Term
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Definition
- Ischemia which reduces the blood and oxygen supply causing damage to the left ventricle and the living tissues (chordae tendineae and/or the papillary muscle). - Endocarditis may cause a perforation of a leaflet. After the infection, scarring may cause retraction of the leaflets or chordae tendineae.
- Rheumatic heart disease and the sequelae (scar tissue) is the most common cause of damaged mitral valves in developing countries.
- Congenital malformations may cause various structural abnormalities that prevent the valve from closing completely.
- Left ventricular dilatation enlarges and stretches the muscle, causing the leaflets and chordae tendineae to stretch and possibly rupture.
- Connective tissue diseases such as systemic lupus erythematosus may cause changes in the left ventricle that shortens, stretches, or ruptures the chordae tendineae, and/or papillary muscles |
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Term
| Signs and Symptoms mitral valve regurgitation |
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Definition
The subjective symptoms of_____ are dyspnea, palpitations, fatigue, weakness, and anxiety.
The objective symptoms are tachypnea, confusion, diaphoresis, and cough |
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Term
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Definition
Diagnostic tests include electrocardiography (ECG), doppler echocardiography, or more specifically, transesophageal echocardiography (TEE). A doppler echocardiography uses a transducer on the chest wall to visualize heart structures and the velocity and direction of blood flow through the heart. When the left atria, and/or mitral valve need to be clearly visualized, the transducer is placed in the esophagus (TEE).
The ECG report may show normal sinus rhythm or atrial fibrillation. The TEE provides the best visual images of the mitral valve. |
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Term
| The treatment for mitral valve regurgitation |
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Definition
is similar to heart failure. The treatment plan is based on the onset and severity of symptoms.
Commonly prescribed medications include angiotensin converting enzyme (ACE) inhibitors and anticoagulants (if atrial fibrillation is present). The American Heart Association has guidelines for physicians/providers addressing potential antibiotic prophylaxis.
Surgical management for this condition involves repair or replacement of the heart valve. |
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Term
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Definition
progressive scarring and thickening of the valve leaflets and/or chordae tendineae
narrows and obstructs blood flow into the left ventricle. Increased blood in the left atria causes dilatation and hypertrophy of the atrial muscle.
Pulmonary blood flow becomes congested, causing increased pressure in the pulmonary vasculature. The workload of the right ventricle increases to pump against high pressures in the pulmonary vasculature. |
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Term
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Definition
Rheumatic heart disease: The most common cause is rheumatic heart disease. The mitral valve leaflets and chordae tendinae become progressively thickened and the leaflets may become fused, obstructing flow into the left ventricle.
- Tumor of the left atria (myxoma), a noncancerous primary heart tumor that grows on the atrial septum. The tumor may interfere with blood flow from the left atrium into the left ventricle |
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Term
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Definition
The subjective symptoms of____ are dyspnea (shortness of breath), palpitations, fatigue, and dysphagia (difficulty in swallowing).
The objective symptoms are cough, wheezing, hemoptysis, orthopnea, and a gradual decline in physical activity. |
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Term
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Definition
Diagnostic tests for ______are electrocardiography (ECG), transthoracic echocardiography, and/or transesophageal echocardiography (TEE).
A 12-lead electrocardiogram may demonstrate atrial fibrillation. ATEE will show the size of the left ventricle, the left atrium, and possibly, left atrial thrombus |
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Term
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Definition
The medical management of _____ includes nutrition and daily activity guidelines along with medications. Patients with _____ are advised to restrict sodium intake and to avoid strenuous activities and competitive sports.
Medications may be prescribed that alter coagulation to decrease the risk of atrial thrombus formation. If the patient is in atrial fibrillation, medications will be prescribed to control heart rate. Antibiotic prophylaxis may be prescribed based on the current American Heart Association Guidelines. |
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Term
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Definition
| The incompetent aortic valve allows blood to flow backward from the aorta into the left ventricle. As more blood flows back into the left ventricle, the left ventricle enlarges and the muscle hypertrophies to pump the increased volume of blood. The amount of blood pumped by the heart (cardiac output) decreases |
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Term
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Definition
Endocarditis is an infection of the inner lining of the heart. This infection causes damage to the heart valves and is the most common cause of sudden onset of aortic regurgitation.
