decrescendo, diastolic murmur<\/p>\n\n\n\n
-history
-physical assessment
-echocardiogram
-TEE (transesophageal echo)
-ETT (exercise tolerance testing)
-chest x ray
-ECG<\/p>\n\n\n\n
-Anticoagulation (if AFIB is present): Coumadin\/ warfarin drug of choice
-Diuretics, beta blocker, ACEI, digoxin, O2<\/p>\n\n\n\n
-ballon valvuloplasty
-TAVR (transcatheter aortic valve replacement)<\/p>\n\n\n\n
-heart valve repair
-heart valve replacement<\/p>\n\n\n\n
-avoid foods high in vitamin K and use of electric razors<\/p>\n\n\n\n
full dental evaluation and treatment of any dental issues before surgery<\/p>\n\n\n\n
-infection of the endocardium or heart valves caused by viruses, bacteria, or fungi. lesions are caused and then stuff gets stuck in the lesions causing obstruction STENOSIS .<\/p>\n\n\n\n
link for heart stuff<\/p>\n\n\n\n
Common in IVDU intravenous drug users
very high mortality<\/p>\n\n\n\n
-iv drug use
-valve replacements
-alteration in immunity
-structural cardiac defects
-streptococcus aureus
-staphylococcus aureus<\/p>\n\n\n\n
-prophylactic antibiotics for certain conditions when having dental procedures
-assessment of skin in susceptible individuals
-awareness of surgical complications in susceptible individuals<\/p>\n\n\n\n
-severity dependent of infecting organism
-fever associated with chills, night sweats, malaise and fatigue
-identify murmur (all patients with infective endocarditis have a new or changed murmur)
-HF is most common complication of infective endocarditis
-Up to half develop aterial embolization
-anorexia
-petechia or splinter hemorrhages
-oslers nodes (on palms of hands or soles of feet)
-janeways lesions (flattened reddned maculae on hands and feet), positive blood cultures.<\/p>\n\n\n\n
-blood cultures
-echocardiogram
-TEE<\/p>\n\n\n\n
-antimicrobials (usually for 4-6 weeks IV)
-Close adherence to asepsis (high risk of secondary infections)
-Rest balanced with activity
-supportive treatment for new heart failure
-valve replacement
-repair or remove shunts
-valve repair
-abscess drainage<\/p>\n\n\n\n
-prophylactic antibiotics for dental work
-good oral hygeine (but no irrigation or floss)
-Continue IV therapy at home (if appropriate)
-PICC line insertion and education
-Follow up care
-Monitor and keep skin clear
-seek attention if concerned<\/p>\n\n\n\n
-inflammation of the pericardium and the problem can be: fibrous, serous, hemmorhagic, purulent, or neoplastic<\/p>\n\n\n\n
-infection
-Dressler’s syndrome (post MI syndrome
-Post pericardiotomy syndrome
-Systemic connective tissue disorders
-chronic inflammation caused by thickening of the pericardial fibrous tissue (TB, radiation, trauma, CKD, cancer)
-chronic can lead to heart failure<\/p>\n\n\n\n
-infective organism
-post-myocardial infestion syndrome
-post-pericardiotomy syndrome
-acute exacerbation of systemic tissue disorders
-tuberculosis
-radiation therapy
-trauma
-renal failure
-metastic cancer<\/p>\n\n\n\n
-substernal pain
-pain described as “grating” or “oppressive”
-worsening pain with coughing or lying down
-elevated WBC in acute**
-fever in acute**
-ST elevation in all leads**
-Afib possible
-Chronic shows signs of right sided heart failure: JV distention, hepatic engorgement, dependent edema.<\/p>\n\n\n\n
-focused on treating the cause and comfort
-pain management (NSAIDS)
-steroid therapy
-antibiotics for bacterial infective causes
-pericardiectomy
-monitor for complications such as pericardial effusion or cardiac tamponade<\/p>\n\n\n\n
-assess chest pain
-ausculate
-maintain comfortable position
-anti inflammatory meds
-education<\/p>\n\n\n\n
when fluid fills the spaces and encases the heart and heart muscle (seen in pericarditis)<\/p>\n\n\n\n
-pulsus paradoxus
-JV distention with clear lungs
-muffled heart sounds
-decreased cardiac output<\/p>\n\n\n\n
-develops after a URI with Group A-beta- hemolytic streptococci
-occurs in half of the patients with rheumatic fever
-causes inflammation in ALL layers of the heart<\/p>\n\n\n\n
-impairs contractility
-thickens the pericardium
-causes valvular damage
-impacts CO<\/p>\n\n\n\n
get adequate antibiotic coverage for strep infections (penicillin for 10 days)<\/p>\n\n\n\n
-tachycardia
-cardiomegaly
-new murmur or change in murmur
-pericardial friction rub
-ECK changes (prolonger PR interval)
-Indications of HF
-evidence of strep infections<\/p>\n\n\n\n
cultures<\/p>\n\n\n\n
penicillin for primary infection<\/p>\n\n\n\n
-education on antibiotic compliance
-fever management
-hydration
-rest
-antibiotic prophylaxis<\/p>\n\n\n\n
-disease of the myocardium that impedes the pumping ability of the heart
-4 different categories: Dilated, hypertrophic, restrictive, and arthyomogenic right ventricular.
