Ch 23 Infectious & Inflammatory
A young adult recently recovered from a viral illness and now reports fatigue, chest pain, and shortness of breath. Which disorder should the nurse suspect? (1) What is the primary teaching for this? (2) Why is this the patient education? (3)
1. What is myocarditis
2. Rest - no strenuous activity
3. Rest decreases the workload of the inflamed heart and helps prevent worsening damage.
A client with mitral stenosis asks why the left atrium is enlarged on echo. The nurse explains this occurs because of this hemodynamic reason.
What is the left atrium having to generate higher pressure to push blood through the narrowed valve opening into the left ventricle, causing chronic atrial strain and dilation?
A client having an acute MI reports 9/10 crushing chest pain despite receiving nitroglycerin and morphine. The nurse recognizes ongoing myocardial ischemia is occurring and understands this pain must be controlled promptly for this physiological reason (1). Explain what "time is muscle" means in the context of MI treatment (2).
(1) What is: unrelieved pain indicates ongoing ischemia/oxygen deprivation to the myocardium, and pain itself increases sympathetic nervous system activation, raising heart rate, blood pressure, and myocardial oxygen demand — worsening the ischemia in a self-perpetuating cycle?
(2) What is: the longer a coronary artery remains occluded, the more myocardial tissue undergoes irreversible necrosis, so rapid restoration of blood flow (via thrombolytics or PCI) within the critical window directly preserves cardiac muscle and function — delays in treatment directly correlate with increased permanent heart damage?
A client with sinus tachycardia at a rate of 130 bpm is being assessed by the nurse. Explain the priority nursing action before treating the rhythm itself (1), and list at least three common underlying causes the nurse should investigate (2).
(1) What is: identify and treat the underlying cause, since sinus tachycardia is typically a physiological response rather than a primary dysrhythmia — treating the rate alone without addressing the cause will not resolve the problem?
(2) What are: pain, fever, anxiety, dehydration/hypovolemia, hemorrhage, hyperthyroidism, stimulant use (caffeine, nicotine), fear, or hypoxia?
A nurse teaches a client that right-sided heart failure most commonly develops as a consequence of this pre-existing condition.
What is left-sided heart failure (chronic left-sided failure causing pulmonary hypertension, which increases the workload on the right ventricle)?
A client with a mechanical heart valve is scheduled for a routine colonoscopy with planned biopsy. The nurse reviews the chart and determines prophylactic antibiotics are indicated. The nurse explains this reasoning to the patient.
What is that a prosthetic valve places the client in a high-risk category, and the biopsy component creates a break in mucosal integrity with potential bacteremia, warranting prophylaxis
A nurse teaches a client with severe aortic stenosis to avoid this class of medications
What is avoid nitrates or other vasodilators since they reduce preload and can cause dangerous hypotension in a client with a fixed cardiac output.
A nurse reviews a client's lipid panel and identifies this specific elevated lab value as the most significant modifiable risk factor for CAD progression (1). The patient should be given this education (2). If requiring medication, a first line treatment might me (3). But other types of lipid lowering medication may be appropriate such as (4). Education we will give the client about their cholesterol lowering medication is (5).
(1) What is LDL cholesterol. Elevated LDL is the most significant modifiable risk factor for CAD progression, since LDL directly contributes to plaque formation within arterial walls (atherosclerosis).
(2) Patient education:
(3) First-line medication: What is a statin (HMG-CoA reductase inhibitor) — e.g., atorvastatin, rosuvastatin, simvastatin? Statins are first-line because they both lower LDL production in the liver and stabilize existing arterial plaque, reducing the risk of plaque rupture.
(4) Other lipid-lowering medication classes:
(5) Medication education for statins specifically:
A client with symptomatic SVT is hemodynamically stable. The nurse anticipates the provider will first attempt this non-pharmacological intervention (1). If this is unsuccessful, the nurse anticipates this medication will be administered next, along with this special administration technique (2).
(1) What are vagal maneuvers (e.g., bearing down/Valsalva maneuver, carotid sinus massage, coughing, or placing the face in cold water)?
KYRSTYN TALK ABOUT PACEMAKERS/ICD
1. A nurse explains to a client that when cardiac output drops, the body initially compensates by activating this nervous system response, increasing heart rate and contractility.
