Chapter 37: Inflammatory & Structural Heart Disorders

Assessment of an IV cocaine user with infective endocarditis should focus on which signs and symptoms (select all that apply)
a. Retinal hemorrhages
b. splinter hemorrhages
c. presence of Osler’s nodes
d. Painless nodules over bony prominences
e. painless erythematous macules on the palms and soles
a. Retinal hemorrhages
b. splinter hemorrhages
c. presence of Osler’s nodes
e. painless erythematous macules on the palms and soles
Rationale: Clinical manifestations of infective endocarditis may include hemorrhagic retinal lesions (Roth’s spots), splinter hemorrhages (black, longitudinal streaks) that may occur in the nail beds, Osler’s nodes (painful, tender, red or purple, pea-size lesions) on the fingertips or toes, and Janeway’s lesions (flat, painless, small, red spots) on the palms and soles.

The nurse is caring for a patient with chronic constrictive pericarditis. Which assessment finding reflects a more serious complication of this condition?
a. fatigue
b. peripheral edema
c. jugular venous distention
d. thickened pericardium on echocardiography
c. jugular venous distention
Rationale: Cardiac tamponade is a serious complication of pericarditis. As the compression of the heart increases, decreased left atrial filling decreases cardiac output. Neck veins usually are markedly distended because of jugular venous pressure elevation.

A patient is admitted with myocarditis. While performing the initial assessment, which clinical signs and symptoms might the nurse find (select all that apply)?
a. angina
b. pleuritic chest pain
c. splinter hemorrhages
d. pericardial friction rub
e. presence of Osler’s nodes
a. angina
b. pleuritic chest pain
d. pericardial friction rub
Rationale: Clinical manifestations of myocarditis may include early systemic manifestations (i.e., fever, fatigue, malaise, myalgias, pharyngitis, dyspnea, lymphadenopathy, and nausea and vomiting), early cardiac manifestations (i.e., pleuritic chest pain with a pericardial friction rub and effusion), and late cardiac signs (i.e., S3 heart sound, crackles, jugular venous distention [JVD], syncope, peripheral edema, and angina).

Priority nursing management for a patient with myocarditis includes interventions related to
a. meticulous skin care
b. antibiotic prophylaxis
c. tight glycemic control
d. oxygenation and ventilation
d. oxygenation and ventilation
Rationale: General supportive measures for management of myocarditis include interventions to improve ventilation and oxygenation (i.e., oxygen therapy, bed rest, and restricted activity).

When teaching a patient about the long-term consequences of rheumatic fever, the nurse should discuss the possibility of
a. valvular heart disease
b. pulmonary hypertension
c. superior vena cava syndrome
d. hypertrophy of the right ventricle
a. valvular heart disease
Rationale: Rheumatic heart disease is a chronic condition resulting from rheumatic fever that is characterized by scarring and deformity of the heart valves.

Which is a priority nursing intervention for a patient during the acute phase of rheumatic fever?
a. administration of antibiotics as ordered
b. management of pain with opioid analgesics
c. encouragement of fluid intake for hydration
d. performance of frequent, active range-of motion exercises
a. administration of antibiotics as ordered
Rationale: The primary goal of managing a patient with acute rheumatic fever is to control and eradicate the infecting organism. The nurse should administer antibiotics as ordered to treat the streptococcal infection and teach the patient that completion of the full course of antibiotic therapy is essential for successful treatment.

Which clinical finding would most likely indicate decreased cardiac output in a patient with aortic valve regurgitation?
a. reduction in peripheral edema and weights
b. carotid venous distention and new-onset atrial fibrillation
c. significant pulses paradoxus and diminished peripheral pulses
d. shortness of breath on minimal exertion and a diastolic murmur
d. shortness of breath on minimal exertion and a diastolic murmur
Rationale: Clinical manifestations of aortic regurgitation (AR) that indicate decreased cardiac output include severe dyspnea, chest pain, and hypotension. Other manifestations of chronic AR include water-hammer pulse (i.e., a strong, quick beat that collapses immediately), soft or absent S1, presence of S3 or S4, and soft, high-pitched diastolic murmur. A low-pitched diastolic murmur may be heard in severe AR. Early manifestations may include exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.

