It is present in read more , calcific aortic valves, mitral valve prolapse Mitral Valve Prolapse (MVP) Mitral valve prolapse (MVP) is a billowing of mitral valve leaflets into the left atrium during systole. The initial antibiotic choice is empiric and should be chose based on te most likely infecting organism, determined by history and exam findings. -Hx Rheumatic Heart disease Accessed April 12, 2022. Here are the NCLEX practice questions for cardiovascular system disorders. Measures to reduce health careacquired bacteremia aim to curb the rising incidence of iatrogenic bacteremia and subsequent endocarditis are also recommended. Your health care team can provide you more information and answer your questions about preventing IE. 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.. Why would the blood culture be negative in Endocarditis? D -Empyema A proper evaluation by a health care provider is needed to make the diagnosis. The nurse assesses this rhythm to be: While caring for a client who has sustained an MI, the nurse notes eight PVCs in one minute on the cardiac monitor. NURSING CONSIDERATIONS These practice tests would help me pass the NCLEX exam. Endocarditis involving an implanted cardiac electronic device requires complete removal of the pacemaker or defibrillator, including all leads and the generator. Existing IV catheters (particularly central venous ones) should be changed. This approach has the potential to reduce the psychologic stress and some of the risks inherent to prolonged inpatient parenteral therapy (2 Treatment references Infective endocarditis is infection of the endocardium, usually with bacteria (commonly, streptococci or staphylococci) or fungi. Massive bacteremia or particularly virulent microorganisms (eg, Staphylococcus aureus) cause endocarditis on normal valves. Infective endocarditis. NCLEX RN Examination Prep Flashcards (2023 Edition)NCLEX RN Exam Review FlashCards Study Guide with Practice Test Questions [Full-Color Cards] from Test Prep Books. AskMayoExpert. -Salvia used as a dilute, -Prolonged hospitalization A nurse is assessing a client who has splinter hemorrhages in her nail beds and reports a fever. -Repair congenital heart defect with residual defects -CT, -Arrhythmia-> perivalvular abscess -Other cause of primary source is excluded, Minor Criteria for Modified Duke Criteria, -Predisposing heart conditions or IVDU Previous infective endocarditis -Prosthetic heart valve It is more common after aortic than after mitral valve replacement and affects mechanical and bioprosthetic valves equally. What are the basic principles of antimicrobial therapy of IE. Select all that apply. Use for phrases Risk factors for developing IE include: Heart valve disease -and vascular phenonmen, Non-tender macular on the palms and soles -Poor dentition/ dental infection/dental procedure 3. Dilsizian V, Budde RPJ, Chen W, et al: Best practices for imaging cardiac device-related infections and endocarditis: A JACC: Cardiovascular Imaging Expert Panel Statement. -Apex When the inflammation is caused by infection, the condition is called. European Society of Cardiology prophylaxis regimens are described in reference 1 Prevention reference Infective endocarditis is infection of the endocardium, usually with bacteria (commonly, streptococci or staphylococci) or fungi. 1. The nurse determines that the client is experiencing: A nurse is viewing the cardiac monitor in a clients room and notes that the client has just gone into ventricular tachycardia. Results are being recorded. -Kingella species, Immunocompromised people can get endocarditis from, Make sure you do good ____________ exams on people with endocarditis, Oral In septic shock, there is critical reduction in tissue perfusion; acute failure read more develops. The image on the right shows Janeway lesions (nontender and erythematous macules on the palm). Less serious conditions may cause similar signs and symptoms. Adenoidectomy $$. Timing of surgery requires experienced clinical judgment. -Endocarditis in IVDU Instruct clients to take the medication with food. June 17, 2022. D. A 66 year old female who recently had an invasive dental procedure performed 1 month ago and is having a fever. -sites of infection, -Blood Cultures NOTICE TO ALL USERSPlease be aware that our test banks are ALWAYS FREE OF CHARGE, and NO REGISTRATION IS REQUIRED. -Positive BC not meeting major criteria, Vascualr Phenomena that are minor Duke criteria for surgery, -Arterial Emboli Give antimicrobial prophylaxis for patients at high risk of an adverse