Agents for Treating HF

Question 1

What is afterload?

Answer 1

The resistance that the heart has to work against to open the mitral valve and push blood into the system.

AKA systemic or peripheral vascular resistance

Question 2

What is cardiac output, how do we calculate it, and what is the normal CO for a healthy adult?

Answer 2

the amount of blood the heart pumps through the circulatory system in 1 minute

Normal is 4.7 L/min

SV x HR

Question 3

What is cardiomegaly and what causes it?

Answer 3

enlargement of the heart muscle

Caused by infection, alcoholism, steroids, chronic HTN, valvular disease, and HF

Question 4

What is cardiomyopathy and what does it cause?

Answer 4

A disease of the heart muscle

Causes a weakened heart and eventual complete heart failure and death

Question 5

What is chronotropic agent?

Answer 5

something that can change the heart rate

Question 6

What is dyspnea and what disease of the heart is it often associated with?

Answer 6

discomfort with respirations, often with a feeling of anxiety and inability to breathe

Left-Sided Heart Failure which makes sense b/c in this causes fluid build up in the lungs

Question 7

Define Heart Failure

Answer 7

a condition where the heart has a decreased ability to pump enough blood around the body

Leads to blood backup, or congestion, in the system

Question 8

What is hemoptysis?

Answer 8

blood-tinged sputum seen in left-sided heart failure when blood backs up into the lungs and fluid leaks out into the lung tissue

Question 9

What is nocturia?

Answer 9

The increased action of getting up to pee at night

Question 10

The nurse’s patient states, “I’m so tired because I’ve been having to get up to pee so much at night”. This is known as ___________.

Answer 10

nocturia

Question 11

What conditions are associated with nocturia and how?

Answer 11

increased renal perfusion when the patient is in the supine position d/t gravity-dependent edema r/t to HF

UTI also increases the need to pee

Question 12

What is orthopnea?

Answer 12

difficulty breathing when lying down

Question 13

What is a positive inotrope?

Answer 13

a drug/chemical that causes an increase in the force of the muscle contraction of the heart

Question 14

What is preload?

Answer 14

the amount of blood that is brought back to the heart to be pumped throughout the body

Puts pressure on the ventricles of the heart

Question 15

What is pulmonary edema?

Answer 15

Loss of fluid into the lung tissue

The is caused by severe left-sided heart failure, which causes fluid backup into the lungs

Question 16

What is tachypnea?

Answer 16

Rapid and shallow respirations seen with left-sided heart failure

Question 17

What is the goal when we treat CHF?

Answer 17

Get the heart to contract more efficiently in an effort to bring the cardiovascular system back into back and perfuse the body

Question 18

What is the leading cause of CHF?

Answer 18

Coronary Artery Disease (CAD)

Question 19

What is valvular heart disease?

Answer 19

Regurgitation of a valve so blood backs up into the ventricle

The ventricle has to work harder and harder to get it’s 4.7L/min to the body, so the muscle wears out and eventually is damaged

Question 20

What are the causes of cardiac muscle damage during HF?

Answer 20

Atherosclerosis and cardiomyopathy

Question 21

When the heart has an increase in workload because it needs to maintain an efficient output of blood, why does it do that?

Answer 21

HTN and/or

Valvular disease

Question 22

What causes structural abnormalities in the heart?

Answer 22

congenital cardiac defects

Question 23

What are the compensatory mechanisms for decreased CO and how do they work?

Answer 23

Sympathetic stimulation: increased vasoconstriction leads to increased HR leads to increased CO

Renin Release: leads to fluid retention leads to increased CO leads to increased perfusion

Question 24

What are the s/sx of left-sided HF?

Answer 24

anxiety

tachypnea
dyspnea
orthopnea
hemoptysis
rales

cardomegaly
S3 sounds
increased HR

GI upset: nausea, abdominal pain

Hypoxia: decreased peripheral pulses

Question 25

What are the s/sx of right-sided HF?

Answer 25

elevated jugular d/t elevated venous pressure

splenomegaly

hepatomegaly

decreased renal perfusion when upright
increased renal perfusion when supine which leads to nocturia

pitting edema

weakness/fatigue

Question 26

Which 3 classes are positive inotropes?

Answer 26

Cardiac glycosides
Phosphodiesterase inhibitors
HCN Blocker

Question 27

Why do we use cardiotonic agents with children?

Answer 27

to treat heart defects and related cardiac problems

Question 28

Which cardiotonic agent is best for children?

Answer 28

Digoxin

Question 29

What should the nurse monitor for when administering digoxin to a child?

Answer 29

Double check dosage with another nurse

Monitor closely for digitalis toxicity

Question 30

What education should the nurse provide for adult patients taking a cardiotonic agent (positive inotrope)?

Answer 30

Teach how to take own pulse daily

Daily wts

Do not switch brands of digoxin

Avoid in pg and lactation

Question 31

What should the nurse monitor for when administering a cardiotonic agent to an older adult?

Answer 31

Digitalis toxicity

Adjust the dose for renal impairment

Question 32

What education should the nurse provide for an older adult patient taking a cardiotonic agent?

Answer 32

Take your own pulse daily

Daily wts

Question 33

What drug(s) are cardia glycosides?

Answer 33

Digoxin

Question 34

Is Digoxin a positive or negative inotrope?

Answer 34

positive

Question 35

Inamrinone is only for use in patients with _________________________.

Answer 35

HF that has not responses to digoxin, diuretics, or vasodilators

Question 36

Milrinone is used for …..

Answer 36

the short-term management of HF in patients who are receiving digoxin and diuretics

Question 37

What does HCN stand for?

Answer 37

Hyperpolarization-Activated Cyclic Nucleotide-Gated