2. The nurse then explains that in heart failure, decreased renal perfusion triggers this hormonal system, which leads to sodium/water retention and vasoconstriction — helpful short-term, but harmful with chronic activation.
1. What is the sympathetic nervous system (release of catecholamines/epinephrine and norepinephrine)?
2. What is the renin-angiotensin-aldosterone system (RAAS)?
A client with ____(1)___carditis develops jugular vein distention, muffled heart sounds, and hypotension. The nurse recognizes this life-threatening triad as a sign of this complication (2). Explain what is happening that made the client have hypotension (3)
1. Peri
2. Cardiac Tamponade
3. The heart can not fill or pump because the pericardial sac is restricting it (being full of fluid), so the cardiac output drops - the heart isnt pumping hardly any blood out so the pressure in the arteries drops = low BP
A nurse explains to a client with chronic aortic regurgitation why the left ventricle has become significantly enlarged (eccentric hypertrophy) on echocardiogram over several years. This compensatory mechanism is explained by this concept.
What is chronic volume overload from regurgitant blood causing the ventricle to dilate and hypertrophy over time in order to maintain adequate forward stroke volume, eventually leading to systolic dysfunction if uncorrected?
A client reports leg cramping and pain that occurs consistently after walking two blocks and resolves with rest. This is called ___(1)___. The nurse documents this classic symptom as part of what diagnosis (2). What is our education for the patient? (3). What meds would you expect for them? (4)
1. What is intermittent claudication?
2. What is PAD
3. Lifestyle modification like exercise and smoking cessation
4. Aspirin, clopidogrel, statins
Identify the rhythm (1) What do we do about it (2) and why (3)?
https://drive.google.com/file/d/1q1E9RKyvIEv7xEFkutnoKYay-HXT7RfS/view?usp=drive_link
1. Ventricular tachycardia
2. CPR/Defib if no pulse
3. The ventricles are contracting so fast, they have no time to fill, and if there is no blood in the ventricles the patient has no pulse, death is imminent.
A nurse explains to a client that the heart's compensatory mechanisms, which initially helped maintain cardiac output, have now become harmful over time. Explain the concept of ventricular remodeling and why this compensatory response ultimately worsens heart failure (1), and identify the medication classes specifically used to counteract this process (2).
(1) What is: chronic neurohormonal activation (SNS and RAAS) causes the ventricle to hypertrophy and dilate over time in an attempt to maintain stroke volume, but this remodeled muscle is less efficient, more oxygen-demanding, and eventually becomes weaker and more dysfunctional — turning an initially adaptive response into a self-perpetuating cycle that accelerates disease progression?
(2) What are ACE inhibitors/ARBs (name some), beta-blockers (name some), and aldosterone antagonists (e.g., spironolactone) — medications that block the harmful long-term effects of RAAS and SNS activation?
The reasons why someone might get infective endocarditis (1)(3 of them minimum), the treatment and length of time (2), the most common valve affected in IV drug use (3), and the potential complication from from this specific valve being affected (4).
1 - IV drug use, PICC line, Recent Invasive surgery, dental procedures
2. antibiotics for 4-6 weeks minimum
3. Tricuspid valve
4. Septic emboli
A nurse assesses a client with chronic (1) regurgitation and notes a blood pressure of 158/48 along with a bounding, pulse that hits hard and drops off suddenly, called a (2). The nurse identifies the abnormal blood pressure pattern as this finding (3). Explain the mechanism that causes this specific finding (4).
(1) What is aortic?
(2) water hammer pulse
(3) What is a widened pulse pressure?
(4) What is: during diastole, blood regurgitates backward from the aorta into the left ventricle instead of staying in the arterial system, causing diastolic pressure to fall; meanwhile increased stroke volume from the larger preload raises systolic pressure, widening the gap between the two?
A nurse assesses a client with PAD and notes a pale, cool, pulseless extremity with sudden onset of severe pain. The nurse recognizes this as this emergent complication (1). Explain the "6 P's" the nurse should assess for (2), and explain why this is a time-sensitive emergency requiring immediate intervention (3).
(1) What is acute arterial occlusion?
(2) What are pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia (coolness)?
