Acute Inflammatory Disease (Myocarditis, Endocarditis, Pericarditis) for Progressive Care Certified Nurse (PCCN)
Included In This Lesson
Study Tools For Acute Inflammatory Disease (Myocarditis, Endocarditis, Pericarditis) for Progressive Care Certified Nurse (PCCN)
Outline
Acute Inflammatory Disease (Myocarditis, Endocarditis, Pericarditis)
Definition/Etiology:
- Pericarditis, endocarditis and Myocarditis are all conditions in which some part of the heart is inflamed.
- Endocarditis (Yolk) is specifically inflammation of the endocardium (inner layer of heart), including the valves of the heart.
- Cause: Usually Bacterial
- IV Drug Use
- Valve Replacement
- Dental Procedures/Tooth abscess
- Cause: Usually Bacterial
- Myocarditis (White) is specifically inflammation of the heart muscle itself.
- Cause: Usually Viral
- Covid-19
- Coxsackie B Virus
- Cause: Usually Viral
- Pericarditis (Shell) is only when the outer membrane of the heart is inflamed → fluid → pressure →↓CO
- Several Causes
- Idiopathic – Usually Inflammatory
- Coxsackie B Virus
- Several Causes
- Endocarditis (Yolk) is specifically inflammation of the endocardium (inner layer of heart), including the valves of the heart.
Pathophysiology:
- Endocarditis
- Affects the “egg yolk” portion of the heart
- Microbial Infection
- Strep (found in mouth)
- Staph (found on skin)
- Non-infective
- Inflammation/Clotting disorders
- Auto-immune Diseases (Lupus)
- ALWAYS vegetation on valves
- Heart valves = Mitral/Aortic most effected
- Result = CVA
- Myocarditis
- Inflammation of the muscular middle layer of heart (egg whites)
- Damages heart muscles = poor contraction
- Result = Heart Failure and/or sudden cardiac death
- Pericarditis
- Affects the outer layer, or the egg shell of the heart.
- Pouch that heart sits inside of with 50 ml of fluid.
- Fluid moves from cells to pouch = increased fluid effusion
- Effusion grows = heart cannot fully relax
- Result = Cardiac Tamponade
- Beck’s triad of hypotension, jugular venous distension, and muffled heart sounds
- Result = Cardiac Tamponade
Noticing: Assessment & Recognizing Cues:
- Cardiac Inflammation General Assessment
- Heart and Lungs sounds
- Friction Rubs
- S3
- Heart Failure symptoms
- SOB/Cough
- Vitals
- Tachycardia
- Fever/Chills
- Pain (Chest pain)
- ↓02 Sat
- Heart and Lungs sounds
- Endocarditis Cues
- Heart Murmur
- Mitral/Aortic
- Inflammation → Clotting
- Sign of Embolism
- Osler/Janeway
- Roth Spots (Retinal hemorrhages)
- Heart Murmur
- Myocarditis Cues
- Arrhythmias
- Inflammation effects pacemaker cells
- Heart Failure symptoms
- Feet & Ankles
- S3/S4
- Arrhythmias
- Pericarditis Cues
- Chest Pain
- Worse with cough, swallowing & deep breaths
- Improves with leaning forward
- Pericardial friction rub
- High pitched
- Muffled Heart sounds
- Chest Pain
Interpreting: Analyzing & Planning:
- General Interpreting: Labs
- CBC/Diff
- Blood Cultures X2
- ↑BNP
- ↑ Troponins
- ↑ ESR & ↑ CRP
- General Interpreting: Diagnostics
- ECG: Electricity
- could be ventricular or supraventricular arrhythmias (in other words, not one “cardinal” rhythm
- Echocardiogram: Plumbing
- Chest X-Ray/CT Chest
- ECG: Electricity
- Endocarditis
- TEE: the initial test of choice for all patients with suspected IE. It should ideally be performed within 12 hours of presentation and repeated after completing treatment
- Myocarditis
- Endomyocardial Biopsy: Looks for dead tissue & exact pathogen
- Pericarditis
- ECGS
- Diffuse ST elevations
- ALTERNANS
- ECGS
Responding: Patient Interventions & Taking Action:
- General
- IV Patent
- Vitals
- Full Cardiopulmonary assessment
- Continuous bedside heart monitor
- Pharmacological Interventions
- Iv Abx (if bacterial)
- Anticoagulants
- Anti-Inflammatory Medications (NSAIDS)
- + inotropes
- Diuretics
- Colchicine
- Corticosteroids
- Nonpharmacological
- Positioning
- Lean Forward
- Positioning
- Adjunct Medical Therapy
- Endocarditis
- DUKE criteria -Physician Calculation
- Consult Infectious Disease
- Long-term infusion therapy
- Myocarditis
- Treat Symptoms of Heart Failure
- Transplant Consult
- Pericarditis
- Pericardiocentesis
- Partial Pericardiectomy (Window)
- Endocarditis
Reflecting: Evaluating Patient Outcomes:
- Flush IV
- Chest Pain = Resolves
- Monitor = Free of arrhythmias
- Vitals = Stable
- Heart Sounds
- S3/S4 → WNL
- New Murmur = Resolves
- Rub → Resolves
- Lung Sounds
- Clear
- Labs Return to baseline/improve
- Inflammation → Clotting
- Resolves lesions
- EKG/ECHO = Electricity & Plumbing Improves
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System