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NU 340 > Ch. 29 > Flashcards

Ch. 29 Flashcards

1
Q

heart failure (HF) is also called

A

pump failure

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2
Q

heart failure

A

general term for the inability of the heart to work effectively as a pump

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3
Q

major types of HF are:

A
  • Left-sided heart failure (most common)
  • Right-sided heart failure (second common)
  • High-output failure (least common)
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4
Q

preload

A

volume of blood in the ventricles at the end of diastole (end of diastolic pressure)

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5
Q

preload is increased in

A
  • hypovolemia
  • regurgitation of cardiac valves
  • heart failure
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6
Q

afterload

A

resistance left ventricle must overcome to circulate blood

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7
Q

afterload is increased in

A
  • HTN
  • vasoconstriction
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8
Q

increased afterload = increased ___

A

increased cardiac workload

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9
Q

ejection fraction (EF)

A

percentage of blood ejected from left ventricle during systole
- normal: 50-70%
- can be assessed with echocardiogram (ultrasound)

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10
Q

how is EF computed?

A

amount of blood pumped out of the ventricle divided by total amount of blood in ventricle

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11
Q

left-sided HF

A

formerly known as congestive heart failure
LV to LA to lung
two types:
- systolic: measured by EF (more common)
* 60% of cases are systolic HF
problem: left ventricle (muscle) is weak (thin) and blood backs up from the heart back into in the lungs *pump problem; fills but doesnt pump

  • diastolic: normal EF
    problem: left ventricle (muscle) is stiff (thick) and as a result does not fill up with blood *not a pump problem; pumps but does not fill and has a limited amount of space to fill anyway
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12
Q

typical causes of left-sided HF

A
  • hypertension
  • coronary artery disease
  • valvular disease
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13
Q

classification of left-sided HF: ACC/AHA

A

A. Patients at high risk for developing heart failure; might have HTN, MI, coronary artery disease; but do not have symptoms
- teaching important!
B. Patients with cardiac structural abnormalities or remodeling who have not yet developed symptoms; chest x-ray or echo reveals valvular abnormality but do not have symptoms
- teaching important!
C. Patients with current or prior symptoms of heart failure.
D. Patients with refractory end-stage heart failure

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14
Q

NYHA staging: class 1

A
  • No limitations of physical activity.
  • Ordinary activity does not cause undue fatigue, palpitations or shortness of breath.
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15
Q

NYHA staging: class 2 (mild)

A
  • slight limitations of physical activity.
  • Comfortable at rest, but ordinary physical activity results in fatigue palpitations and SOB. (walking to the mailbox)
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16
Q

NYHA staging: class 3 (moderate)

A
  • Marked limitations in physical activity.
  • Comfortable at rest, but less than ordinary activity causes fatigue, palpitations and SOB. (walking to the bathroom)
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17
Q

NYHA staging: class 4 (severe)

A
  • Unable to carry out physical activity without symptoms.
  • Symptoms of cardiac insufficiency at rest. If any physical activity is taken, symptoms increase. (cutting up pancake while sitting in bed)
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18
Q

NYHA staging: changes

A
  • Changes are bases on exacerbations and remissions
  • Can change depending on symptoms and treatment
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19
Q

right-sided HF: causes

A
  • Left ventricular failure (left sided HF progresses to right-sided HF)
  • Right ventricular MI
  • Pulmonary hypertension (constriction of pulmonary ventricles)
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20
Q

right-sided HF

A
  • right ventricle cannot empty completely
  • increased volume and pressure in venous system and peripheral edema
  • backs up from RV to RA to SV to rest of body
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21
Q

high-output failure: cardiac ouput

A

cardiac output remains normal or above normal

22
Q

high-output failure: causes

A

caused by increased metabolic needs of hyperkinetic conditions such as:
- septicemia
- anemia (hgb around 5-6; prob getting blood transfusions)
- hyperthyroidism (T3, T4, TSH numbers out of wack)

23
Q

compensatory mechanisms for heart failure

A
  • sympathetic nervous system stimulation
  • renin-angiotensin system (RAS) activation
  • other chemical responses: B-type natriuretic peptide (BNP) released from L ventricle and responds to fluid volume overload
  • myocardial hypertrophy: muscular wall around heart thickens to cause more forceful contractions
24
Q

HF is caused by _____ in 75% of cases

A

systemic HTN

25
Q

about 1/3 of patients experiencing an MI also develop ___

A

HF

26
Q

HF etiology

A

Structural heart changes, such as valvular dysfunction (usually aorta or mitral valve), cause pressure or volume overload on the heart.

