Perfusion: Valves/Infective Heart

Perfusion: Valves/Infective Heart

Labelling

Label the parts of the heart.

Drag labels to their correct position on the image

Sup/Inf Vena Cava

Tricuspid Valve

Pulmonary Veins

Mitral valve

Aortic Valve

Left Ventricle

Aorta

Pulmonary Artery

Pulmonic Valve

Right Ventricle

Multiple Choice

A present presents to the emergency room complaining of severe chest pain. The EKG is presented. VS: HR 132 bpm, RR 24 BP 189/99 (129) mmHg. Which finding would indicate this client is having pericarditis and NOT a myocardial infarction?

• Presence of a pericardial friction rub on auscultation.
• Elevated troponin levels in the blood.
• ST-segment elevation on the EKG.
• Severe shortness of breath with exertion.

Multiple Choice

Which diagnostic tool is the MOST VALUABLE to diagnosing endocarditis?

• Chest X-ray
• Blood culture
• CT scan
• Echocardiography

Multiple Choice

What is a priority goal of treatment for a client who has endocarditis or pericarditis?

• Administer anticoagulants to prevent clots.
• Increase heart rate and blood pressure.
• Promote bed rest and limit fluid intake.
• Eliminate infection and reduce inflammation.

Multiple Choice

Who is at the highest risk of developing endocarditis?

• Someone who has chronic UTIs

• Someone who has high blood pressure

• IV drug user

• Someone who receives chemotherapy

Multiple Choice

For a patient diagnosed with infective endocarditis, which would be an important part of their treatment plan?

• Intravenous antibiotics
• Antiviral medication
• Surgical intervention
• Oral antibiotics

Multiple Choice

You are caring for a client on the med-surg floor who presented with fever of unknown origin. During your assessment, you notice this spots on the hands. What are these spots and what is the cause?

• Rash caused by an allergic reaction.
• Blisters from a viral infection.
• Burns from chemical exposure.
• Petechiae caused by bleeding under the skin.

Match

This is the beginning of a case study, please answer the questions appropriately.

A homeless client is brought into the ED. Upon assessment you notice poor dental hygeine, loose teeth, a murmur at the right sternal border, and the skin is warm to touch. VS HR 112 bpm, RR 25 min, BP 94/64 (74) mmHg, Sat 92% on room air, Temp 102.3 F. GCS 12 Fingers are cyanotic with a delayed capillary refill. There is bruising to the right flank and scabbed areas to the right and left antecubital areas.

In the spots below, match the assessment findings with the primary survey

Match the assessment findings that correspond to the ABCs.

• Airway

• Breathing

• Circulation

• Disability

• Exposure

loose teeth

RR 25, SpO2 92%

Delay capillary refill

GCS 12

Scabbed areas to ACs, bruising

• loose teeth

• RR 25, SpO2 92%

• Delay capillary refill

• GCS 12

• Scabbed areas to ACs, bruising

Drag and Drop

(Recognize Cues) A homeless client is brought into the ED. Upon assessment you notice poor dental hygeine, loose teeth, a murmur at the right sternal border, and the skin is warm to touch. VS HR 112 bpm, RR 25 min, BP 94/64 (74) mmHg, Sat 92% on room air, Temp 102.3 F. GCS 12 Fingers are cyanotic with a delayed capillary refill. There is bruising to the right flank and scabbed areas to the right and left antecubital areas.

Labs have been obtained: WBC 22,000, Hgb 8.2, Platelets 147,000, Na 132, K 3.5, INR 1.2, Lactate 2.6.

Which findings are the most concerning on this client? ​

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murmur

cyanosis

Platelets 147,000

BP

Temperature

INR

bruising

poor dental hygeine

Reorder

(Analyze Cues) A homeless client is brought into the ED. Upon assessment, you notice poor dental hygiene, loose teeth, a murmur at the right sternal border, and the skin is warm to touch. VS HR 112 bpm, RR 25 min, BP 94/64 (74) mmHg, Sat 92% on room air, Temp 102.3 F. GCS 12 Fingers are cyanotic with a delayed capillary refill. There is bruising to the right flank and scabbed areas to the right and left antecubital areas.

Labs have been obtained: WBC 22,000, Hgb 8.2, Platelets 147,000, Na 132, K 3.5, INR 1.2, Lactate 2.6.

Based on your suspicion of what is happening to the client. Reorder the following based on how they should be completed.

