Chapter 23
A 41-year-old IV heroin user has been admitted to the hospital with a diagnosis of infective endocarditis and begun on IV antibiotic therapy. The patient is eager to be discharged from the hospital and has asked the nurse when he is likely to be discharged. How should the nurse reply?
"Endocarditis involves a very resilient infection, so it's common to need several weeks of IV antibiotics."
A client needs to have a cardiac valve replacement. The nurse offers client education about the procedures involved—including the benefits and risks. Which client statement indicates the need for more education?
"I'm anxious because I'll need to have cardiopulmonary bypass."
A client is being discharged home with a diagnosis of hypertrophic cardiomyopathy. Which statement by the client demonstrates that he understands the disease process?
"Since this is a heredity disorder, my family members should probably be evaluated for similar symptoms."
Infective Endocarditis (IE)
(formerly called bacterial endocarditis) is inflammation of the inner layer of heart tissue as a result of an infectious microorganism
Mary Seaver is admitted to the pediatrics unit where you practice nursing. She was admitted by her pediatrician due to suspected rheumatic fever. Aggressive antibiotic therapy and comfort measures have been instituted to minimize the long-lasting effects of the systemic inflammation. How long after Mary recovered from her streptococcal infection is it most common for rheumatic fever to develop?
2 - 3 weeks
A 6-year-old client is receiving aggressive antibiotic therapy to minimize the long-lasting effects of a systemic inflammation. Rheumatic fever may develop following streptococcal infection within:
2 to 3 weeks.
A nurse is caring for four clients on the cardiac unit. Which client has the greatest risk for contracting infective endocarditis?
A client 4 days postoperative after mitral valve replacement
effusion
A process by which gas particles pass through a tiny opening
A client with restrictive cardiomyopathy (RCM) is taking digoxin. Because of the risk of increased sensitivity, the nurse should carefully assess the client for which manifestations?
Anorexia and confusion
The nurse is assessing a patient and feels a pulse with quick, sharp strokes that suddenly collapse. The nurse knows that this type of pulse is diagnostic for which disorder?
Aortic regurgitation
The nurse is auscultating the heart sounds of a patient with mitral stenosis. The pulse rhythm is weak and irregular. What rhythm does the nurse expect to see on the electrocardiogram (ECG)?
Atrial fibrillation
A client with a recent myocardial infarction was admitted to the hospital with a new diagnosis of mitral valve regurgitation. Which assessment data obtained by the nurse should be immediately communicated to the health care provider?
Crackles audible throughout the lungs
endocarditis s/s
Fever, weigh loss, joint pain, changing heart murmur, splenomegaly, petechiae, clubbing, CHF signs
A client is diagnosed with rheumatic endocarditis. What bacterium is the nurse aware causes this inflammatory response?
Group A, beta-hemolytic streptococcus
A client has been living with dilated cardiomyopathy for several years but has experienced worsening symptoms despite aggressive medical management. The nurse should anticipate what potential treatment?
Heart transplantation
A client has been diagnosed with DVT and placed on warfarin to decrease the likelihood of developing additional thrombi. The client's most recent prothrombin time (PT) is 2.1. What is the nurse's best action?
Inform the physician, hold the medication, and observe for bleeding.
The staff educator is presenting a workshop on valvular disorders. When discussing the pathophysiology of aortic regurgitation, the educator describes what consequence of this disorder ?
Left ventricular hypertrophy
Myofibrils
Microscopic protein filaments that make up muscle cells.
What should be included in the client teaching instructions for client with thrombophlebitis who is being discharged?
Perform leg exercises each hour. Ambulate as tolerated. Avoid sitting for too long.
The nurse has created a care plan for a client admitted with acute pericarditis and a nursing diagnosis of acute pain related to pericardial inflammation. What is an appropriate nursing intervention for this client?
Placing the patient in the high-Fowler's position with an over-the-bed table for the patient to lean on
A client with infective endocarditis is assessed by the nurse for the presence of Janeway lesions. On inspection, the nurse recognizes these lesions by identifying which characteristic sign?
Red or purple macules found on the palms of the hands
Which intervention should the nurse include in the plan of care for a client with valvular heart disease who is experiencing pulmonary congestion?
Rest and sleep in a chair or sit in bed with head elevated
Which type of cardiomyopathy are characterized by diastolic dysfunction caused by rigid ventricular walls that impair diastolic filling and ventricular stretch.
Restrictive cardiomyopathy (RCM)
The nurse is caring for a client with acute pericarditis. What nursing management should be instituted to minimize complications?
