Sherpath - Chapter 40 - Myocarditis, Rheumatic Fever, and Rheumatic Heart Disease

Which action would the nurse take to assess for subcutaneous nodules in a patient with rheumatic fever (RF)? Assess in good light because the rash is hard to see. Palpate over all bony surfaces and along extensor tendons of the hands and feet. Palpate over fingertips, palms, soles of the feet, and/or toes. Look for lesions with an eye examination.

Palpate over all bony surfaces and along extensor tendons of the hands and feet.Inspect the skin for subcutaneous nodules and erythema marginatum. Palpate for subcutaneous nodules over all bony surfaces and along extensor tendons of the hands and feet. The nodules range in size from 1 to 4 cm and are hard, painless, and freely movable.

Which organism can cause myocarditis? Select all that apply. One, some, or all responses may be correct. Viruses Bacteria Fungi Amoebae Parasites

Viruses Myocarditis is a focal or diffuse inflammation of the myocardium. One of the causes of myocarditis is viruses. Coxsackie A and B viruses are the most common causative agents. Bacteria Myocarditis is a focal or diffuse inflammation of the myocardium. Bacteria can cause myocarditis. Fungi Myocarditis is a focal or diffuse inflammation of the myocardium. One cause of myocarditis is fungi.

Which cardiac valves are most often affected in infective endocarditis (IE)? Tricuspid and aortic Mitral and tricuspid Aortic and mitral Pulmonic and aortic

Aortic and mitral Rheumatic IE is found mainly in the valves, with swelling and erosion of the valve leaflets. Valve leaflets may become calcified, resulting in stenosis. The less mobile valve leaflets may not close properly, resulting in regurgitation. The mitral and aortic valves are most often affected.

Which intervention would the nurse anticipate in the plan of care for a patient with myocarditis who develops severe heart failure? Cardiac transplant Endomyocardial biopsy Immunosuppressive therapy Angiotensin-converting enzyme (ACE) inhibitors and ß-blockers

Cardiac transplant Although most patients recover spontaneously, some develop dilated cardiomyopathy. If severe HF occurs, the patient may need a heart transplant.

Which finding is normally noted on a chest x-ray in a patient with rheumatic fever (RF)? Lung infiltrates Enlarged heart Calcium in the arteries of the heart Atelectasis

Enlarged heart An enlarged heart can be found on a chest x-ray in patients with RF.

Which assessment finding supports the diagnosis of rheumatic fever? Osler's nodes Janeway's lesions Roth's spots Erythema marginatum

Erythema marginatum Erythema marginatum is an assessment finding consistent with rheumatic fever. It can occur on the trunk and inner aspects of the upper arm and thigh. Assess for these bright pink maculae in good light because the rash is hard to see, especially in patients with dark skin.

Which pharmacologic intervention would the nurse incorporate into the plan of care for a patient with myocarditis caused by autoimmune disease? Antiinflammatories Anticoagulants Antiarrhythmics Immunosuppressive agents

Immunosuppressive agents Myocarditis with an autoimmune basis is treated with immunosuppressive agents to reduce heart inflammation and damage.

Which function does digoxin perform to increase cardiac output? Reduces fluid volume and preload Reduces clot formation Improves contractility Increases heart rate

Improves contractility Digoxin improves heart contractility and reduces HR. It is used with caution because of increased sensitivity to the adverse effects (e.g., dysrhythmias) and the potential toxicity.

What information would the nurse provide to the patient regarding an endomyocardial biopsy? It assesses cardiac function. It confirms a diagnosis of rheumatic heart disease .It can be used to detect viral infection in myocardium. It is most diagnostic during the first 6 weeks of acute illness.

It is most diagnostic during the first 6 weeks of acute illness.Endomyocardial biopsy provides histologic confirmation of myocarditis. A biopsy is most diagnostic during the first 6 weeks of acute illness, when lymphocytic infiltration and myocyte damage are present.

Which intervention would the nurse incorporate into the plan of care for a patient with rheumatic carditis? Lifelong prophylactic antibiotics Prophylactic anticoagulants Prophylactic antibiotics for a minimum of 5 years Lifelong prophylactic antiarrhythmics

Lifelong prophylactic antibiotics Patients with rheumatic carditis and residual heart disease (e.g., persistent valve disease) need lifelong prophylaxis. Teach the patient with a history of rheumatic fever (RF) about the disease process and the need for ongoing antibiotic prophylaxis.

