Care of Patients with Heart Failure Flashcards
heart failure statistics
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.
heart failure
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.
types of heart failure
left sided
right sided
high output failure
most heart failure of the left ventricle and progresses to failure of both ventricles.
right sided heart failure
right ventricle can not empty effectively.
causes of right sided heart failure
left ventricular failure
right ventricular MI
pulmonary HTN
chronic ling disease
symptoms of right sided heart failure
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
left sided heart failure
decreased tissue perfusion form poor cardiac output and pulmonary congestion.
systolic heart failure
heart can not contract forcefully enough to eject adequate blood
diastolic heart failure
ventricle can not relax adequately during diastole preventing adequate filling of blood
causes of left sided heart failure
HTN
CAD
valvular disease
symptoms of left sided heart failure
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
high output heart failure
occurs when cardiac output remains normal or above normal but there are increased metabolic needs to hyperkinetic conditions
causes of high output heart failure
septicemia
high fever
anemia
hyperthyroidism
**not as common as the other two types
compensatory mechanisms
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.
compensatory mechanism: sympathetic nervous system stimulation
increase HR and blood pressure
compensatory mechanism: RAAS
causes vasoconstriction and retention of Na and water
compensatory mechanism: other chemical responses
immune responses causes ventricular remodeling. endothelium causes vasoconstriction. vasopressin causes vasoconstriction
compensatory mechanism: myocardial hypertrophy
thicken of heart walls to increase muscle mass lead to more forceful contractions
electrolytes
abnormalities from complications of HF or side effects of drug therapy
BUN and creatinine
inadequate perfusion of kidneys can result in impairment and elevated levels
hemoglobin and hematocrit
could be low secondary to demodilution
urinalysis
possible proteinuria and high specific gravity