27
Q

HF incidence and prevalence

A
  • 6.5 million people in the U.S. have
  • Common chronic health problem with acute episodes causing frequent hospitalizations
  • *Most common reason for hospital admission for people > 65 years old
  • More common in African American individuals under 50 yo; over age of 50 kind of evens out ethnically
  • Major cause of disability and death after MI
28
Q

L-sided HF manifestations

A

*think fluid is backing up into the lungs; not enough oxygenation to the brain
- Weakness
- Fatigue
- Dizziness
- Acute Confusion (low flow)
- Pulmonary congestion (crackles) **
- Breathlessness/SOB/tachypnea/orthopnea (cant breathe lying flat)
- Oliguria: decreased UO (d/t decreased perfusion to the kidneys)
- Arrhythmias
(daily weights**)

29
Q

R-sided HF manifestations

A
  • Distended neck veins, increased abdominal girth
  • Hepatomegaly (liver engorgement)
  • Hepatojugular reflux
  • Ascites
  • Dependent edema (legs, feet, pitting edema)
  • Weight—the most reliable indicator of fluid gain or loss (daily weights**)
30
Q

lab assessment for HF

A

Electrolytes
Hemoglobin and hematocrit (may be decreased)
B-type natriuretic peptide (BNP) *specific for HF (released from ventricles when there is FVO; normal level is <100)
Urinalysis (proteinuria- if kidneys affected/high specific gravity- oliguria: retaining fluid&concentrated urine)
ABGs (may or may not be done)

31
Q

imaging for HF

A
  • CXR
  • *Echocardiography (best diagnostic tool)
  • Radionucleotide studies
32
Q

HF priority hypotheses (nursing problems)

A
  • Decreased gas exchange due to ventilation/perfusion imbalance (kidneys, heart, brain)
  • Potential for decreased perfusion due to inadequate cardiac output
  • Potential for pulmonary edema due to left-sided HF
33
Q

non-surgical treatments for HF

A
  • drug therapy
    • Drugs to reduce afterload and preload
    • Drugs to enhance contractility
  • nutrition therapy/diet
34
Q

interventions to promote oxygenation and gas exchange

A
  • Ventilation assistance (nasal cannula, face mask)
    • Maintain oxygen saturation of 90%
  • Monitor respiratory rate every 1-4 hr
  • Auscultate breath sounds every 4-8 hr
  • Position in high Fowler’s if patient dyspneic
35
Q

interventions to increase perfusion

A
  • Improved and increased cardiac pump effectiveness
  • Hemodynamic regulation
  • drugs to reduce afterload
36
Q

drugs that reduce afterload

A

(decreases resistances)
- ACE inhibitors (lisinopril), ARB’s (valsartan)
- Angiotensin receptor neprilysin inhibitor (ARNI)-combination drug- sacubitril/Valsartan
- Arterial vasodilators that reduce resistance
- Angiotensin Receptor Blockers (ARB)

37
Q

interventions that reduce preload

A
  • nutrition therapy: limit salt (2g sodium restrictive), fluid restriction (2L/day) (magic number 2)
  • drug therapy
38
Q

drug therapy that reduces preload

A

(decreases volume)
- Morphine- like 1-2mg through IV (decreases preload and afterload)
- diuretics (furosemide*, lasix, HCTZ)
- venous vasodilators (nitroglycerin)- sublingual, IV, transdermal: patch, paste route (s/e: flushing, HA,