Which assessment finding is the most common in rheumatic fever (RF)? Monoarthritis Hyperthermia Erythema marginatum Subcutaneous nodules

Monoarthritis Monoarthritis or polyarthritis is the most common finding in RF. It occurs in up to 75% of patients. The inflammatory process affects the synovial membranes of the joints. This causes swelling, heat, redness, tenderness, and limitation of motion. The larger joints, particularly the knees, ankles, elbows, and wrists, are most often affected.

Which medication would the nurse anticipate administering to a patient with a new diagnosis of rheumatic heart disease? Levofloxacin Penicillin G Aspirin Ibuprofen

Penicillin G Treatment with an initial dose of intramuscular Benzathine Penicillin G is the most widely used antibiotic to treat RHD. If the patient is allergic to penicillin, a narrow-spectrum cephalosporin (e.g., cephalexin), clindamycin (Cleocin), or azithromycin (Zithromax) is used.

Which action would the nurse take to decrease cardiac workload for a patient with myocarditis? Placing the patient in a prone position Positioning the patient in semi-Fowler's Keeping the patient on strict bed rest Placing patient on oxygen

Positioning the patient in semi-Fowler's Focus interventions on improving CO and managing the signs and symptoms of HF. Select nursing measures to decrease cardiac workload. These include placing the patient in a semi-Fowler's position, spacing activity and rest periods, and providing a quiet environment.

Which ECG finding is most consistently seen in rheumatic fever (RF)? T wave inversions Prolonged PR intervals Prolonged QT intervals ST segment elevations

Prolonged PR intervals No single diagnostic test exists for RF. The most consistent ECG change is a prolonged PR interval from delayed AV conduction.

Which statement describes rheumatic heart disease? Select all that apply. One, some, or all responses may be correct. Occurs as a complication after streptococcal pharyngitis Result of damage from an immune response to streptococcus Affects the heart, skin, and joints Affects the heart valves Mainly affects children and young adults Mainly affects the elderly

Result of damage from an immune response to streptococcus Rheumatic heart disease is the result of valve damage from an abnormal immune response to Streptococcus. Affects the heart valves Rheumatic heart disease is chronic scarring and deformity of the heart valves resulting from RF. It is the result of valve damage from an abnormal immune response to Streptococcus. Mainly affects children and young adults Rheumatic heart disease is chronic scarring and deformity of the heart valves resulting from RF. It mainly affects children and young adults.

Which late clinical manifestation is related to the development of heart failure (HF) in myocarditis? Select all that apply. One, some, or all responses may be correct. S3 heart sound Peripheral edema Rhonchi Angina Myalgia Jugular venous distention (JVD)

S3 heart sound Peripheral edema angina Jugular venous distention (JVD)

Which condition would the nurse teach the patient to treat promptly to help prevent rheumatic fever (RF)? Viral pericarditis Staphylococcal fever Streptococcal pneumonia Streptococcal pharyngitis

Streptococcal pharyngitis RF is an inflammatory disease of the heart that occurs as a complication following group A streptococcal pharyngitis. Teach people in the community to seek prompt medical care for symptoms of streptococcal pharyngitis. Early detection and immediate treatment can prevent RF.

Which condition is a central nervous system manifestation of rheumatic fever (RF) characterized by involuntary movements, muscle weakness, and speech and gait problems? Carditis Monoarthritis Sydenham's chorea Erythema marginatum lesions

Sydenham's chorea Sydenham's chorea is the major CNS manifestation of RF. It is characterized by involuntary movements, muscle weakness, and speech and gait problems.

A patient with rheumatic heart disease complains of painful joints. Which supportive care measures should the nurse implement to relieve these symptoms? Select all that apply. One, some, or all responses may be correct. Administering salicylates Applying heat to the affected joints Placing the patient in supine position Repositioning the affected extremities Placing ice packs on the affected joints Administering nonsteroidal antiinflammatory drugs (NSAIDs)

all are correct

Which class of medication is used to manage the symptoms of myocarditis? Select all that apply. One, some, or all responses may be correct. Angiotensin-converting enzyme (ACE) inhibitors Nitroprusside Diuretics Digoxin α-Adrenergic receptor blockers Anticoagulants

all are correct