The nurse helps the client with activities until the pain and fever subside.
deep vein thrombosis (DVT).
Thrombi that form in or above the popliteal vein of the leg are at high risk for migration toward the pulmonary circulation;
When auscultating the heart of a client with mitral regurgitation, the nurse would expect to hear:
a diminished S1.
The nurse is obtaining a history from a client diagnosed with hypertrophic cardiomyopathy. What information obtained from the client is indicative of hypertrophic cardiomyopathy?
a parent has the same disorder
Sequelae
a problem resulting from a disease or injury conditions that are a consequence of a disease, include carditis (inflammation of the layers of the heart)
cardiac tamponade
acute compression of the heart caused by fluid accumulation in the pericardial cavity
myocardial disarray
alteration in the usual alignment of myofibrils, the contractile component of muscle tissue
vena caval filter
an umbrella-like filter inserted to trap emboli before they reach the heart and lungs.
The nurse is performing a medication review of a client diagnosed with myocarditis. What medication may have precipitated the client to have myocarditis?
azathioprine
Chorea
characterized by jerky involuntary movements and an inability to use skeletal muscles in a coordinated manner.
cardiomyopathy
chronic condition characterized by structural changes in the heart muscle (1) dilated cardiomyopathy, (2) hypertrophic cardiomyopathy, and (3) restrictive cardiomyopathy
Pulsus paradoxus
difference of 10 mm Hg or more between the first Korotkoff sound heralding systolic blood pressure (BP) heard during expiration and the first that is heard during inspiration.
postphlebitic syndrome
for up to 5 years after the initial episode
pulmonary embolus (PE).
high risk for migration toward the pulmonary circulation; these cases are referred to
Statistics show an increase in the prevalence of infective endocarditis among older adults. Which factor places older adults at risk for developing infective endocarditis?
increased use of prosthetic valve replacements
A client reports headaches and "just not feeling right," which the client blames on ongoing sleep disturbances. Inspection reveals Janeway lesions on the bottoms of the client's feet. These symptoms may indicate:
infective endocarditis.
Thrombophlebitis
inflammation of a vein accompanied by clot or thrombus formation.
Buerger's disease/Thromboangiitis obliterans,
inflammation of blood vessels associated with clot formation and fibrosis of the blood vessel wall. It affects primarily the small arteries and veins of the legs. It occasionally involves the arms.
polyarthritis
inflammation of many joints (inflammation of more than one joint
pericarditis
inflammation of the pericardium
Myocarditis
is an inflammation of the myocardium (the muscle layer of the heart)
Pericardiocentesis
needle aspiration of fluid from between the visceral and parietal pericardium, may be necessary when cardiac output is severely reduced
precordial pain
pain in the anterior chest overlying the heart).
Which cardiomyopathy is not a major type of cardiomyopathy?
peripartum cardiomyopathy
Virchow's triad,
predispose clients to thrombosis and thrombophlebitis.
vena caval plication
procedure that changes the lumen of the vena cava from a single channel to several small channels through the use of a suture or Teflon clip
Venography
radiopaque dye instilled into the venous system, indicates a filling defect in the area of the clot.
rheumatic carditis
refers to the inflammatory cardiac manifestations of rheumatic fever in either the acute or later stage
ventriculomyomectomy
removal of thickened myocardial muscle from the septum
Syncope (fainting)
sudden loss of consciousness, "fainting") or near-syncopal episodes, which the client may describe as "graying out.
Sympathectomy
surgical interruption or suppression of some portion of the sympathetic nerve pathway, is performed to relieve vasospasm
pericardiostomy
surgical opening or window, is made in the pericardium to allow the fluid to drain.
Thrombectomy
surgical removal of a clot, is performed if the clot interferes with venous drainage from a large vein such as the femoral vein.
Impedance plethysmography (IPG)
the preferred test for diagnosing clots in deep veins.
A client is admitted to the hospital with suspected rheumatic endocarditis. What diagnostic test will the nurse anticipate being ordered?
throat culture
A client is admitted to the hospital with suspected rheumatic endocarditis. What diagnostic test will the nurse anticipate being ordered?
throat culuture
decortication
to allow more adequate filling and contraction of the heart chambers.
A client with mitral insufficiency is being treated with quinidine to control tachycardia. When assessing the client, the nurse should observe for signs of:
toxicity
murmur
which is an atypical heart sound, may be the first abnormal sign detected in any type