IV in acute exacerbation situations always

39
Q

drugs that enhance contractility

A

Digoxin
- Increases contractility
- Reduces heart rate (HR) (always assess HR first- typically hold if HR is <60 bpm)
- Slows conduction through atrioventricular node
- Inhibits sympathetic activity
- very narrow therapeutic window: use cautiously with elderly d/t toxicity risk
- check blood levels

Inotropic drugs
- IV (Dobutamine) (output infusion, or admitted to ICU/tele)
- Beta-adrenergic blockers (metoprolol, carvedilol)
- Aldosterone Antagonists

40
Q

treating acute HF/congestive HF aka L-sided HF (acronym)

A

UNLOAD FAST

41
Q

treating acute HF/congestive HF

A

Upright position
Nitrates
Lasix
O2
ACEI
Digoxin

Fluids (decrease)
Afterload (decrease)
Sodium restriction (2g/day)
Test (Dig level, ABGs, electrolytes-K+ level)

42
Q

nonsurgical treatment options for congestive HF

A
  • drug therapy
  • Continuous positive airway pressure (CPAP): high amounts of oxygen through triangular mask
  • Cardiac resynchronization therapy: affects both ventricles to help the L and R pump
  • CardioMEMS implantable monitoring system: device sits in pulmonary artery; continuous readings of pressure in the artery
  • Gene therapy (not used frequently)
43
Q

interventions to decrease fatigue and weakness:

A
  • Balance activity and rest.
  • Nap to restore energy as needed.
  • Recognize energy limitations.
  • Conserve energy.
  • Adapt lifestyle to energy level.
  • Report adequate endurance for activity.
44
Q

surgical management of congestive HF

A

Heart transplantation
Ventricular assist devices: internal pump
Other surgical therapies:
- LV surgical reconstruction

(need to know: these options only surface if diet/lifestyle and medication therapy does not work)

45
Q

pulmonary edema

A

LV fails to eject blood adequately, ↑pressure in lungs, fluid leaks from capillaries into airways/tissues
- life threatening event- call a rapid response
- happens acutely/ sudden onset

46
Q

pulmonary edema symptoms

A
  • Extremely anxious
  • Tachycardia
  • Struggling for air
  • Frothy blood-tinged sputum
  • Crackles can be heard without stethescope
47
Q

interventions for pulmonary edema

A
  • Assess for early signs, such as crackles in the lung bases, dyspnea at rest, disorientation, and confusion.
  • High-Fowler’s (90°)
  • Oxygen therapy (face mask for extra oxygen)
  • Meds: nitroglycerine: IV drip, rapid-acting diuretics: IV lasix, IV morphine sulfate
  • Continual assessment
48
Q

indications for worsening or recurrent HF

A
  • Rapid weight gain (gaining 5lb or more in 1 week or 2-3lb in 1 day- call HCP)
  • Decrease in exercise tolerance (SOB going to mailbox again)
  • Cold symptoms: cough or SOB
  • Excessive awakening at night to urinate
  • Development of dyspnea/angina at rest: SOB at rest
  • Increased edema in feet, ankles, hands: difficulty getting socks and shoes on
49
Q

community-based care for pulmonary edema

A
  • Home care management
  • Teaching for self-management: MAWDS
    Meds: explain what it is, how many times to take/when, side effects, purpose of med
    Activity: want them to be active and exercising
    Weights: daily weights, ask if they have a scale
    Diet: 2g sodium, 2L fluid (restrictive!)
    Symptoms: when to call HCP: weight gain, cold like symptoms, edema
  • Health care resources: visiting nurse

*if pt is readmitted within 30 days of d/c with pulmonary edema, medicare will not pay/cover the costs- hospital is not getting reimbursed

50
Q

HF/PE: evaluating outcomes- the patient will ____

A
  • Have adequate pulmonary tissue perfusion
  • Have increased cardiac pump effectiveness
  • Be free of pulmonary edema
51
Q

expected changes in VS as a result of giving IV morphine, IV nitroglycerine, IV furosemide

A
  • decreased BP (make sure dont become hypotensive)
  • decreased HR (make sure dont become bradycardic)
  • decreased RR (make sure dont become resp depressed)
  • increased O2
  • improved lung sounds (decreased crackles)

NU 340 (26 decks)

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