(3) What is: tissue distal to the occlusion is receiving no blood flow, and without prompt restoration of circulation (within hours), irreversible ischemia, tissue necrosis, and limb loss can occur? **Teaching point - PAD is OFTEN caused by atherosclerosis - making these patients more prone to embolism
Identify the rhythm (1) What do we do about it (2) and why (3)?
https://drive.google.com/file/d/10QLNcnyKesapRnymY6xm41ferEfUvX01/view?usp=drive_link
1. Atrial fibrillation
2. Beta blockers, cardioversion and Anticoagulants
3. We need to slow the electrical conduction to the heart if SNS activated, we need to restore normal rhythm, and not allow coagulated blood clots to travel to the body. Don't forget A-fib is the cause of a lot of falls. Why?
A client on digoxin therapy reports nausea, vomiting, and anorexia, along with seeing yellow-green halos around lights. The nurse recognizes these as classic early signs of this complication (1).
The client has a hx (history) of hypertension, DM II, OA and migraines. Which medication for which problem do you think may have contributed to the digoxin toxicity (2)?
1. What is digoxin toxicity?
2. Diuretics (name some), if the client takes insulin (why?)
A client with a history of rheumatic fever in childhood, now 45 years old, presents with progressive dyspnea on exertion, orthopnea, and a diastolic murmur best heard at the apex. An echocardiogram shows a markedly narrowed ____(1)__ valve opening. The nurse understands this progression occurred through this specific pathophysiological sequence, spanning decades from the original illness to current presentation (2). What do you think are the medications used to treat this and why? (3)
1. Mitral (mitral stenosis)
2. Rheumatic fever can result in an autoimmune response against M proteins from the strep bacteria. These M proteins mimic the heart muscle cells and attack
3. Beta-blockers or calcium channel blockers to slow HR and improve diastolic filling time across the narrowed valve. Diuretics to reduce pulmonary congestion/dyspnea
A client with severe (1) stenosis reports chest pain, dizziness, and a brief loss of consciousness while climbing stairs. The nurse recognizes this classic triad of angina, syncope, and dyspnea as a hallmark of this valve disorder (2). Explain the hemodynamic reason exertional syncope occurs in this condition (3).
(1) What is aortic?
(2) What is aortic stenosis?
(3) What is: the stenotic valve creates a fixed, obstructed cardiac output, so during exertion when systemic vascular resistance drops and peripheral demand increases, the heart cannot increase output to compensate — resulting in a drop in cerebral perfusion pressure and syncope?
A nurse assesses a client's lower legs and notes brownish discoloration, edema, and thick, leathery skin near the ankles. This is consistent with this chronic condition (1). What orders are we asking the doctor for (2)? If they complain of pain, what will make it better (3)? What is the patient education(4)?
1. What is chronic venous insufficiency?
2. Compression stockings
3. Elevate the legs
4. Lose weight, wear compression socks
Identify the rhythm (1) What do we do about it (2) and why (3)?
https://drive.google.com/file/d/1cLCIh-e8bG081ZZBIj_o8Kod6iGOITWy/view?usp=drive_link
1. VFib
2. Get the DEFIB!
3. This is a lethal rhythm. Remember fibrillation means quivering - the ventricles are NOT pumping at all.
A client with severe heart failure (NYHA Class IV) is being evaluated for hospice versus continued aggressive management. The nurse is explaining the NYHA functional classification system to a student. Explain what distinguishes each of the four NYHA classes (1), and explain why understanding this classification system matters for guiding treatment decisions and goals of care conversations (2).
What is: Class I = no symptoms with ordinary activity; Class II = mild symptoms/slight limitation with ordinary activity but comfortable at rest; Class III = marked limitation, symptoms with less-than-ordinary activity, comfortable only at rest; Class IV = symptoms present even at rest, unable to carry out any physical activity without discomfort?
(2) What is: the NYHA classification provides a standardized way to communicate disease severity and functional capacity across the healthcare team, helps guide escalation of therapy (e.g., Class III/IV clients may be candidates for advanced therapies like VADs, transplant, or CRT), and Class IV in particular often prompts important goals-of-care and palliative/hospice discussions given the poor prognosis associated with end-stage, refractory heart failure?