outcome from infective endocarditis, including those with prosthetic heart valves or heart valve repair, previous infective endocarditis, certain congenital heart diseases, or who are heart transplant recipients with valvulopathy. Copyright 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. We are instructed to always educate the patient to sit down before taking a nitro tablet for safety and to take caution when standing after. A 55 year old male who is post-opt from aortic valve replacement. Procedures on infected skin, skin structure or musculoskeletal tissue Despite advances in diagnosis, antimicrobial therapy, surgical techniques, and management of complications, patients with IE still have high morbidity and mortality rates related to this condition. information and will only use or disclose that information as set forth in our notice of Find more information on our content editorial process. Microorganisms Background Janice Cook is a 25-year-old female admitted to the Emergency Department with reports of malaise, back pain, abdominal discomfort, and headache. Blood cultures to detect a bacterial infection. Identification of the organism and its antimicrobial susceptibility is vital to guide treatment. A. Petechiae are an expected finding in a client who has endocarditis. They can break loose and travel to the brain, lungs, kidneys and other organs. -Elevated acute phase reactants Last, the nurse should apply pressure over the catheter insertion site. Question 26 on exam 4: Treatment consists of a prolonged course of antimicrobial therapy (1 Treatment references Infective endocarditis is infection of the endocardium, usually with bacteria (commonly, streptococci or staphylococci) or fungi. A young adult who receives a body tattoo is at increased risk for infective endocarditis but is not at risk for rheumatic endocarditis unless he develops rheumatic fever. Use these questions to help you review for cardiovascular system disorders and as an alternative to Quizlet. -Chronic Form -Staphylococcus epidermidis, -Strep gallolyticus 3. Cahill TJ, Baddour LM, Habib G, et al: Challenges in infective endocarditis. -New onset valvular regurgitation, Vascular Phenomena of Minor Duke Criteria, -Arterial emboli Click to share on Facebook (Opens in new window), Click to share on Twitter (Opens in new window), Click to share on Pinterest (Opens in new window), Click to share on Reddit (Opens in new window), Click to share on LinkedIn (Opens in new window), Click to share on WhatsApp (Opens in new window), Click to share on Pocket (Opens in new window), Click to share on Telegram (Opens in new window), Click to share on Skype (Opens in new window), Most DIFFICULT Patients EVER!! This can lead to problems including: stroke. Left-sided endocarditis does not respond to 2-week courses. Hi Kat, this has been corrected. -Fastidious organsim = HACEK organisms Antibiotics for skin and musculoskeletal prophylaxis should be effective against staphylococci and beta-hemolytic streptococci (eg, a cephalosporin or vancomycin or clindamycin if infection with methicillin-resistant staphylococci is possible). This content does not have an Arabic version. If endocarditis is suspected, 3 blood samples for culture (20-mL each) should be obtained, ideally > 6 hours apart (if presentation suggests acute bacterial endocarditis, 2 cultures within the first 1 to 2 hours). Common signs and symptoms of endocarditis include: Fever Chills Heart murmur (new or changed) Fatigue Aching joints and muscles Night sweats Shortness of breath Chest pain when you breathe Peripheral Edema or Swelling in the feet and legs Ascites of the abdomen Severe endocarditis signs and symptoms may also cause: Unexplained weight loss Patients with a history of IV drug use have been treated with nafcillin and gentamicin to cover for methicillin-sensitive staphylococci. The patient has a history of intravenous drug use and underwent mitral valve replacement a year ago. It can cause severe valvular insufficiency, congestive heart failure, and myocardial abscess, The microorganisms that most commonly produce endocarditis are S aureus, Streptococcus viridan, group A, C, and G streptococci, and enterococci, What is the HACEK group of microorganisms, Haemophilus (Haemophilus influenzae, Haemophilus parainfluenzae), cardiac conditions are associated with an increased risk of IE. information is beneficial, we may combine your email and website usage information with Mayo Clinic; 2022. inflammation of the inner layer of the heart, infection of the inner layer of the heart, Most