A patient is diagnosed with mitral stenosis and new-onset atrial fibrillation. Which interventions could the nurse delegate to nursing assistant personnel (NAP) (select all that apply)?
a. obtain and record daily weight
b. determine apical-radial pulse rate
c. observe for overt signs of bleeding
d. obtain and record vital signs, including pulse oximetry
e. teach the patient how to purchase a Medic Alert bracelet
a. obtain and record daily weight
c. observe for overt signs of bleeding
d. obtain and record vital signs, including pulse oximetry
Rationale: The nurse may delegate routine procedures such as obtaining weights and vital signs. The nurse may give specific directions to the nursing assistive personnel (NAP) to observe and report obvious signs of bleeding. The nurse cannot delegate teaching, assessment, or activities that require clinical judgment. Obtaining an apical-radial pulse rate is an assessment.

Which of the following diagnostic study best differentiates the various types of cardiomyopathy?
a. echocardiography
b. arterial blood gases
c. cardiac catheterization
d. endomyocardial biopsy
a. echocardiography
Rationale: The echocardiogram is the primary diagnostic tool used to differentiate between the different types of cardiomyopathies and other structural cardiac abnormalities.

The nurse is caring for a patient newly admitted with heart failure secondary to dilated cardiomyopathy. Which of the following interventions would be a priority?
a. encourage caregivers to learn CPR
b. consider a consultation with hospice for palliative care
c. monitor the patient’s response to prescribed medications
d. arrange for the patient to enter a cardiac rehabilitation program
c. monitor the patient’s response to prescribed medications
Rationale: Observing for signs and symptoms of worsening heart failure, dysrhythmias, and embolic formation in patients with dilated cardiomyopathy is essential, as is monitoring drug responsiveness. The goal of therapy is to keep the patient at an optimal level of functioning and out of the hospital. The priority intervention is to manage the acute symptoms with medications. The caregivers should learn cardiopulmonary resuscitation (CPR) before hospital discharge, and the patient may be referred to cardiac rehabilitation. Patients with dilated cardiomyopathy with progression to class IV stage D heart failure are candidates for palliative care.

Upon admission assessment, the nurse notes clubbing of the patient’s fingers. Based on this finding, the nurse will question the patient about which of the following disease processes?
a. Endocarditis
b. Acute renal failure
c. Myocardial infarction
d. Chronic thrombophlebitis
a. Endocarditis
Rationale: Clubbing of the fingers is a loss of the normal angle between the base of the nail and the skin. This finding can be found in endocarditis, congenital defects, and/or prolonged oxygen deficiency.

While admitting a patient with pericarditis, the nurse will assess for which of the following signs, symptoms, and complications of this disorder?
a. Pulsus paradoxus
b. Prolonged PR intervals
c. Widened pulse pressure
d. Clubbing of the fingers
a. Pulsus paradoxus
Rationale: Pericarditis can lead to cardiac tamponade, an emergency situation. Pulsus paradoxus >10 mm Hg is a sign of cardiac tamponade that should be assessed at least every 4 hours in a patient with pericarditis.

The nurse conducts a complete physical assessment on a patient admitted with infective endocarditis. Which of the following findings are significant?
a. Respiratory rate of 18 and heart rate of 90
b. Regurgitant murmur at the mitral valve area
c. Heart rate of 94 and capillary refill time of 2 seconds
d. Point of maximal impulse palpable in fourth intercostal space
b. Regurgitant murmur at the mitral valve area
Rationale: A regurgitant murmur would indicate valvular disease, which can be a complication of endocarditis. All the other findings are within normal limits.

When caring for a patient with infective endocarditis, the nurse will assess the patient for which of the following vascular manifestations (select all that apply)?
a. Osler’s nodes
b. Janeway’s lesions
c. Splinter hemorrhages
d. Subcutaneous nodules
e. Erythema marginatum lesions
a. Osler’s nodes
b. Janeway’s lesions
c. Splinter hemorrhages
Rationale: Osler’s nodes, Janeway’s lesions, and splinter hemorrhages are all vascular manifestations of infective endocarditis. Subcutaneous nodules and erythema marginatum lesions occur with rheumatic fever.