Blunt chest trauma can cause damage or a tear in the aorta.
Dissecting aortic aneurysm causes dilatation and possibly tears and rupture of the ascending aorta.
Deterioration of the valve with advancing age. The risk for damage or degenerative changes to the valve increases with advancing age and is made worse with hypertension. Hypertension causes the heart to work harder and increases pressure on the valve, making it more prone to leaks.
Unknown (idiopathic): May be related to a malformed valve. |
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Term
| Signs and Symptoms of aortic regurgitation |
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Definition
The subjective symptoms of ____ are dyspnea, weakness, chest pain, and fatigue.
The objective symptoms are orthopnea, fainting, nodding of the head with each heartbeat, and a bounding pulse. |
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Term
| Diagnostic tests for AOR Regurg |
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Definition
include echocardiography and an electrocardiogram.
Diagnostic findings include diastolic heart murmur and widening pulse pressure (the difference between the systolic and diastolic blood pressure). |
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Term
| The medical management of aortic regurgitation |
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Definition
includes avoidance of physical exertion and competitive sports.
Angiotensin converting enzyme inhibitors (ACE) may be prescribed to decrease afterload or force required by the heart to eject blood out of the ventricles.
Antibiotic prophylaxis may be prescribed based on the current American Heart Association Guidelines.
Surgical management for this condition involves repair or replacement of the heart valve |
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Term
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Definition
is the narrowing of the valve opening between the left ventricle and the aorta.
Pathophysiology
Progressive narrowing of the valve opening obstructs the forward blood flow. To overcome the obstruction, the left ventricle contracts slowly and with force to squeeze blood forward. Thus, the left ventricle enlarges and hypertrophies over time |
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Term
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Definition
The causes of _______ can be congenital or acquired.
Congenital malformations include abnormally shaped and/or unequal-sized valves. In infants, the most common cause is a unicuspid valve. In adults, the problem usually is a bicuspid aortic valve. Degenerative calcifications are caused by inflammatory changes with years of mechanical stress. The risk factors for degenerative changes include diabetes mellitus, hypertension, smoking, and hypercholesterolemia. Rheumatic heart disease can cause progressive fibrosis of the valve edges. Patients often also have mitral valve disease. |
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Term
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Definition
Patients with _________ initially are asymptomatic. Symptoms that do occur usually are present late in the disease process.
NUR211: Health Differences Across the Life Span 1 Module 3
©Excelsior College 2017
The subjective symptoms are dyspnea, palpitations, fatigue, anxiety, and chest pain or angina (this is a danger sign).
The objective symptoms are syncope on exertion, orthopnea, tachypnea, and low blood pressure. |
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Term
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Definition
Diagnostic findings include a systolic heart murmur. An echocardiogram is done to diagnose and monitor the disease process. It is unsafe to do an exercise stress test because the patient may develop ventricular tachycardia.
12-lead electrocardiography may be normal, or it may show conduction defects and atrial fibrillation |
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Term
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Definition
The medical management of ________ includes activity restrictions. Patients with or without symptoms are told to avoid strenuous activity and competitive sports. Medications are prescribed to treat the symptoms of heart failure. Antibiotic prophylaxis is based on the current American Heart Association Guidelines.
Surgical management for this condition involves replacement of the heart valve |
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Term
| The following topics should be included in the teaching plan for valvular disorder |
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Definition
The progressive nature of the specific disease.
Clarification and reinforcement of the medical treatment plan.
The signs and symptoms that need to be reported to the physician/provider.
Basic methods to decrease the risk for infections
Review the annual influenza vaccinations recommendations.
Seek methods to improve medication adherence.
Reinforce nutritional guidelines. Provide guidelines on how to conserve energy.
Encourage smoking cessation techniques. |
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Term
| While caring for patients who have had valve replacement or repair surgeries: |
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Definition
Know the type of operative procedure.