• Obtain blood cultures

• Begin antibiotics

• Call for ECHO

• Obtain type and screen

• Administer acetaminophen

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• 5

Labelling

(Prioritize Hypothesis) A client is brought in upon assessment you notice poor dental hygiene, loose teeth, a murmur at the right sternal border, and the skin is warm to touch. VS HR 112 bpm, RR 25 min, BP 94/64 (74) mmHg, Sat 92% on room air, Temp 102.3 F. GCS 12 Fingers are cyanotic with a delayed capillary refill. There is bruising to the right flank and scabbed areas to the right and left antecubital areas.

Labs have been obtained: WBC 22,000, Hgb 8.2, Platelets 147,000, Na 132, K 3.5, INR 1.2, Lactate 2.6.

Complete the bow tie. by filling in the priority actions and priority things to monitor.

Drag labels to their correct position on the image

Lactate

Pericarditis

SpO2

Endocarditis

Sodium

Apply oxygen

Temperature

Administer 1/2 NS

Administer antibiotics

INR

Drag and Drop

(Generate Solutions) ​ A homeless client is brought into the ED. Upon assessment, you notice poor dental hygiene, loose teeth, a murmur at the right sternal border, and the skin is warm to touch. VS HR 112 bpm, RR 25 min, BP 94/64 (74) mmHg, Sat 92% on room air, Temp 102.3 F. GCS 12 Fingers are cyanotic with a delayed capillary refill. There is bruising to the right flank and scabbed areas to the right and left antecubital areas.

Labs have been obtained: WBC 22,000, Hgb 8.2, Platelets 147,000, Na 132, K 3.5, INR 1.2, Lactate 2.6.

Which interventions would the nurse question if ordered by the provider?​

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Ambulate

Strict intake and output

Apply a warm blanket

Lactate q3 hr x 3

Apply telemetry

Administer 80 mg enoxaparin IV q8 hr

Multiple Select

(Take Action) A homeless client is brought into the ED. Upon assessment you notice poor dental hygeine, loose teeth, a murmur at the right sternal border, and the skin is warm to touch. VS HR 112 bpm, RR 25 min, BP 94/64 (74) mmHg, Sat 92% on room air, Temp 102.3 F. GCS 12 Fingers are cyanotic with a delayed capillary refill. There is bruising to the right flank and scabbed areas to the right and left antecubital areas.

Labs have been obtained: WBC 22,000, Hgb 8.2, Platelets 147,000, Na 132, K 3.5, INR 1.2, Lactate 2.6.

The provider has placed order in the EMR, which order(s) would be appropriate for the nurse to implement?

• CT of head

• CT of abdomen

• 
  Start IV fluids, obtain blood cultures, administer broad-spectrum antibiotics, and obtain a chest x-ray.

• Administer a sedative to calm the patient

• Administer 3% NS over 3 hours

Drag and Drop

(Evaluate Outcomes) A homeless client is brought into the ED. Upon assessment, you notice poor dental hygiene, loose teeth, a murmur at the right sternal border, and the skin is warm to touch. VS HR 112 bpm, RR 25 min, BP 94/64 (74) mmHg, Sat 92% on room air, Temp 102.3 F. GCS 12 Fingers are cyanotic with a delayed capillary refill. There is bruising to the right flank and scabbed areas to the right and left antecubital areas.

Labs have been obtained: WBC 22,000, Hgb 8.2, Platelets 147,000, Na 132, K 3.5, INR 1.2, Lactate 2.6.

Which assessment findings would indicate FURTHER DETERIORATION of this client?​

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INR 3.6

Hgb 6.1

WBC 15,000, Hgb 10.5

Platelets 200,000, Na 140

Temp 98.6 F, HR 80 bpm

Lactate 5.6

Lactate 1.9

RR 36

GCS 9

Multiple Choice

Which is a common symptom of infective endocarditis that requires immediate medical attention?

• Headache

• Chest pain during exercise
• Petechial rash

• Sudden weight loss

Multiple Choice

When assessing a patient with pericarditis, what symptoms would you expect to find?

• Shortness of breath and wheezing
• Persistent cough and fatigue
• Chest pain, fever, pericardial friction rub, and signs of inflammation.
• Nausea and vomiting

Multiple Choice

In the management of a patient with endocarditis, why is it crucial to monitor blood cultures regularly?

• To assess for signs of heart failure

• To assess treatment effectiveness and detect complications.
• To evaluate for anemia

• To monitor the patient's blood pressure regularly.

Multiple Choice

What is the advantage of prosthetic valves over mechanical heart valves?

• Easier to implant than prosthetic valves.
• Prosthetic valves require more frequent maintenance

• Prosthetic valves do not require long-term blood thinning medication.

• Higher durability compared to prosthetic valves.

Multiple Choice

A client who has a mechanical heart valve has been taking warfarin for years. Which laboratory finding would be the most concerning for the client?

• Platelets 125,000

• INR 5.3

• RBC 3.6

• Hgb 8.6