Which of the following nursing actions should the nurse prioritize during the care of a patient who has recently recovered from rheumatic fever?
a. Teach the patient how to manage his or her physical activity.
b. Teach the patient about the need for ongoing anticoagulation.
c. Teach the patient about his or her need for continuous antibiotic prophylaxis.
d. Teach the patient about the need to maintain standard infection control procedures.
c. Teach the patient about his or her need for continuous antibiotic prophylaxis.
Rationale: Patients with a history of rheumatic fever frequently require ongoing antibiotic prophylaxis, an intervention that necessitates education. This consideration is more important than activity management in preventing recurrence. Anticoagulation and standard precautions are not indicated in this patient population.

A 20-year old patient has acute infective endocarditis. While obtaining a nursing history, the nurse should ask the patient about which of the following (select all that apply)
a. renal dialysis
b. IV drug abuse
c. recent dental work
d. cardiac catheterization
e. recent urinary tract infection
a. renal dialysis
b. IV drug abuse
c. recent dental work
d. cardiac catheterization
e. recent urinary tract infection
Rationale: recent dental, urologic, surgical, or gynecologic procedures and history of IV drug abuse, heart disease, cardiac catheterization or surgery, renal dialysis, and infections all increase the risk of IE.

A patient has an admitting diagnosis of acute left-sided infective endocarditis. The nurse explains to the patient that this diagnosis is best confirmed with
a. blood cultures
b. a complete blood count
c. a cardiac catheterization
d. a transesophageal echocardiogram
a. blood cultures
Rationale: Although a complete blood cell count (CBC) will reveal a mild leukocytosis and erythrocyte sedimentation rates (ESRs) will be elevated in patients with infective endocarditis, these are nonspecific findings, and blood cultures are the primary diagnostic tool for infective endocarditis. Transesophageal echocardiograms can identify vegetations on valves but are used when blood cultures are negative, and cardiac catheterizations are used when surgical intervention is being considered.

A patient with infective endocarditis of a prosthetic mitral valve develops a left hemiparesis and visual changes. The nurse expects that collaborative management of the patient will include
a. an embolectomy
b. surgical valve replacement
c. administration of anticoagulants
d. higher than usual antibiotic dosages
b. surgical valve replacement
Rationale: Drug therapy for patients who develop endocarditis of prosthetic valves is often unsuccessful in eliminating the infection and preventing embolization, and early valve replacement followed by prolonged drug therapy is recommended for these patients.

A patient with aortic valve endocarditis develops dyspnea, crackles in the lungs, and restlessness. The nurse suspects that the patient is experiencing
a. vegetative embolization to the coronary arteries
b. pulmonary embolization from valve vegetations
c. nonspecific manifestations that accompany infectious diseases
d. valvular incompetence with possible infectious invasion of the myocardium
d. valvular incompetence with possible infectious invasion of the myocardium
Rationale: The dyspnea, crackles, and restlessness the patient is manifesting are symptoms of heart failure and decreased cardiac output (CO) that occurs in up to 80% of patients with aortic valve endocarditis as a result of aortic valve incompetence. Vegetative embolization from the aortic valve occurs throughout the arterial system and may affect any body organ. Pulmonary emboli occur in right-sided endocarditis.

A patient hospitalized for 1 week with subacute infective endocarditis is afebrile and has no signs of heart damage. Discharge with outpatient antibiotic therapy is planned. During discharge planning with the patient, it is most important for the nurse to
a. plan how his needs will be met while he continues on bed rest
b. teach the patient to avoid crowds and exposure to upper respiratory infections
c. encourage the use of diversional activities to relieve boredom and restlessness
d. assess the patient’s home environment in terms of family assistance and hospital access
d. assess the patient’s home environment in terms of family assistance and hospital access
Rationale: The patient with outpatient antibiotic therapy requires vigilant home nursing care, and it is most important to determine the adequacy of the home environment for successful management of the patient. The patient is at risk for life-threatening complications, such as embolization and pulmonary edema, and must be able to access a hospital if needed. Bed rest will not be necessary for the patient without heart damage. Avoiding infections and planning diversional activities are indicated for the patient but are not the most important step while he is on outpatient antibiotic therapy.