In cases where the native valve has been repaired or replaced with tissue valve, there is generally no need for long-term anticoagulation.
If the native valve has been replaced with a mechanical valve, long-term anticoagulation will be required.
Anticipate patient recovery to be slow. Patients who undergo valve replacement or repair surgeries usually have had heart failure prior to surgery and will require time to heal and recover |
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Term
| are all appropriate nursing interventions for a person with decreased cardiac output. |
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Definition
| Providing rest periods, elevating the head of the bed, and encouraging small, frequent meals |
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Term
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Definition
| indicates decreased blood flow to the brain. There is significant decrease in cardiac output for syncope to occur. Therefore, the patient is at high risk of sudden cardiac death and requires immediate medical attention. |
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Term
| Signs and Symptoms of cardiomyapthy |
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Definition
Symptoms may occur very slowly or initial presentation may be sudden cardiac death.
Subjective symptoms include dyspnea, fatigue, palpitations, dizziness, chest pain, and nausea.
Objective signs include cough, orthopnea, irregular heartbeat, syncope with exertion, peripheral edema, and, in infants, failure to thrive.
The presenting signs and symptoms are often related to the potential complications (heart failure, blood clots, valve dysfunction, dysrhythmias, and/or sudden cardiac death). |
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Term
| The following diagnostic studies are used for cardiomyopathy: |
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Definition
Radiology reports may show an enlarged heart.
The patient may also have pulmonary congestion.
12-lead electrocardiogram is used to observe for dysrhythmias and conduction abnormalities.
Echocardiography is used to assess ventricular function.
Cardiac catheterization is used to assess patency of coronary arteries |
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Term
| Treatment of cardiomyopathy includes |
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Definition
lifestyle changes, exercise, medications, and the use of devices to maintain heart rhythm.
Lifestyle changes recommended to the patient as a means of reducing symptoms include:
Smoking cessation. Avoid alcohol and illegal drug use. Maintain a normal weight; lose excess weight. Restrict sodium intake. Manage stress in life.
Exercise: Patients are advised to exercise per physician or healthcare provider guidelines
Medications: Medications are prescribed according to the type of cardiomyopathy.
Blood pressure control: Hypertension increases the workload of the heart. Medications may be prescribed to lower blood pressure.
Devices surgically implanted to assist the heart function:
Implantable cardioverter defibrillator (ICD) is a device that detects and treats lethal cardiac rhythms.
Artificial cardiac pacemaker is a device that provides electrical stimuli to the heart muscle. A specialized pacemaker called a biventricular pacemaker or resynchronization therapy stimulates both the right and left ventricle coordinating contraction. Ventricular assist device (VAD) is a device that assists the heart in pumping blood.
Surgical treatment for end-stage cardiomyopathy is a heart transplant. The diseased heart is replaced with the heart of a deceased person. |
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Term
| When caring for a patient with cardiomyopathy, |
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Definition
nurses should focus on the following areas:
Anticipate the disease trajectory: Further progression of the disease may be stopped and the disease may be stabilized with medical management.
Educate patients about activity levels: Patients should avoid activities that aggravate symptoms; strenuous, vigorous exercise or when the person cannot carry on a conversation during the activity should be avoided.
Advise patients to avoid dehydration.
If a genetic component is suspected, encourage family members to have follow-up medical screening.
Provide medication education to enhance medication adherence.
Provide information about prevention and/or early treatment of infection.
Refer patients for psychosocial, spiritual support.
Teach patient/families to identify conditions that require immediate medical attention |
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Term
| Hypertrophic cardiomyopathy |
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Definition
is a rare, autosomal dominate condition. Cardiac output is dependent on adequate blood volume entering the heart, so dehydration can be very detrimental.
Straining for a bowel movement can stimulate the vagus nerve (parasympathetic stimulation) and cause a drop in heart rate.
Chest pain can indicate a decrease in cardiac output causing cardiac angina.
Routine physical activity is encouraged; however, strenuous, vigorous activity should be avoided. |
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Term
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Definition
| Helping the patient to identify stressors, teaching methods of stress reduction, referring the patient and the family to counseling, and assisting the patient and the family to identify strengths all help the patient identify and reduce stressors. |
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Term
| In most patients, cardiomyopathy |
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Definition
may be stabilized or even improved with medical management.