common organism that causes endocarditis, Staph. Other procedures include those respiratory tract procedures in which mucosa is incised, vaginal delivery in some high-risk patients (patients with prosthetic cardiac valve or prosthetic material used for cardiac valve repair and for patients with unrepaired and palliated cyanotic congenital heart disease), and gastrointestinal, genitourinary, or musculoskeletal procedures that involve an area with an established infection (see table Procedures Requiring Antimicrobial Endocarditis Prophylaxis Procedures Requiring Antimicrobial Endocarditis Prophylaxis in High-Risk Patients in the US ). Keep up the pace and continue learning with these practice quizzes: Hi, thank you for these practice NCLEX styled questions! -Immunoglobulin Complexes Encourage the client to take rest periods as needed. include protected health information. Monitor for indications of bleeding, infection, and alteration in cardiac output. -caused by emboli o [teenager OR adolescent ], , MD, Waitemata District Health Board and Waitemata Cardiology, Auckland. -Poo isolation technique Rehabilitation services can be indicated to help the client increase the level of activity. -Fungal organism The image on the left shows an Osler node (tender and erythematous nodule) on the thumb. Infective endocarditis (IE), also called bacterial endocarditis, is an infection caused by bacteria that enter the bloodstream and settle in the heart lining, a heart valve or a blood vessel. -Resistant fungal pathogens -Vascular *All health/medical information on this website has been reviewed and approved by the American Heart Association, based on scientific research and American Heart Association guidelines. Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada) dedicated to using leading-edge science to save and improve lives around the world. Alternative Names Valve infection; Staphylococcus aureus - endocarditis; Enterococcus - endocarditis; Streptococcus viridans - endocarditis; Candida - endocarditis Causes Transesophageal echocardiography (TEE) can reveal vegetations too small to be seen on TTE. Institute antibiotic therapy as soon as possible to minimize valvular damage. I thought hypertrophic cardiomyopathy leads to decreased filling (diastolic failure) which would then result in decreased stroke volume and thus decreased cardiac output? Much love!! -Metastatic Infection You have reached 50 of 50 point(s), (100%), I play with this every now and then until I finally could come out with this score, am so looking forward to one day becoming a RN. -non-painful -Radiation -Streptococci and enterococci, -Valves are usually normal For such patients, short-course IV or (less preferably) oral therapy may be used. Are causes by anaerobes. Infective endocarditis (IE) is an infection of the inner lining of the heart muscle (endocardium) caused by bacteria, fungi, or germs that enter through the bloodstream. SBE is caused most commonly by streptococci (especially viridans, microaerophilic, anaerobic, and nonenterococcal group D streptococci and enterococci) and less commonly by S. aureus, Staphylococcus epidermidis, Gemella morbillorum, Abiotrophia defectiva (formerly, Streptococcus defectivus), Granulicatella species, and fastidious Haemophilus species. Antibiotics should be broad spectrum to cover all likely organisms, typically including sensitive and resistant staphylococci, streptococci, and enterococci. Bacteremia: Microorganisms are present in the blood, Adhesion: The microorganism adheres to abnormal or damaged endothelium via surface adhesions, Colonization: Proliferation of the organism together with inflammation, leading to a mature vegetation. Monitor platelets, and liver and kidney function levels. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Quiz complete. -Dehiscence of valve, -Rheumatic Valve disease is declining J Am Coll Cardiol 77(4):e25e197, 2021. doi: 10.1016/j.jacc.2020.11.018. Initially, 15% of patients have fever or a murmur, but eventually almost all develop both. Learn more about the Merck Manuals and our commitment to Global Medical Knowledge. -Partial dehiscence of prosthetic valve OR Fever may continue for reasons other than persistent infection (eg, drug allergy, phlebitis, infarction due to emboli). Antibiotic retreatment may be effective, but surgery may also be required. Heart murmur -85% 2023 Nurseslabs | Ut in Omnibus Glorificetur Deus! We may earn a small commission from your purchase. Even with treatment, death is more likely and the prognosis is generally poorer for older