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
microalbuminuria
early indicator of decreased compliance of heart and occurs before the BNP rises
ABGs
evaluates hypoxemia
decrease in gas exchange secondary to fluid filled alveoli
BNP
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
imaging
chest xray
echocardiography
chest xray
cardiomegaly may be present
echocardiography
best tool in diagnosing HF
measures chamber size, EF and flow
priority problems
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.
nursing interventions
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
drug therapy effect
to improve stroke volume- reduced after load, preload, but improve cardiac muscle contractility
if dyspnea present, high fowlers position because…
maximize chest expansion and improve oxygenation
reposition, cough, deep breath every 2 hours because…
improve oxygenation and prevent atelectasis
nutrition therapy because…
goal to reduce sodium and water retention
reduce sodium intake 2g/day
fluid restriction limit…
range from 2 liters to 3 liters per day
weigh daily because
most reliable indicator of fluid gain or loss. 1 kg of weight gin or loss equals 1 liter of retained or lost fluid
nonsurgical options
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
surgical options
heart transplant
ventricular assistive devices (VAD)- mechanical pump is implanted to work with patient’s heart to improve function
patient teaching for heart failure
diet: sodium restriction and fluid restriction
activity schedule
drug therapy
discharge instructions
resources and equipment needs
decreases readmissions!!!
symptoms to report to HCP
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
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
1,4
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?”
1, 2
When planning care for Bert the
nurse anticipates what diagnostic
procedure?
– 1. Cardiac catheterization
– 2. Echocardiogram
– 3. Angiography
– 4. Exercise electrocardiograpy
2
Which assessment finding would
indicate to the nurse that Bert is
experiencing right-sided heart
failure?
1. Dyspnea
2. Tachycardia
3. Edema
4. Fatigue
3
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?
1 mL
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%
2
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
2
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
2
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
4
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
3
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
3
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
1
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
1,2,3
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”
1
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
2,3,4
