Care of Patients with Heart Failure

Question 1

heart failure statistics

Answer 1

leading cause of hospital admission for patients over 65. major cause of disability and death. Readmission an important quality measure in acute care. CMS core measure.

Question 2

heart failure

Answer 2

chronic inability of heart to work effectively as a pump. Heart not able to maintain adequate cardiac output to meet the metabolic needs of the body.

Question 3

types of heart failure

Answer 3

left sided
right sided
high output failure
most heart failure of the left ventricle and progresses to failure of both ventricles.

Question 4

right sided heart failure

Answer 4

right ventricle can not empty effectively.

Question 5

causes of right sided heart failure

Answer 5

left ventricular failure
right ventricular MI
pulmonary HTN
chronic ling disease

Question 6

symptoms of right sided heart failure

Answer 6

systemic congestion
- JVD
- enlarged liver and spleen
- anorexia and nausea
- dependent edema
- distended abdomen
- swollen hands and fingers
- polyuria at night
- weight gain
- increased blood pressure from excess volume
- decrease blood pressure from failure

Question 7

left sided heart failure

Answer 7

decreased tissue perfusion form poor cardiac output and pulmonary congestion.

Question 8

systolic heart failure

Answer 8

heart can not contract forcefully enough to eject adequate blood

Question 9

diastolic heart failure

Answer 9

ventricle can not relax adequately during diastole preventing adequate filling of blood

Question 10

causes of left sided heart failure

Answer 10

HTN
CAD
valvular disease

Question 11

symptoms of left sided heart failure

Answer 11

pulmonary congestion
- hacking cough, worse at night
- dyspnea
- crackles/wheezes in lungs
- pink, frothy sputum
- tachypnea
- S3/S4 gallop
Decreased cardiac output
- fatigue and weakness
- oliguria during day/nocturia at night
- angina
- confusion and restlessness
- dizziness
- pallor and cool extremities
- weak peripheral pulses
- tachycardia

Question 12

high output heart failure

Answer 12

occurs when cardiac output remains normal or above normal but there are increased metabolic needs to hyperkinetic conditions

Question 13

causes of high output heart failure

Answer 13

septicemia
high fever
anemia
hyperthyroidism
**not as common as the other two types

Question 14

compensatory mechanisms

Answer 14

when cardiac output is insufficient to meet the demands of the body, compensatory mechanisms work to improve cardiac output. eventually the heart can not keep up with the demands, then CM of HF occur.

Question 15

compensatory mechanism: sympathetic nervous system stimulation

Answer 15

increase HR and blood pressure

Question 16

compensatory mechanism: RAAS

Answer 16

causes vasoconstriction and retention of Na and water

Question 17

compensatory mechanism: other chemical responses

Answer 17

immune responses causes ventricular remodeling. endothelium causes vasoconstriction. vasopressin causes vasoconstriction

Question 18

compensatory mechanism: myocardial hypertrophy

Answer 18

thicken of heart walls to increase muscle mass lead to more forceful contractions

Question 19

electrolytes

Answer 19

abnormalities from complications of HF or side effects of drug therapy

Question 20

BUN and creatinine

Answer 20

inadequate perfusion of kidneys can result in impairment and elevated levels

Question 21

hemoglobin and hematocrit

Answer 21

could be low secondary to demodilution

Question 22

urinalysis

Answer 22

possible proteinuria and high specific gravity

Question 23

microalbuminuria

Answer 23

early indicator of decreased compliance of heart and occurs before the BNP rises

Question 24

ABGs

Answer 24

evaluates hypoxemia
decrease in gas exchange secondary to fluid filled alveoli

Question 25

BNP

Answer 25

will be elevated and used for diagnosing HF BNP is produced and released by the ventricles when the patient is fluid overload natiuretic peptides are neurohormones that promote vasodilation and diuresis through sodium loss in the renal tubules patients with renal disease may also have elevated levels

Question 26

imaging

Answer 26

chest xray echocardiography

Question 27

chest xray

Answer 27

cardiomegaly may be present

Question 28

echocardiography

Answer 28

best tool in diagnosing HF measures chamber size, EF and flow

Question 29

priority problems

Answer 29

impaired gas exchange related to ventilation/perfusion imbalance. decreased cardiac output related to altered contractility, preload, and after load. fatigue related hypoxemia. potential for pulmonary edema.

Question 30

nursing interventions

Answer 30

oxygen (90% or greater) monitor respirations and lung sounds if dyspnea present, high fowlers position reposition, cough, deep breath every 2 hours drug therapy nutrition therapy fluid restriction weight daily monitor and record I&O provide periods of uninterrupted rest asses the patient's response to increased activity

Question 31

drug therapy effect

Answer 31

to improve stroke volume- reduced after load, preload, but improve cardiac muscle contractility

Question 32

if dyspnea present, high fowlers position because...

Answer 32

maximize chest expansion and improve oxygenation

Question 33

reposition, cough, deep breath every 2 hours because...

Answer 33

improve oxygenation and prevent atelectasis

Question 34

nutrition therapy because...

Answer 34

goal to reduce sodium and water retention reduce sodium intake 2g/day

Question 35

fluid restriction limit...

