10 minute topic Heart failure

Question 1

Heart failure

Answer 1

cardiac muscle is unable to pump effectively and unable to maintain adequate circulation to meet tissue needs

Question 2

Result of HF

Answer 2

inadequate cardiac output
myocardial hypertrophy
pulmonary/systemic congestion

Question 3

Causes of HF

Answer 3

can be acute or chronic

HTN, MI, Pulmonary HTN, dysrhythmias, valve disease, pericarditis, cardiomyopathy

Question 4

Class I HF

Answer 4

Client exhibits no symptoms with activity

Question 5

Class II HF

Answer 5

Client has symptoms with ordinary exertion

Question 6

Class III HF

Answer 6

Client displays symptoms with minimal exertion

Question 7

Class IV HF

Answer 7

Client has symptoms at rest (SOB and chest pain at rest)

Question 8

Low-output heart failure

Answer 8

can initially occur on either the left or right side of the heart

Question 9

Left sided (ventricular) HF

Answer 9

results in inadequate left ventricle (cardiac) output and inadequate tissue perfusion

Question 10

Systolic failure

Answer 10

ejection fraction below 40%, pulmonary and systemic congestion

Question 11

Diastolic failure

Answer 11

inadequate relaxation or “stiffening” prevents ventricular filling

Question 12

Right Sided (ventricular) HF

Answer 12

inadequate right ventricle output and systemic venous congestion (peripheral edema)

Question 13

Risk Factors for Left-sided (ventricular) HF (left = lungs)

Answer 13

Hypertension
Coronary artery disease
Angina
MI
Valvular disease (mitral and aortic)

Question 14

Risk Factors for right-sided (ventricular) HF

Answer 14

Left-sided heart (ventricular) failure – it backs up to the right
Right ventricular MI
Pulmonary problems (COPD, pulmonary fibrosis)

Question 15

Risk factors for high output HF

Answer 15

Increased metabolic needs
Septicemia (fever)
Anemia
Hyperthyroidism

Question 16

Risk factors for cardiomyopathy

Answer 16

Coronary artery disease
Infection or inflammation of the heart muscle
Various cancer treatments (cause) 
Prolonged alcohol use
Heredity

Question 17

Cardiomyopathy sx

Answer 17

Fatigue 
Weakness
Heart failure
Heart block 
Gallop
Cardiomegaly

Question 18

Human B-type natriuetic peptides (hBNP)

Answer 18

used to Dx HF from other respiratory problems and to monitor effectiveness of tx

Question 19

Human B-type natriuetic peptides (hBNP) levels

Answer 19

100 < 300 pg/mL suggest HF is present.
> 300 pg/mL indicates mild HF
> 600 pg/mL indicates moderate HF
> 900 pg/mL indicates severe HF

Question 20

Hemodynamic monitoring

Answer 20

done in the ICU to dx HF

Question 21

Cardiac ultrasound or ECG

Answer 21

measures both systolic & diastolic function of the heart

Question 22

Left ventricular ejection fraction (LVEF)

Answer 22

The volume of blood pumped from the left ventricle into the arteries upon each beat. Normal is 55% to 70%

Question 23

Right ventricular ejection fraction (RVEF)

Answer 23

The volume of blood pumped from the right ventricle to the lungs upon each beat. Normal is 45% to 60%.

Question 24

HF nursing care

Answer 24

Position to maximize ventilation (high fowlers, sit them up)
Bedrest until stable
Fluid and Na+ restrictions
Provide O2

Question 25

HF medications

Answer 25

preload and afterload reducing agents 
Inotropic agents
Vasodilators 
Anticoagulants 
hBNP

Question 26

Medication to reduce preload

Answer 26

diuretics

Question 27

Medication to reduce afterload

Answer 27

ACE inhibitors, ARBs to help the heart pump more easily by altering the resistance to the contraction

Question 28

Inotropic agents

Answer 28

digoxin which will increase contractility and increase cardiac output

Question 29

Vasodilators

Answer 29

will help to reduce preload and afterload and decrease myocardial demand (Nitro)

Question 30

Anticoagulants

Answer 30

Coumadin – especially if they have a history of thrombus formation

Question 31

nesiritide (Natrecor)

Answer 31

hBNP

used to treat acute HF, it causes natriuresis (loss of NA and vasodilation)

Question 32

hBNP – nesiritide (Natrecor)nursing considerations,

Answer 32

hypotension, VT & bradycardia – on monitor & close VS monitoring
BNP levels will rise while on med
Give in separate IV d/t incompatibility with other meds (HEPARIN)

Question 33

Ventricular assist device (VAD)

Answer 33

surgically implanted mechanical pump that assists a heart that is too weak to pump blood through the body.

Question 34

Heart transplantation

Answer 34

End stage HF patients get this
The new hearts will often develop CAD
Will need increased K+ intake