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ADH 1 > ADH 3; CHF + Shock > Flashcards

ADH 3; CHF + Shock Flashcards

1
Q

What is CHF?

A

Congestive Heart Failure
PUMPING/FILLING problem
usually due to impaired myocardial contraction
positive feedback! hence “congestion”

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2
Q

ACUTE (acute excess demands)

A

Fluid overload
A-fib
Injury
MI

Hyperthyroidism*
Infection/Fever*

*from book

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3
Q

CHRONIC (chronic excessive workload)

A 
Hypertension
CAD
Valve problems
COPD
Obesity, sedentary lifestyle
Thyroid
Inflammation/Infection
Substance abuse
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4
Q

Cardiac Output is…regulated by…

Cardiac Reserve is…affected by…

*NOT

A
  • AMOUNT of blood pumped in 1 min (HR x stroke volume)
  • regulated by O2 demands - as O2 use increases, CO increases (perfusion) think of running & flushing
  • Ability of heart to increase CO to meet demands
  • Ventricle damage (pumping)
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5
Q

Contractility is…

Ejection Fraction is…

*NOT

A
  • ability of cardiac muscle to shorten during systole
  • necessary to eject blood during systole

-(approx 60)% of blood in ventricles that is ejected during systole

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6
Q

HR
Rapid HR

*NOT

A

Ventricular contractions per minutes; affects CO
Rapid HR - shorten ventricular filling (diastole) reducing stroke volume & CO
SLOW HR - reduces CO because of less cardiac cycles

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7
Q

What are the 5 TYPES of Heart Failure

A 
Systolic
Diastolic
LF side
RT side
HIGH output
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8
Q

Systolic

A

PUMPING problem (afterload)
Ventricle not pumping
DEC ejection fraction

Ex. Hypertension increases afterload/resistance

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9
Q

Diastolic

A

FILLING problem (preload)
Ventricle not relaxing/STIFF
NORM ejection fraction

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10
Q

LF side

A

Left Ventricle (backing up into LUNGS)

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11
Q

RT side

A

Right ventricle (backing up to REST of BODY)

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12
Q

HIGH output

A

OK but not meeting demands of body

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13
Q

S/S of RT sided HF; backup to rest of body - 4

CAUSE is…

A
  • Edema
  • JVD
  • GI congestion = anorexia, ascited, WT gain
  • Liver/Spleen enlargement (RUQ pain)

pulmonary issue; restricted blood flow to lungs
(pulmonary edema)

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14
Q

S/S of LF sided HF; backup to lungs - 4
pulmonary congestion (backward effects)
decreased cardiac output (forward effects)

CAUSES - 2

A
  • SOB (orthopnea/dyspnea)
  • Cough/Crackles
  • S3 gallop (over already filled ventricles)
  • Nocturia

Hypertension, CAD

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15
Q

HIGH output; PTs in hypermetabolic states 4

require…

A
  • Hyperthyroidism
  • Infection
  • Anemia
  • Pregnancy

require INC CO

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16
Q

Flash Pulmonary Edema is…
HALLMARK SIGN?
Treatment?

A

Acute emergency condition
pink frothy speutum

  • O2, intubation,
  • diuretics,
  • morphine (to relaxt PT + vasodilation + DEC preload)
17
Q 
NY Heart Association Classification:
Class 1
Class 2
Class 3
Class 4
A

Class 1: no limitation, asymptomatic during ADLs
Class 2: slight limitation, mild symptoms during ADLS
Class 3: moderate limitations, symptoms w/minimal activity
Class 4: severe limitations,symptoms present at rest; end stage CHF, shock

18
Q 
Compensatory Mechanisms:
SNS
RAAS
Ventricular Hypertophy
BNP
A

SNS - inc HR, vasoconstricts, INC BR
RAAS - retains, vasoconstricts, DEC UR,
Ventricular Hypertophy - thickening of muscle
BNP - release to decrease SNS

19
Q 
Diagnostic Studies:
CXR
EKG
Echocardiogram
Liver & Renal function test
A

CXR - lungs & heart size & congestion
EKG - monitor for changes/arrhythmias
Echo - moving heart pictures (beating of your heart baby)
LFT/Urinalalysis- BUN, Creatinine (assess liver function affected by heart failure)

20
Q 
Diagnostic Studies:
BNP
ABGs
CBC
K levels
A

BNP - enzyme released during HF (need additional tests to confirm)
ABGs - gas exchanged in lungs & tissues
CBC - Hgb, Hct
K levels - (3.5 - 5)

21
Q

BNP: B-type Natriuretic Peptide

LEVELS

A 
< 100 no failure
100-300 some failure
> 300 mild failure
> 600 moderate failure
> 900 severe failure
22
Q

Treatment

UNLOAD!

