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Study Guide/Review for Final Exam Practice Questions for Exam 1 Endocarditis/Pericarditis The pericardium layer consists of a fibrous layer that is made up of two layers called the parietal and visceral layers. a.True b.False A patient is recovering from a myocardial infarction (MI) and develops chest pain on day 3 that increases when taking a deep breath and is relieved by leaning forward. Which action should the nurse take next? a. Assess the feet for pedal edema. b. Palpate the radial pulses bilaterally. c. Auscultate for a pericardial friction rub. d. Check the heart monitor for dysrhythmias. True or False: Endocarditis only affects the atrioventricular and semi-lunar valves in the heart. False Rationale: Endocarditis can affect not only the heart valves but the interventricular septum and chordae tendineae as well. You're providing discharge teaching to a patient being treated for endocarditis. Which statement by the patient demonstrated they understood your teaching about this condition? A. "I will stop taking the antibiotics once my fever is gone in order to prevent antibiotic resistance." B. "I will only wash my hands with soap and water." C. "I will inform my dentist about my history of endocarditis prior to any invasive procedures." D. "I will avoid eating fish and organ meats." A patient being treated for infective endocarditis is complaining of very sharp radiating abdominal pain that goes to the left shoulder and back. As the nurse familiar with complications of infective endocarditis, what do you suspect is the cause of this patient finding? A. Renal embolic event B. Pulmonary embolic event C. Central nervous system embolic event D. Splenic embolic event You are providing care to a patient with pericarditis. Which of the following is NOT a proper nursing intervention for this patient? A. Monitor the patient for complications of cardiac tamponade. B. Administer Ibuprofen as scheduled. C. Place the patient in supine position to relieve pain. D. Monitor the patient for pulsus paradoxus and muffled heart sounds. A patient with severe pericarditis has developed a large pericardial effusion. The patient is symptomatic. The physician orders what type of procedure to help treat this condition? A. Pericardiectomy B. Heart catheterization This is an NCLEX review for endocarditis. Patients who have endocarditis are experiencing inflammation of the endocardium layer of the heart. There are two types of endocarditis: infective and non-infective. This NCLEX review will focus on the the infective endocarditis (IE). When taking care of a patient with endocarditis, it is very
important the nurse knows how to recognize the typical signs and symptoms seen in this condition, the types of endocarditis, treatments, nursing interventions, and patient education . Don’t forget to take the endocarditis quiz. In this NCLEX review for endocarditis, you will learn the following: Definition: Inflammation of the endocardium layer of the heart. What is the endocardium layer? The endocardium is a membrane
that lines the inside of the heart chambers and the heart valves. How many heart valves do you have? Four….Atrioventricular (tricuspid and mitral valve) and Semilunar (pulmonic and aortic valves) Endocarditis mainly affects the heart valves but it can affect the: Endocarditis is hard to treat because there is no blood flow to the valves so the body does NOT respond properly to the pathogen present (hence, WBCs can NOT get to the valves to fight the infection) and it is hard for antibiotics to get to it (so the patient will need weeks of IV antibiotics). Patients who have defective heart valves can experience complications of heart failure (valves are leaking or have stenosis, embolic events (strokes), erosion of
valve leaflets, and abscesses of the heart tissue. Non-infective: sterile platelets and fibrin (thrombus) form on the valve due to trauma or some other issue (hypercoagulated blood) but it isn’t pathogenic. However, it is a site of origin for possible infective endocarditis. *IV drug uses are susceptible to both Remember the mnemonic: Pathogens Petechiae (tiny purplish red
spots on the skin….from emboli) Anorexia (loss of appetite and enlarged spleen pushing on the stomach) Tired and weak High Fever & Heart Failure Osler’s Nodes: tender, red lesions on the hands and feet finGernail changes: splinter hemorrhages that are small, dark lines under the nails…like petechiae but found under the nails Embolic events, Erythematous, non-tender nodular lesions on the palms or soles of feet (Janeway Lesions)…small, septic emboli that form abscesses Night sweats, New cardiac heart murmur or worsening of one Splenomegaly (helps fight infection so it becomes enlarged), Roth Spots (burst of blood vessels in the retinas with white centers) Diagnosed:TEE (transesophageal echocardiogram): an ultrasound probe is placed down through the patient throat and it looks at the back side of the heart which helps assess the heart valves. Nursing Interventions for Infective Endocarditis:Monitor:
Interventions:
Educate the patient about:
You may be interested in more NCLEX Reviews. References:
Which clinical manifestations would the nurse expect to find when assessing a patient with infective endocarditis?Fever and chills are the most common symptoms; anorexia, weight loss, malaise, headache, myalgias, night sweats, shortness of breath, cough, and joint pains are common problems as well. Primary cardiac disease may present with signs of congestive heart failure caused by valvular insufficiency.
Which intervention will help provide pain relief for the patient with pericarditis?For patients with idiopathic or viral pericarditis, therapy is directed at symptom relief. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstay of therapy. These agents have a similar efficacy with relief of chest pain in about 85-90% of patients within days of treatment.
Which assessment finding is expected in a patient with pericarditis?Characteristic clinical findings in pericarditis include pleuritic chest pain and pericardial friction rub on auscultation of the left lower sternal border. Electrocardiography may reveal diffuse PR-segment depressions and diffuse ST-segment elevations with upward concavity.
Which diagnostic study detects the presence of vegetation on heart valves in a client with infective endocarditis?Transthoracic echocardiography (TTE) is often the first choice for testing. However, its sensitivity is only about 70% for detecting vegetations on native valves and 50% for detecting vegetations on prosthetic valves.
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The nurse provides education about home care management to a patient with infective endocarditis
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