When teaching a patient with endocarditis how to prevent recurrence of the infection, the nurse instructs the patient to
a. start on antibiotic therapy when exposed to persons with infections
b. take one aspirin a day to prevent vegetative lesions from forming around the valves
c. always maintain continuous antibiotic therapy to prevent the development of any systemic infection
d. obtain prophylactic antibiotic therapy before certain invasive medical or dental procedures (e.g. dental cleaning)
d. obtain prophylactic antibiotic therapy before certain invasive medical or dental procedures (e.g. dental cleaning)
Rationale: Prophylactic antibiotic therapy should be initiated before invasive dental, medical, or surgical procedures to prevent recurrence of endocarditis. Continuous antibiotic therapy is indicated only in patients with implanted devices or ongoing invasive procedures. Symptoms of infection should be treated promptly, but antibiotics are not used for exposure to infection.

A patient is admitted to the hospital with a suspected acute pericarditis. To establish the presence of a pericardial friction rub, the nurse listens to the patient’s chest
a. while timing the sound with the respiratory pattern
b. with the bell of the stethoscope at the apex of the heart
c. with the diaphragm of the stethoscope at the lower left sternal bored of the chest
d. with the diaphragm of the stethoscope to auscultate a high-pitched continuous rumbling sound
c. with the diaphragm of the stethoscope at the lower left sternal bored of the chest
Rationale: The stethoscope diaphragm at the left sternal border is the best method to use to hear the high-pitched, grating sound of a pericardial friction rub. The sound does not radiate widely and occurs with the heartbeat.

A patient with acute pericarditis has markedly distended jugular veins, decreased BP, tachycardia, tachypnea, and muffled heart sounds. The nurse recognizes that these symptoms occur when
a. the pericardial space is obliterated with scar tissue and thickened pericardium
b. excess pericardial fluid compresses the heart and prevents adequate diastolic filling
c. the parietal and visceral pericardial membranes adhere to each other, preventing normal myocardial contraction
d. fibrin accumulation on the visceral pericardium infiltrates into the myocardium, creating generalized myocardial dysfunction.
b. excess pericardial fluid compresses the heart and prevents adequate diastolic filling
Rationale: The patient is experiencing a cardiac tamponade that consists of excess fluid in the pericardial sac, which compresses the heart and the adjoining structures, preventing normal filling and cardiac output. Fibrin accumulation, a scarred and thickened pericardium, and adherent pericardial membranes occur in chronic constrictive pericarditis.

A patient with acute pericarditis has a nursing diagnosis of pain related to pericardial inflammation. An appropriate nursing intervention for the patient is
a. administering opioids as prescribed on an around the clock schedule
b. promoting progressive relaxation exercises with the use of deep, slow breathing
c. positioning the patient on the right side with the head of the bed elevated 15 degrees
d. positioning the patient in Fowler’s position with a padded over the bed table for the patient to lean on
d. positioning the patient in Fowler’s position with a padded over the bed table for the patient to lean on
Rationale: Relief from pericardial pain is often obtained by sitting up and leaning forward. Pain is increased by lying flat. The pain has a sharp, pleuritic quality that changes with respiration, and patients take shallow breaths. Anti-inflammatory medications may also be used to help control pain, but opioids are not usually indicated.

When obtaining a nursing history for a patient with myocarditis, the nurse specifically questions the patient about
a. a history of CAD with or without an MI
b. prior use of digoxin for treatment of cardiac problems
c. recent symptoms of a viral illness, such as fever or malaise
d. a recent streptococcal infection requiring treatment with penicillin
c. recent symptoms of a viral illness, such as fever or malaise
Rationale: Viruses are the most common cause of myocarditis in the US, and early manifestations of myocarditis are often those of systemic viral infections. Myocarditis may also be associated with systemic inflammatory and metabolic disorders as well as with other microorganisms, drugs, or toxins. The heart has increased sensitivity to digoxin in myocarditis, and it is used very cautiously, if at all, in treatment of the condition.

The most important role of the nurse in preventing rheumatic fever is to
a. teach patients with infective endocarditis to adhere to antibiotic prophylaxis
b. identify patients with valvular heart disease who are at risk for rheumatic fever
c. encourage the use of antibiotics for treatment of all infections involving a sore throat
d. promote the early diagnosis and immediate treatment of group A streptococcal pharyngitis
d. promote the early diagnosis and immediate treatment of group A streptococcal pharyngitis
Rationale: Initial attacks of rheumatic fever and the development of rheumatic heart disease can be prevented by adequate treatment of group A streptococcal pharyngitis. Because streptococcal infection accounts for only about 20% of acute pharyngitis, cultures should be done to identify the organism and direct antibiotic therapy. Viral infections should not be treated with antibiotics. Prophylactic therapy is indicated in those who have valvular heart disease or have has rheumatic heart disease.