most common is dilated cardiomyopathy<\/p>\n\n\n\n
-alcohol abuse
-chemotherapy
-infection
-inflammation
-poor nutrition
-genetics<\/p>\n\n\n\n
-genetics<\/p>\n\n\n\n
-endocardial or myocardial disease
-sarcoidosis
-amyloidosis<\/p>\n\n\n\n
-family history<\/p>\n\n\n\n
-fatigue
-heart failure LEFT
-Dysrhythmias
-Systemic or pulmonary emboli
-moderate to severe cardiomegaly<\/p>\n\n\n\n
-dyspnea
-angina
-fatigue, syncope
-mild cardiomegaly
-ventricular dysrhythmias
-sudden death common**
-heart failure<\/p>\n\n\n\n
similar to HF<\/p>\n\n\n\n
-history
-echocardiogram
-redionuclide imaging
-angiocardiography during cathertization<\/p>\n\n\n\n
-symptomatic treatment: diuretics, vasodilators (dilated), betablockers (hypertrophic)
-control dysrhythmias
-medications to improve underlying issue<\/p>\n\n\n\n
-ventriculomyomectomy
-percutaenous alcohol septal ablation<\/p>\n\n\n\n
prepare for major surgery
-life expectancy 1 year
-heart class III or IV
-normal or only slightly increased pulmonary vascular resistance
-absence of active infection
-stable psychosocial status
-no evidence of current drug or alcohol use<\/p>\n\n\n\n
-monitor for signs of bleeding and\/or tamponade
-monitor for signs of rejection: sob, fatigue, fluid gain, abdominal bloating, new bradycardia, hypotension, afid or flutter, decreased activity tolerance.<\/p>\n\n\n\n
infection make sure you are performing strict handwashing and asepsis<\/p>\n\n\n\n
Blood pressure is the force exerted by blood during ventricular contraction, against the walls of the blood vessels.<\/p>\n\n\n\n
-Atrial baroreceptors
-Renin-angiotensin system
-Epinephrine
-Norepinephrine<\/p>\n\n\n\n
-Primary: most common caused by an existing health problem
-Secondary: caused by specific disease processes or medications- kidney disease is the most common cause
-Malignant: most severe form where BP increases rapidly to dangerous levels<\/p>\n\n\n\n
-kidney disease
-genetics
-race (african americans are more likely)
-Obesity
-Smoking
-Alcoholism
-Poor diet
-Alcoholism
-Poor diet
-Sedentary lifestyle
-Age
-Diabetes
-Pregnancy
-metabolic disorders
-certain drugs and medications<\/p>\n\n\n\n
stroke, MI, kidney failure, and death<\/p>\n\n\n\n
-Treat BP 150\/90 in > 60 year olds
-Treat BP 140\/90 in < 60 year olds<\/p>\n\n\n\n
-usually none
-headaches
-facial flushing
-dizziness or fainting<\/p>\n\n\n\n
-BP in both arms
-2 or more readings at the same visit (white coat syndrome)
-BMP, Urinalysis, Xray, ECG.<\/p>\n\n\n\n
-diuretics
-beta blockers
-calcium channel blockers
-Angiotensin- converting enzymes (ace) inhibitors
-Angiotensin II receptor blockers (ARBs)<\/p>\n\n\n\n
-encourage intake of veggies, fruits, whole grains
-low fat dairy products, poultry, fish, legumes, non tropical vegetable oils & nuts
-limit sweets, sugar sweetened beverages and red meat
-lower sodium intake <2400 mg per day prefer <1500 mg
-engage in aerobic activity 3-4 times per week for 40+ min<\/p>\n\n\n\n
-stop smoking
-reduce alcohol
-lose weight
-adhere to medication regime
-evaluate stressors
-help identify relaxation techniques<\/p>\n\n\n\n
-Garlic & CoQ10<\/p>\n\n\n\n
arterial walls become thick and heart causing a narrowing that impedes blood flow (usually affects large arteries: coronary artery, aorta, carotid, renal, iliac, femoral arteries)<\/p>\n\n\n\n
is a STABLE blood clot that can obstruct a vessel lumen and can lead to inadequate perfusion and oxygenation to distal tissues<\/p>\n\n\n\n
underlying tissue causes platelete aggregation and rapid thrombus formation which suddenly blocks a blood vessel can cause ischemia & infarction<\/p>\n\n\n\n
-blood vessel damage
-genetics
-hyperlipidemia (high LDL-C, Low HDL-C, High triglycerides)
-diabetes
-obesity
-smoking
-sedentary lifestyle
-stress
-african american or hispanic
-age<\/p>\n\n\n\n
*high LDL, Low HDL-C, High triglycerides)<\/p>\n\n\n\n