Thus, all patients do not require heart transplants.
Smoking cigarettes is strongly discouraged, because by-products of cigarettes decrease oxygen in the blood and cause arterial constriction, decreasing oxygen to the muscles.
In hypertrophic cardiomyopathy, the left ventricle is decreased in size; therefore, it is not true that the left ventricle is always enlarged with cardiomyopathy |
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Term
| NANDA-I nursing diagnoses can be used for the patient with cardiomyopathy |
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Definition
Activity intolerance
Decreased cardiac output
Readiness for enhanced knowledge Fatigue |
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Term
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Definition
Risk Factors: Patients who have congenital heart defects, damaged or artificial heart valves, a past history of endocarditis, or use illicit drugs intravenously are at an increased risk for endocarditis.
Causes: The most common cause of endocarditis is microbial invasion. Bacteria, such as streptococcus or staphlococcus are the frequent microbes. However, viruses and fungi may also be a source of infection. Signs and Symptoms: Signs and symptoms include fever, chills, night sweats, fatigue, muscle aches, dyspnea, cough, petechiae, splinter hemorrhages under the nails, and heart failure.
Diagnostic Tests: Diagnostic tests for endocarditis include blood cultures and echocardiography.
Medical Treatment: Medical treatment is administration of an intravenous antimicrobial for four to six weeks and treatment of symptoms.
Potential Complications: The disease could lead to potential complications such as embolization of part of the vegetation to organs (brain, peripheral arteries, and kidneys), heart failure, or myocardial damage. |
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Term
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Definition
Risk Factors: The risk factors include genetic susceptibility and environmental issues, such as overcrowding and poor sanitation.
Causes: The body’s immune response to group A streptococcus infection of the throat can lead to rheumatic fever.
Signs and Symptoms: Fever; painful, tender, red or hot joints; fatigue; painless nodules underneath the skin; dyspnea; painless, ragged rash; and jerky body movements (St. Vitus dance) could all be signs and symptoms of rheumatic fever.
Diagnostic Tests: The diagnostic tests include the patient’s history and physical findings, blood test for streptococcus antibodies, and echocardiography.
Medical Treatment: Medical treatment includes antibiotics, anti-inflammatory medications, and anticonvulsant medications if the patient’s involuntary movements are severe.
Potential Complications: Rheumatic fever can potentially lead to heart valve damage (stenosis or regurgitation) or heart failure |
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Term
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Definition
Signs and symptoms include subjective complaints of a “cold,” chest pain, abdominal discomfort, myalgias, dyspnea, palpitations, fatigue, and weakness.
Objective findings for ________ include tachycardia, enlarged lymph nodes, pruritic rash, and hypotension. Patients may initially exhibit signs of heart failure or may sustain sudden cardiac death.
Diagnostic Tests: Diagnostic testing begins with the patient’s history and physical examination. Cultures of blood, throat, urine, and stool are obtained. Echocardiography is done to evaluate the heart function and electrocardiography is performed to identify cardiac dysrhythmias.
Medical Treatment: Treatment focuses on the underlying cause and also on providing supportive care. In most cases, myocarditis is a mild disease which resolves itself and the patient recovers completely. However, myocarditis can also lead to severe cardiovascular compromise and death.
Potential Complications: can lead to dysrhythmias, pericarditis, or mild to severe heart failure. |
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Term
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Definition
Signs and symptoms include anxiety, difficulty breathing when lying down, and chest pain which may be relieved by sitting up and leaning forward. The patient may feel anxious, weak, and fatigued.
Objective findings include fever, tachycardia, cough, peripheral edema, and pallor.
Diagnostic Tests: Chest x-ray may show cardiac enlargement. An MRI scan would detect thickening of the pericardium, and an echocardiogram is done to quantify fluid around the heart.
Medical Treatment: Treatment includes anti-inflammatory medication, pain relief measures, antimicrobials (if the inflammation is infectious in origin), and surgery for removal of fluid (if there is a significant amount around the heart).