The diagnosis of acute rheumatic fever is most strongly supported in the patient with
a. carditis, polyarthritis, and erythema marginatum
b. polyarthritis, chorea, and increased antistreptolysin O titer
c. positive C-reactive protein, elevated WBC, subcutaneous nodules
d. organic heart murmurs, fever, and elevated erythrocyte sedimentation rate (ESR)
a. carditis, polyarthritis, and erythema marginatum
Rationale: Major criteria for the diagnosis of rheumatic fever include evidence of carditis, polyarthritis, chorea (often very late), erythema marginatum, and subcutaneous nodules. Minor criteria include all laboratory findings as well as fever, arthralgia, and a history of previous rheumatic fever.

A patient with rheumatic heart disease with carditis asks the nurse how long his activity will be restricted. The best answer by the nurse is that he
a. can perform non- strenuous activities as soon as antibiotics are started
b. will be confined to bed until symptoms of heart failure are controlled
c. will be able to have full activity as soon as cute symptoms have subsided
d. must be on bed rest until anti-inflammatory therapy has been discontinued
b. will be confined to bed until symptoms of heart failure are controlled
Rationale: When carditis is present in the patient with rheumatic fever, ambulation is postponed until any symptoms of heart failure are controlled with treatment, and full activity cannot be resumed until anti-inflammatory therapy has been discontinued. In the patient without cardiac involvement, ambulation may be permitted as soon as acute symptoms have subsided, and normal activity can be resumed when anti-inflammatory therapy is discontinued.

An RN is working with an LPN in caring for a group of patients on a cardiac telemetry unit. A patient with aortic stenosis has the nursing diagnosis of activity intolerance related to fatigue and exertional dyspnea. Which of these nursing activities could be delegated to the LPN?
a. explain the reason for planning frequent periods of rest
b. evaluate the patient’s understanding of his disease process
c. monitor BP, HR, RR, and SpO2 before, during, and after ambulation
d. teach the patient which activities to choose that will gradually increase endurance
c. monitor BP, HR, RR, and SpO2 before, during, and after ambulation
Rationale: Monitoring VS before and after ambulation is the collection of data. Instructions should be provided to the LPN regarding what changes in these should be reported to the RN. Other actions listed are RN responsibilities.

Drugs that the nurse would expect to be prescribed for patients with a mechanical valve replacement include
a. oral nitrates
b. anticoagulants
c. atrial antidysrhythmics
d. beta adrenergic blocking agents
b. anticoagulants
Rationale: Patients with mechanical valves have an increased risk for thrombus formation. Therefore prophylactic anticoagulation therapy is used to prevent thrombus formation and systemic or pulmonary embolization. Nitrates are contraindicated for the patient with aortic stenosis because an adequate preload is necessary to open the stiffened aortic valve. Antidysrhythmics are used only if dysrhythmias occur, and alpha or beta adrenergic blocking agents may be used to control the HR as needed.

A patient with symptomatic mitral valve prolapse has atrial and ventricular dysrhythmias. In addition to monitoring for decreased cardiac output related to the dysrhythmias, an appropriate nursing diagnosis related to the dysthymias identified by the nurse is
a. ineffective breathing pattern related to hypervolemia
b. risk for injury related to dizziness and lightheadedness
c. disturbed sleep pattern related to paroxysmal nocturnal dyspnea
d. ineffective self-health management related to lack of knowledge of prevention and treatment strategies
b. risk for injury related to dizziness and lightheadedness
Rationale: Dysrhythmias frequently cause palpitations, lightheadedness, and dizziness, and the patient should be carefully attended to prevent falls. Hypervolemia and paroxysmal nocturnal dyspnea (PND) would be apparent in the patient with heart failure.

A patient is scheduled for a percutaneous transluminal valvuloplasty. The nurse understands that this procedure is indicated for
a. any patient with aortic regurgitation
b. older patients with aortic regurgitation
c. older patients with stenosis of any valve
d. young adult patients with mild mitral valve stenosis
c. older patients with stenosis of any valve
Rationale: This procedure has been used for repair of pulmonic, tricuspid, and mitral stenosis, but usually for those patients that are poor surgical risks.