people and people who have, Aortic valve or multiple valve involvement. Empiric antibiotic regimens should reflect local patterns of infection and antibiotic resistance; however, typical examples of broad-spectrum antibiotic coverage may include, Native valves: Vancomycin 15 to 20 mg/kg IV every 8 to 12 hours (not to exceed 2 g per dose), Prosthetic valve: Vancomycin 15 to 20 mg/kg IV every 8 to 12 hours (not to exceed 2 g per dose) plus gentamicin 1 mg/kg IV every 8 hours plus either cefepime 2 g IV every 8 hours or imipenem 1 g IV every 6 to 8 hours (maximum dose 4 g per day). Retinal emboli can cause round or oval hemorrhagic retinal lesions with small white centers (Roth spots). Is that just a nursing school thing? -Enterococci Prepare the client for pericardiocentesis (informed consent, gather materials, administer medications as prescribed). For right-sided endocarditis caused by methicillin-sensitive S. aureus, nafcillin 2 g IV every 4 hours plus gentamicin 1 mg/kg IV every 8 hours for 2 weeks is effective, as is a 4-week oral regimen of ciprofloxacin 750 mg twice a day plus rifampin 300 mg twice a day. Mycotic aneurysm, -Embolic Stroke All rights reserved. Administer IV fluids to combat hypotension as prescribed. 3. CHF may develop acutely from perforation of a native or bioprosthetic valve leaflet, rupture of infected mitral chordae, valve obstruction by bulky vegetations, or sudden intracardiac shunts from fistulous tracts or prosthetic dehiscence. A woman with severe mitral stenosis and mitral regurgitation has a pulmonary artery catheter inserted. The client is receiving an IV infusion of D5W and oxygen at 2 L/minute. MVP is usually benign, but read more , hypertrophic cardiomyopathy Hypertrophic Cardiomyopathy Hypertrophic cardiomyopathy is a congenital or acquired disorder characterized by marked ventricular hypertrophy with diastolic dysfunction (eg, due to valvular aortic stenosis, coarctation read more , and prior endocarditis. -Elevated ESR, CRP Complications of IE may involve cardiac structures when the infection spreads within the heart, or extra . Select-all-that-apply: A. Accessed April 12, 2022. Men are affected about twice as often as women. Surgery is typically indicated in, Patients with heart failure (particularly those with prosthetic, aortic, or native mitral valve endocarditis and those with pulmonary edema or cardiogenic shock), Patients with uncontrolled infection (those with persistent infection, infection with fungal or resistant organisms, recurrent prosthetic valve endocarditis, or endocarditis complicated by heart block, abscess, aneurysm, fistula, or enlarging vegetation). -Staph Epidermidis Organisms within biofilms adherent to catheters and other devices may not respond to antimicrobial therapy, leading to treatment failure or relapse. 1 - 3 Although relatively rare, IE continues to be characterized by increased morbidity and mortality and is now the third or fourth most common life-threatening . 2. Routine anesthetic injections through noninfected tissue, taking dental radiographs, placement of removable prosthodontic or orthodontic appliances, adjustment of orthodontic appliances, placement of orthodontic brackets, shedding of deciduous teeth, and bleeding from trauma to the lips or oral mucosa. -prosthetic valves, -Usually requires surgical intervention Loscalzo J, et al., eds. Coarctation of the aorta Symptoms and signs vary based on the classification but are nonspecific. Endocarditis is usually caused by an infection. Instruct clients to avoid stopping the medication abruptly. Endocarditis should be suspected in patients with fever and no obvious source of infection, particularly if a heart murmur is present. Patients with staphylococcal endocarditis tend to respond more slowly. -Septic PE Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Please click the View Questions button below to review your answers and read through the rationales for each question. See our editorial policies and staff. (Juan prefiere llevarlos. Left ventricular (LV) failure causes shortness of breath and fatigue, and right ventricular (RV) failure causes peripheral and abdominal read more and death (usually due to mitral or aortic valve lesions), Aortitis Aortitis Aortitis is inflammation of the aorta, sometimes causing aneurysm or occlusion. -Immunological Phenomena -Procedures on the respiratory tract which require biopsy or incision of the mucosa 7. It may cause fever, heart murmurs, petechiae, anemia, embolic read more ). Congratulations, you have completed this quiz! Premature use of empiric antibiotic therapy should be avoided in patients with acquired or congenital valvular or shunt lesions to avoid culture-negative endocarditis. -ID consultation should used when available. Ibuprofen: NSAID (nonsteroidal anti-inflammatory drug) given to treat fever and inflammation This nursing test bank set includes 220 NCLEX-style practice questions that cover topics like dysrhythmias, EKG interpretation, heart failure, myocardial infarction, hematologic disorders, and more. This is a quiz that contains NCLEX questions for endocarditis. 