Potential Complications: can lead to cardiac dysrhythmias or cardiac tamponade |
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Term
| When caring for patients with infectious and/or inflammatory diseases of the heart, |
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Definition
the nurse should focus on the following areas.
Prevention: Preventive care helps to avoid illness and improve overall health.
Education: Educate the patient and family who are high risk and those who develop the disease about the following:
Good oral hygiene with brushing, flossing, and regular dental care. Avoid activities that could lead to skin infections such as body piercing, tattoos, or nail biting. Minimize exposure to infection (avoid contact with people who have viral or flu-like illnesses). Follow good general hygiene measures. Get recommended immunizations (yearly influenza, for instance). When to seek medical care.
Nutrition: Encourage heart-healthy nutrition.
Activity: Recommend physical activity based on the severity of the illness.
Medication: Use of preventative antimicrobials as prescribed by physician/provider. Educate the patient for home care if long-term intravenous antimicrobials are prescribed.
Support: Provide or refer patient and family for psychosocial, spiritual support |
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Term
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Definition
In the acute phase of _______, the patient is at risk for life-threatening cardiac dysrhythmias and is hospitalized for cardiac monitoring.
Hypoxia can occur, and maintaining an oxygen saturation of greater than 92% is recommended.
Physical activity is restricted; initially patients are on bed rest. |
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Term
| The New York Heart Association’s Functional Classification of heart failure |
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Definition
places patients in one of four categories depending on the severity of their symptoms (such as fatigue, dyspnea, palpitations, or angina pain) and limitations on physical activity.
Class I Class I (mild) comprises patients that have no limitations on ordinary physical activity and experience no symptoms with activities of daily living (ADLs).
Class II Patients in Class II have some limits on ordinary levels of physical activity and experience mild symptoms with ADLs, but have no symptoms at rest.
Class III Patients in Class III have significant limitations on physical activity, experience symptoms at less than ordinary activity levels, but are symptom-free at rest.
Class IV Patients in Class IV (severe) experience discomfort with activity and they experience symptoms at rest |
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Term
| The causes of heart failure include |
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Definition
coronary heart disease,
cardiomyopathy,
hypertension,
valvular disorders,
diabetes mellitus,
sleep apnea,
severe lung disease,
and end-stage renal disease.
Acute illnesses such as sepsis, acidosis, and cardiac dysrhythmias may precipitate heart failure. |
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Term
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Definition
| rapid decompensation that causes decreased cardiac output, acute presentation of symptoms, and signs of low perfusion to all body systems. A classic presentation of acute heart failure is pulmonary edema. |
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Term
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Definition
a progressive lifelong condition that is treated with lifestyle changes and medications. Patients may have signs and symptoms of:
right-sided, left-sided, or both right and left ventricular failure |
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Term
| Left-Sided Heart Failure: |
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Definition
| The left ventricle cannot pump effectively to move blood from left ventricle into the aorta |
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Term
| Right-Sided Heart Failure: |
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Definition
| The right ventricle cannot eject blood into the pulmonary circulation |
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Term
Signs and Symptoms
Left-Sided Heart Failure: |
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Definition
Shortness of breath or dyspnea
Crackles heard on auscultation
Poor color, weak pulses and cool temperatures in extremities
Fatigue |
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Term
Signs and Symptoms
Right-Sided Heart Failure: |
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Definition
Jugular venous distention
Generalized edema
Hepatomegaly
Ascites |
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Term
Treatment
Left-Sided Heart Failure: |
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Definition
| Medications, biventricular cardia pacemaker, lifestyle changes |
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Term
Treatment
Right-Sided Heart Failure: |
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Definition
| Medications, lifestyle changes |
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Term
| Expected Patient Outcomes for txt of L or R-sided HF: |
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Definition
Eliminate or reduce contributing factors Optimize therapeutic regimens (medications) Promote heart-healthy lifestyle
Prevent episodes of acute decompensated heart failure |
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Term
| Medical Treatment for L&RHF includes |
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Definition
medications,
nutrition (sodium limitation),
oxygen,
and other interventions aimed at improving cardiac function.