A patient is scheduled for an open surgical valvuloplasty of the mitral valve. In preparing the patient for surgery, the nurse recognizes that
a. cardiopulmonary bypass is not required with this procedure
b. valve repair is a palliative measure, whereas valve replacement is curative
c. the operative mortality rate is lower in valve repair than in valve replacement
d. patients with valve repair do not require postoperative anticoagulation as they do with valve replacement
c. the operative mortality rate is lower in valve repair than in valve replacement
Rationale: Repair of mitral or tricuspid valves has a lower operative mortality rate than does replacement and is becoming the surgical procedure of choice for these valvular diseases. Open repair is more precise than closed repair and requires cardiopulmonary bypass during surgery. All types of valve surgery are palliative, not curative, and patients require lifelong health care. Anticoagulation therapy is used for all valve surgery for at least some time postoperatively.

A mechanical prosthetic valve is most likely to be preferred over a biologic valve for valve replacement in a
a. 41-year-old man with peptic ulcer disease
b. a 22-year-old woman who desires to have children
c. a 35-year-old man with a history of seasonal asthma
d. 62-year-old woman with early Alzheimer’s disease
c. a 35-year-old man with a history of seasonal asthma
Rationale: Mechanical prosthetic valves require long-term anticoagulation, and this is a factor in making a decision about the type of valve to use for replacement. Patients who cannot take anticoagulant therapy, such as women of childbearing age, patients at risk for hemorrhage, or patient who may not be compliant with anticoagulation therapy, may be candidates for the less durable biologic valves.

When performing discharge teaching for the patient following a mechanical valve replacement, the nurse determines that further instruction is needed when the patient says,
a. I may begin an exercise program to gradually increase my cardiac tolerance
b. I will always need to have my blood checked once a month for its clotting function
c. I should wear a medic alert bracelet to identify my valve and anticoagulant therapy
d. the biggest risk I have during invasive health procedures is bleeding because of my anticoagulants
d. the biggest risk I have during invasive health procedures is bleeding because of my anticoagulants
Rationale: The greatest risk to a patient who has an artificial valve is the development of endocarditis with invasive medical or dental procedures; before any of these procedures, antibiotic prophylaxis is necessary to prevent infection. Health care providers must be informed of the presence of the valve and the anticoagulation therapy, but the most important factor is using antibiotic prophylaxis before invasive procedures.

When performing discharge teaching for the patient with any type of cardiomyopathy, the nurse instructs the patient to (select all that apply)
a. eat a low-sodium diet
b. suggest that caregivers learn CPR
c. engage in stress reduction activities
d. abstain from alcohol and caffeine intake
e. avoid strenuous activity and allow for periods of rest
a. eat a low-sodium diet
b. suggest that caregivers learn CPR
c. engage in stress reduction activities
d. abstain from alcohol and caffeine intake
e. avoid strenuous activity and allow for periods of rest
Rationale: These are all points that can apply to any cardiomyopathy.

INFECTIVE ENDOCARDITIS • Infective endocarditis (IE) is an infection of the endocardial surface of the heart that affects the cardiac valves. • IE can be classified by rapidity of onset, cause, or site of involvement. • The most common causative …

1. The nurse obtains a health history from a 65-year-old patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse is most appropriate? a. “Do you have a history of a heart …

Nursing Diagnosis for Coronary Heart Disease Imbalanced Nutrition: More than Body Requirements (encourage dietary changes in fat content Ineffective Health Maintenance(discuss modifiable risk factors) Nursing Diagnosis for Angina Pectoris Ineffective Tissue Perfusion: Cardiac Anxiety Risk for Ineffective Therapeutic Regimen Management(denial …

Arrhythmia Irregular heart rhythm A-V block Impairment of the conduction btwn atria and ventricles of the heart WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my sample Aneurysm Abdominal widening of …

pericardium outer layer of the heart myocardium muscle layer of the heart WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my sample begin chest compressions when administering CPR, the first action …

Overview Systemic inflammatory disease that occurs 2 to 6 weeks after an inadequately treated upper respiratory tract infection with group A beta-hemolytic streptococci Principally involves the heart, joints, central nervous system, skin, and subcutaneous tissues In rheumatic heart disease, early …

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