Answer 35

range from 2 liters to 3 liters per day

Question 36

weigh daily because

Answer 36

most reliable indicator of fluid gain or loss. 1 kg of weight gin or loss equals 1 liter of retained or lost fluid

Question 37

nonsurgical options

Answer 37

CPAP- improves sleep apnea and supports cardiac output and ejection fraction cardiac resynchronization therapy- uses a permanent pacemaker alone or in combination with implantable cardioverter-defibrillator gene therapy

Question 38

surgical options

Answer 38

heart transplant ventricular assistive devices (VAD)- mechanical pump is implanted to work with patient's heart to improve function

Question 39

patient teaching for heart failure

Answer 39

diet: sodium restriction and fluid restriction activity schedule drug therapy discharge instructions resources and equipment needs decreases readmissions!!!

Question 40

symptoms to report to HCP

Answer 40

rapid weight gain (3 lb/week or 1-2 lb/night) decrease in exercise tolerance lasting 2-3 days cold symptoms lasting more than 3-5 days excessive awakening at night to urinate development of dyspnea or angina at rest or worsening angina increased swelling in feet, ankles or hands

Question 41

Bert is concerned and he is not sure what caused this problem? What prior medical history puts Bert at risk for heart failure(Select all that apply)? – 1. Hypertension – 2. Hypothyroidism – 3. GERD – 4. Aortic valve stenosis

Answer 41

1,4

Question 42

Which question will provide the nurse the best data about any additional risk factors for heart failure? (Select all that apply) 1. “Do you have any chronic lung disorders?” 2. “Have you ever had a heart attack?” 3. “Do you have varicose veins?” 4. “Have you ever had low blood pressure?”

Answer 42

1, 2

Question 43

When planning care for Bert the nurse anticipates what diagnostic procedure? – 1. Cardiac catheterization – 2. Echocardiogram – 3. Angiography – 4. Exercise electrocardiograpy

Answer 43

2

Question 44

Which assessment finding would indicate to the nurse that Bert is experiencing right-sided heart failure? 1. Dyspnea 2. Tachycardia 3. Edema 4. Fatigue

Answer 44

3

Question 45

The nurse prepares a dose of Digoxin (Lanoxin) 0.125 mg IV push. The drug is supplied 0.25 mg in 2 mL. How many mL should the nurse prepare to administer?

Answer 45

1 mL

Question 46

Prior to administration what assessment finding would prevent the nurse from administering lanoxin? 1. BP 99/68 2. Apical pulse 48 3. Respiratory rate 28 4. SpO2 89%

Answer 46

2

Question 47

Which assessment is most important for the nurse to perform prior to the administration of captopril(Capoten)? 1. Apical pulse 2. Blood pressure 3. Respiratory rate 4. Intake and output

Answer 47

2

Question 48

Which complaint by Bert would be of highest concern after adminstration of captopril? 1. Diarrhea 2. Itching in throat 3. Constant dry cough 4. Dizziness when standing

Answer 48

2

Question 49

When planning care for Bert what should be the priority nursing diagnosis? 1. Fluid volume deficit 2. Ineffective airway clearance 3. Altered nutrition, greater than needs 4. Impaired gas exchange

Answer 49

4

Question 50

Which intervention should be implemented based on the diagnosis of activity intolerance? 1. Provide 3 large meals daily 2. Provide all activities of daily living (ADLs) for the patient 3. Encourage frequent rest periods 4. Encourage regular aerobic exercise

Answer 50

3

Question 51

The nurse enters Bert’s room and finds him lying in bed in a supine position. His respiratory rate is 32 per minute and he states that his back hurts. Which action should the nurse implement first? 1. Notify the respiratory therapist 2. Assist Bert to turn on his side 3. Elevate the head of Bert’s bed 4. Offer Bert a back massage

Answer 51

3

Question 52

The nurse assesses that Bert is becoming increasingly confused and restless, and that he has developed a frothy, productive cough. His vital signs are temperature 98, P 148, R 36, BP 110/64. Which intervention should the nurse implement first? 1. Obtain an oxygen saturation level via pulse oximeter 2. Call the lab to obtain a stat serum potassium level 3. Collect a sputum specimen for culture and sensitivity 4. Initiate suctioning to remove lung secretions

Answer 52

1

Question 53

Bert’s condition worsens and he is transferred to ICU. What are the priorities of care at this time (Select all that apply) 1. Rapid acting diuretics 2. Nitroglycerin 3. Aggressive pulmonary therapy 4. Aggressive IVF replacement 5. Beta blockers

Answer 53

1,2,3

Question 54

Bert is now recovered and on a medical surgical unit preparing for discharge. What statement by Bert indicates to the nurse that further teaching is required? 1. “I must weigh myself once a month and watch for fluid retention” 2. “If my heart feels like it is racing I should call the doctor” 3. “I’ll need to consider my activities for the day and rest as needed” 4. “I’ll need periods of rest and should avoid activity after a meal”

Answer 54

1

Question 55

Six months later Bert is back on your unit recovering from an AVR (aortic valve replacement) with an artificial valve. What should be including in his discharge teaching (Select all that apply)? – 1. Weigh yourself daily – 2. Use electric razors for shaving – 3. Pre-medicate with antibiotics prior to invasive procedures – 4. Avoid heavy lifting for 3-6 months

Answer 55

2,3,4