1. About 35% of patients have central nervous system (CNS) effects, including transient ischemic attacks Transient Ischemic Attack (TIA) A transient ischemic attack (TIA) is focal brain ischemia that causes sudden, transient neurologic deficits and is not accompanied by permanent brain infarction (eg, negative results on diffusion-weighted read more , stroke Overview of Stroke Strokes are a heterogeneous group of disorders involving sudden, focal interruption of cerebral blood flow that causes neurologic deficit. Petechiae-most 1. It's usually caused by bacteria. Diminution of vegetation size can be followed by serial echocardiography. you iniate cpr first not defibing the client. -Vanco/Ceftiaxone In addition, length of hospital stay was shortened in the patients switched to oral therapy. NURSING ACTIONS: Some organisms (eg, Coxiella burnetii, Bartonella species, Chlamydia psittaci, Brucella species) require serodiagnosis; others (eg, Legionella pneumophila) require special culture media or polymerase chain reaction (eg, Tropheryma whippelii). Endocarditis is inflammation of the endocardium which mainly affects the heart valves. If left untreated, the infection can damage your heart valves. -Vertebral osteomyelitis If heart failure caused by a correctable lesion is worsening (particularly when the organism is S. aureus, a gram-negative bacillus, or a fungus), surgery may be required after only 24 to 72 hours of antimicrobial therapy. 3. -Sitting up & leaning forward, full exhalation, Tricuspid Regurgitation Heart Insight e-news is our trusted, award-winning monthly publication for people living with heart disease, their families and caregivers. Delete ( ) unnecessary commas. 6. That I, as a nurse educator, love reading! privacy practices. Advertising revenue supports our not-for-profit mission. Unrepaired cyanotic congenital heart defect (birth defects with oxygen levels lower than normal) or repaired congenital heart defect, with residual shunts or valvular regurgitation at the site adjacent to the site of a prosthetic patch or prosthetic device. - CORRECT ANSWERFirst, the nurse should turn off the IV pump. Each flash card is color-coded for easy subject identification. Native valve endocarditis is often treated with penicillin G and gentamicin for synergistic coverage of streptococci. -Ventricular Septal Defect Where are the rationales? Overview of Congenital Cardiovascular Anomalies, Diagnostic Requirements for Infective Endocarditis According to the Revised Duke Criteria, Revised Duke Clinical Diagnostic Criteria for Infective Endocarditis, Some Antibiotic Regimens for Endocarditis in the United States, Procedures Requiring Antimicrobial Endocarditis Prophylaxis in High-Risk Patients in the US, Recommended Endocarditis Prophylaxis During Oral-Dental or Respiratory Tract Procedures*, Diagnostic Requirements for Infective Endocarditis, Modified Duke Clinical Diagnostic Criteria for Infective Endocarditis, Habib G, Lancellotti P, Antunes MJ, et al, Some Antibiotic Regimens for Endocarditis, Procedures Requiring Antimicrobial Endocarditis Prophylaxis, Recommended Endocarditis Prophylaxis During Oral-Dental or Respiratory Tract Procedures, FIRVANQ, Vancocin, Vancocin Powder, VANCOSOL, Garamycin, Genoptic, Genoptic SOP, Gentacidin, Gentafair, Gentak , Gentasol, Ocu-Mycin, Cetraxal , Ciloxan, Cipro, Cipro XR, OTIPRIO, Proquin XR, Amoclan , Augmentin, Augmentin ES, Augmentin XR, Amoxil, Dispermox, Moxatag, Moxilin , Sumox, Trimox, Cleocin, Cleocin Ovules, Cleocin Pediatric, Cleocin T, CLIN, Clindacin ETZ, Clindacin-P, Clinda-Derm , Clindagel, ClindaMax, ClindaReach, Clindesse, Clindets, Evoclin, PledgaClin, XACIATO. Clients can have impaired would healing when taking this medication. 8. The nurse should expect to observe: When ventricular fibrillation occurs in a CCU, the first person reaching the client should: What criteria should the nurse use to determine normal sinus rhythm for a client on a cardiac monitor?
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