A 
U - Upright position
N - Nitrates
L - Lasix
O - Oxygen
A - ACE/ARBS (inhibit RAAS)
D - Digoxin
23
Q

Non-Pharmacological MGMT

A 
Oxygen
Smoking cessation
Exercise - NOT for Class 5
WT loss
ETOH limitation
Na restricted diet
Fluid restriction - strict I/O; 1500ml/day
24
Q

Device therapy

A

Pacemakers
Internal Cardiac Defibrillator
Ventricular Assist Device

25
Q 
Pharmacological Tx:
Sympathomimetic Agents (2)
Phosphodietrerase Inhibitors (PDEs)
A
  • Dopamine: B1 & Alpha; INC contractility, vasoconstriction
  • Dobutamine: B1; INC CO
    & contractility
    -Primacor: INC ccardiostimulatory & vasodilatory, cardiac inotropy
    Short-term treatment of HF unresponsive to conventional therapy with digoxin, diuretics, and vasodilators.
26
Q

Cardiogenic Shock is when…

DEC in CO causes a DEC in…

A

heart cannot maintain cardiac output & tissue perfusion

MAP

27
Q 
SHOCK Manifestations:
BP
Pulse
Respirations
Skin
MS
UR
Other
A

BP - hypotension
Pulse - rapid, thready
Respirations - INC, labored, crackles/wheezes, pulmonary edema
Skin - pale, cyanotic, cold, moist
MS - restless, anxious, lethargy to comatose
UR - oliguria to anuria
Other - dependent edema, elevated CVP,

28
Q

Hemodynamics is the study of…

A

forces involved in blood circulation, assess cardiovascular function.

29
Q

Hemodynamic Monitoring (Non-Invasive):

A

measure the pressure within a vessel & convert this signal into an electrical wave form that is amplified & displayed.

for CVP, RAP, PAP

30
Q

MAP

formula

ranges?

A

average pressure in the arterial circulation throughout cardiac cycle

(2 X DBP + SBP) / 3

MAP > 60
< 60 = severe DEC perfusion
>105 = hypertension, vasoconstriction

31
Q

NX MGMT for SHOCK

A

Monitor EKG, cardiac rhythm
Hemodynamics
Fluid status (electrolytes K & Ca)
Adjust medication & therapies to prevent refractory stage (end stage HF)

32
Q

Rx for SHOCK

A
  • Diuretics
  • Vasodilators
  • Primacor, nipride, Tridil
  • Positive inotopics
  • Dopamine, Dobutamine
  • Vasopressors - DEC BP
  • Levophed
33
Q

Intra-Aortic Ballon Pump (IABP)
temporary for…
what does it do? (3)

A

for heart stabilization

  • INC myocardial O2 supply/DEC myocarial demand
  • Improve CO/ejection fraction
  • INC coronary & systemic perfusion
34
Q

Intra-Aortic Ballon Pump (IABP)

Nx interventions

A

Check for collateral circulation before catheter is inserted
-Allen Test; occlude ulnar & radial arteries, make fist & release
Continuous BP monitoring

35
Q

Intra-Aortic Ballon Pump (IABP)

Complications

A
  • Distal ischemia ; warmth, color
  • External hemorrhage - any disconnection/dislodgement
  • Thrombosis - keep line patent
  • Air embolism
  • Infection
36
Q

CVP Monitoring

A
  • Monitored for fluid status
  • Pressure in Vena Cava or RT Atrium, measures preload
  • Used for administering IV fluids/medications & drawing blood specimen
37
Q

CVP Monitoring

normal range
significance

A

(2 - 8 mmHg)

DEC; hypovolemic, dehydration
INC; hypervolemic - vasoconstriction, cardiac tamponade

38
Q

Nx for Hemodynamic Monitoring

pg 397

A 
HR, BP, RR, - know baseline at rest, during, & after
Activity tolerance
Calibrate system
Maintain 300 mmHg pressure
Dressing & pressure monitoring according to hospital policy, sterile technique
FLUSH tip of catheter
Monitor for complications
Arrhythmias

ADH 1 (3 decks)

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