Medications that may be prescribed for patients of heart failure include angiotensin-converting enzyme (ACE) inhibitors,
angiotensin II receptor blockers (ARB), beta-adrenergic blocking agents (beta-blockers),
diuretics,
digitalis,
and anticoagulants.
Other interventions for patients of heart failure include cardiac resynchronization therapy,
heart assist devices,
and heart transplantation surgery |
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Term
| Heart failure can lead to several complications |
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Definition
Acute decompensated heart failure (pulmonary edema):
Cardiogenic Shock
Thromboembolism |
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Term
| Acute decompensated heart failure (pulmonary edema): |
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Definition
an acute event, where there is an accumulation of fluid in the interstitial lung spaces. The main cause of is left ventricular failure
S&S: |
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Term
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Definition
life-threatening condition of inadequate tissue perfusion resulting from severe cardiac dysfunction.
The signs and symptoms include low blood pressure; confusion; restlessness; tachypnea; oliguria; cold, clammy, or gray skin; pulmonary congestion; nausea; or diarrhea. Treatment includes medications, oxygen administration, possible mechanical circulatory assist device, and/or heart transplantation. |
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Term
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Definition
The formation of a thrombus or clot within the blood vessel or the heart chambers can occur when blood flow is slowed or impaired. The thrombus can break off travel through the bloodstream until the clot occludes blood flow, and oxygen and nutrients to the brain, lungs, and other organ systems.
The signs and symptoms of thromboembolism depend on where the clot travels in the body. The treatment focuses on preventing blood clot formation |
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Term
| NANDA-I nursing diagnoses for patients with heart failure may include: |
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Definition
Activity intolerance related to weakness (There has to be a symptom that occurs during activity)
Decreased cardiac output related to impaired cardiac function
Fatigue related to disease process Excess fluid volume related to impaired excretion of sodium and water
Impaired gas exchange related to fluid excess
Ineffective family therapeutic regimen management related to complexity of disease management
Powerlessness related to chronic illness |
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Term
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Definition
| Insufficient physiological or psychological energy to endure or complete required or desired activities |
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Term
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Definition
- abnormal BP response to activity
- " HR "
- ECG change (arrhythmia, conduction abnormality, ischemia)
- exertional discomfort
- exertional dyspnea
- fatigue
- generalized weakness |
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Term
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Definition
| Activity intolerance related to weakness Decreased cardiac output related to impaired cardiac function Fatigue related to disease process Excess fluid volume related to impaired excretion of sodium and water Impaired gas exchange related to fluid excess Ineffective family therapeutic regimen management related to complexity of disease management Powerlessness related to chronic illness |
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Term
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Definition
Severity of heart failure is classified according to the patient’s____ - Symptoms Drugs that remove excess fluid - Diuretics Activation of this nervous system increases blood pressure - Sympathetic
Resistance to the ejection of blood from the ventricle - Afterload
Administered to treat hypoxia - Oxygen Reduces effects of sympathetic nervous system, decreases heart rate - Beta blocker Released by adrenal cortex and causes sodium and water retention – Aldosterone Recommended dietary restriction is 2 grams a day or less - Sodium |
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Term
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Definition
|
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Term
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Definition
- alienation
- depression
- dependency
- doubt about role performance
- frustration about inability to perform previous activities
- inadequate participation in care
- insufficient sense of control
- shame |
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Term
|
Definition
Definition
- pattern of regulating and integrating into daily living a therapeutic regimen for the txt of illness and its sequelae that is unsatisfactory for meeting specific health goals
Defining Characteristics
- difficulty with prescribed regimen
- failure to include txt regimen into daily living
- failure to take action to reduce risk factors
- ineffective choices in daily living for meeting health goals |
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Term
| Nursing DX: Decreased Cardiac Output |
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Definition
Definition
- inadequate blood pumped by the heart to meet the metabolic needs of the body
Defining Characteristics
- bradycardia
- ECG change
- arrhythmia
- conduction abnormality
- ischemia |
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