30 Flashcards
____ ____ is the inability of the heart to pump sufficient blood to meet the needs of tissues for O2 and nutrients
heart failure
how would you measure R ventricular preload?
by measuring venous distention (JVD)
how would you measure left ventricular afterload?
mean arterial BP
_____ _____ ____ is a fluid overload associated with HF
congested heart failure
_____ _____ HF is acute exacerbation of HF with s/s resulting in lower systemic perfusion
acute decompensated
___ HR is the most common and is the inability of the heart to contract resulting in a reduced EF
systolic
____ HF is the least common and is a stiff heart muscle making it difficult for the ventricle to fill resulting gin a normal EF
diastolic
how is EF calculated?
by subtracting the amount of blood present in the left ventricle at the end of systole from the amount present at the end of diastole and calculating the present of blood that is ejected
what is a normal EF??
55-65%
_____ ____ is when hypertrophy results in an abnormal proliferation of myocardial cells (thickened heart muscle)
ventricular remodeling
_____ is a disease of the myocardium and is identified as dilated, hypertrophic and restrictive
cardiomyopathy
______ cardiomyopathy is most common and causes diffuse cellular necrosis and fibrosis leading to decreased contractility (systolic failure)
dilated
_____ and ____ cardiomyopathy lead to a decreased distensibility and ventricular filling (diastolic failure)
hypertorphic and restrictive
NYHA classifications of HF
I: ordinary activity does not cause fatigue dyspnea etc, no pulonary congestion or peripheral hypotension, pt. asymptomatic, no limitations to ADLs (GOOD) II: slight limitations to ADLS, no symptoms at rest but symptoms with activity, may have crackles and S3 murmur(GOOD) III: limitation w/ ADLS, no symptoms at rest but symptoms w/ activity (FAIR) IV: symptoms of cardiac insufficiency at rest (POOR)
ACC/AHA classifications of HF
Stage A: high risk for developing left ventricular dysfunction, no structural heart disease or symptoms of HF Stage B: pts w/ left ventricular dysfunction or structural heart disease, no symptoms of heart failure Stage C: pt w/ left ventricular dysfunction or structural heart disease, current or prior symptoms of heart failure Stage D: pts. w/ refractory end stage heart failure requiring specialized interventions
____ ____ HF occurs when left ventrical cant pump blood effectively into the aorta and systemic circulation.
left sided
what is the result of left sided HF?
pulmonary venous pressure increase causing pulmonary congestion w/ dyspnea, cough, crackles and impaired O2 exchange. possible S3 “ventricular gallop or orthopenia, reduced urine output, altered digestion, dizziness, lightheadedness, confusion, tachycardia, palpitations, weak and thready pulses, fatigue
_____ results in difficulty breathing when lying flat. pt may need pillows to prop themselves up up in bed, may sit in chair, or may sleep sitting up
orthopenia
dyspnea at night is known as ____ _____ ___
paroxysmal nocturnal dyspnea (PND)
What are the characteristics of a cough associated with left sided HF
dry “hacking” and non productive can become moist over time frothy “pink” (blood tinged) sputum indicating pulmonary edema
____ ___ _HF results when the R ventricle cant eject sufficient amounts of blood and blood backs up in the venous system b/c the right side can not accommodate all the blood that is normally returned to it
right sided
what are the characteristics that follow R sided HF
peripheral edema, hepatomegaly(enlarged liver), ascites(fluid in peritoneal cavity), anorexia, nausea, weakness, weight gain due to fluid retention
How is the diagnosis of HF usually confirmed?
echocardiogram
Which lab value is a key diagnostic indicator of HF?
Brain Natriuretic peptide (BNP), high levels are a sign of cardiac filling pressure
medical management of HF
eliminate or reduce etiologic or contributory factors optomize pharmacologic and therapeutic regimens reduce workload on the heart bu reducing afterload and preload promote a lifestyle conducive to cardiac health prevent episodes of acute HF
Meds for HF
Ace inhibitors (slow progression of HF, increase exercise tolerance, decrease # of hospitalizations) ARB (alternative to ACE inhib’s d/t cough) Beta blockers Diuretics Digoxin
meds for HF are commonly ______ meaning they are increased every 2 weeks. during this action there is potential for symptoms to worsen and improvement may take several weeks
titrated
diuretics may be most effect when the patient is in _____ position for 1 or 2 hrs.
supine
_____ a BNP that is made using recombinant technology is used for pts w/ acute decompensated HF
nesiritide
what is the recommended diet for HF?
low sodium and and fluid intake. low sodium reduces fluid retention and symptoms of peripheral and pulmonary congestion, decrease in amount of circulating blood volume, and decrease in myocardial work
pts with HF are at high risk for ________
dysrhythmias
Pts with severe L ventricular dysfunction and life threatening dysrhythmias can be placed on a ____ ____ ____ to prevent sudden cardiac death and extend survival
implantable cardioverter defibrillator (ICD)
pts with HF that do not improve with standard therapy are treated with ___ ____ ___ which involves the use of a bioventricular pacemaker to treat electrical conduction defect (contractions)
cardiac resynchronization therapy
Assessment of pt with HF
sleep and activity # of pillow needed for sleep? mental status ADLs knowledge and coping with HF lung sounds: crackles wheezes heart sounds: is S3 present?? sensations and LOC edema (weight gain/loss), hepatojugular reflux I&O
clinical manifestations of pulmonary edema
decreased cerebral O2 restlessness anxious breathlessness sense of suffocation cold/moist hands cyanoic nail beds weak/rapid pulse
pts w/ HF experience activity intolerance b/c their symptoms worsen. how much physical activity is encouraged for these pts.
a total of 30 minutes every day w/ a 5 minute warm up
what is the position for pts with pulmonary edema?
pt positioned upright w/ legs dangling over side of bed this decreases venous return, R ventricular stroke volume, and lung congestion
_____ _____ is abnormal accumulation of fluid in interstitial spaces of lungs that diffuses into the alveoli
pulmonary edema
what is the classic symptom of pulmonary edema?
frothy pink (blood tinged) sputum
pulmonary edema results in _____
hypoxemia
____ ____ occurs when decreased CO leads to inadequate tissue perfusion and initiation of the shock syndrome
cardiogenic shock
___ ____ ___ __ used in cardiogenic shock and inflates at the beginning of diastole which results in increased perfusion of the coronary and peripheral arteries. it deflates just before systole which results in a decrease in afterload and in the left ventricular workload
intra aortic balloon pump
pts with cardiac disorders have decreased mobility and circulation which increases the risk for __________
thromboembolism
blood clots from the legs move to obstruct the pulmonary vessels which results in ______ _______
pulmonary embolism
____ ____ is accumulation of fluid in the pericardial sac. this results in elevated pressure n all cardiac chambers, decreased venous return due to atrial compression, and inability of the ventricles to distend and fill adequately
pericardial infusion
cardiac arrest occurs when the heart ceases to produce an effective pulse and circulate blood. the ABCD protocol must be used. What is the ABCD protocol?
airway: opening and maintaining an airway breathing: provide artificial ventilation by rescue breathing circulation: promote circulation with compressions defibrillation: for V tach and V fib
what is the most reliable sign of cardiac arrest in an adult and child?
carotid pulse infant= brachial pulse
