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Advanced MedSurg > Ch 34 Heart Failure (Exam 2) > Flashcards

Ch 34 Heart Failure (Exam 2) Flashcards

1
Q

Heart failure is a ______ disease that causes _____

A

progressive; insufficient blood supply/oxygen to tissues and organs

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2
Q

What is ejection fraction?

A

amount of blood pumped by the left ventricular with each heartbeat

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3
Q

normal ejection fraction

A

55-60%

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4
Q

in patients with reduced ejection fraction, expected amount

A

<45%

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5
Q

Etiology of heart failure

A

direct damage to the heart that causes increased peripheral resistance

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6
Q

diagnosis for heart failure is based on? (3)

A
  • s/s
  • normal left ventricular EF
  • evidence of LV dysfunction by an ECG or cardiac catheterization
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7
Q

Primary risk factor of HF?

A

hypertension

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8
Q

Decreased CO leads to? (5)

A
  • decreased tissue perfusion
  • impaired gas exchange
  • fluid volume imbalance
  • decreased functional ability
  • decreased LOC
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9
Q

CO depends on which factors? (4)

A
  • preload
  • afterload
  • myocardial contractility
  • HR
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10
Q

Pathophysiology of HF

A

result of neurohormonal compensatory mechanisms activated in response to myocardial dysfunction, leading to remodeling of myocardial structure/function

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11
Q

Low CO s/s (8)

A
  • dizziness
  • fatigue (d/t decreased blood flow)
  • SOB/trouble breathing
  • weak peripheral pulses
  • tachycardia (“my heart is pounding”)
  • pallor (for darker skin tones, ashen undertones)
  • dry skin, loss of elasticity
  • decreased LOC (d/t general hypoxia)
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12
Q

Is chronic HF a medical emergency?

A

not emergent, but can still lead to an emergency cardiac situation

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13
Q

FACES acronym for HF s/s stands for

A

F: fatigue (d/t low hemoglobin and oxygen/nutrients to cells/tissues)

A: limitation of Activities

C: chest congestion/cough

E: edema

S: shortness of breath

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14
Q

Patho of systolic HF (HFrEF - heart failure with reduced EF)

A

inability of heart of pump effectively, causing blood to back up into the LA, causing fluid accumulation in the lungs, to pulmonary congestion (s/s: SOB, dyspnea, crackles)

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15
Q

Systolic HF (HFrEF) is caused by

A
  • increased afterload (pressure)

- cardiomyopathy and mechanical abnormalities

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16
Q

Patho of diastolic HF (HFpEF - heart failure with preserved EF)

A

inability of the ventricles to RELAX and fill during diastole (stiffness does not allow ventricular filling), leading to impaired CO and pulmonary congestion

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17
Q

Main compensatory mechanisms of HF: neurohormonal renin-angiotensin-aldosterone system (RAAS) and SNS (2)

A
  • RAAS: kidneys sense decreased renal perfusion from low CO, promotes sodium and fluid retention
  • continuation of RAAS in HR leads to increased levels of ADH (water retention) and vasoconstriction, increasing BP
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18
Q

Ventricular remodeling

A

Actual change in the structure of the heart, occurs overtime in response to pressure or volume overload and/or cardiac injury

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19
Q

Ventricular Remodeling causes the ventricles to become

A

larger but less effective in pumping

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20
Q

Ventricular dilation

A

enlargement of the chambers of the heart d/t ineffective left ventricular pumping

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21
Q

Ventricular hypertrophy

A

increase in muscle mass and cardiac wall thickness, DECREASES STROKE VOLUME

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22
Q

Counterregulatory mechanisms (GOOD) of HF (4)

A

the body tries to maintain balance through: ANP, BNP, nitric oxide and prostaglandins

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23
Q

diagnostic test and predictor of mortality in HF is indicated by

A

high serum BNP (corresponds proportionately with fluid retention)

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24
Q

5 complications of HF

A
  • pleural effusion
  • arrhythmias (afib is the most common, leading to blood clot rist)
  • thrombus formation
  • renal insufficiency (cardiorenal syndrome) and anemia (hepatomegaly)
  • sudden cardiac death
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25
Q

HF with preserved ejection fraction (diastolic) is described as (5)

A
  • uncontrolled hypertension is the primary cause
  • LV EF may be within normal limits
  • patho involves ventricular relaxation and filling
  • therapies focus on symptom control and treatment of underlying conditions
26
Q

Acute decompensated heart failure (ADHF) is

A

the sudden onset of HF, causing blood to back up into the systemic and lungs medical emergency

27
Q

ADHF can manifest and mask as

A

pulmonary edema

28
Q

S/S of ADHF (9)

A
  • JVD
  • coughing
  • anxiety/restlessness
  • crackles in the bases
  • SOB
  • pallor
  • cyanosis (LATE)
  • tachycardia
  • drop in SaO2
29
Q

Common s/s of ADHF (6)

A
  • fatigue
  • cough
  • dyspnea
  • tachycardia
  • edema
  • limitations on usual activities of daily living
30
Q

Decompensation of chronic HF usually begins with?

A

s/s of fluid retention (weight gain, dyspnea, orthopnea)

31
Q

As HF advances, ______ (4)

A

BP drops!! (indicator of cardiogenic shock), extremities become cold, decrease in peripheral pulses, and voice becomes hoarse

32
Q

Early signs of ADHF

A

increased pulmonary pressure - leads to an increase in RR and a decrease in PaO2 (respiratory failure!)

33
Q

Later signs of ADHF

A

interstital edema - tachypnea

34
Q

Further progression of ADHF

A

alveolar edema - respiratory acidemia and ARDS

35
Q

Some S/S of pulmonary edema that require an emergency response to ADHF (5)

A
  • orthopnea (unable to tolerate lying flat)
  • abnormal S3 or S4 sounds
  • paroxysmal noctural dyspnea (nightmares)
  • nocturia (increased need to urinate at night)
  • sudden weight gain of >3 lbs in 2 days
36
Q

Intervention priorities for ADHF include (5)

A
  • admission to ICU
  • set HOB to 90 degrees with the legs flat if the patient is experiencing difficulty breathing (initial intervention!)
  • insertion of a foley cath
  • oxygen therapy: relieve dyspnea and fatigue
  • physical and emotional rest: conserve energy and decrease oxygen needs
37
Q

Foley catheter considerations in the intervention for ADHF (3)

A
  • normal urine output: 30 mL/hr
  • allows patient to void without exertion
  • monitor urine output and effectiveness of diuretics
38
Q

Purpose of high-Fowler’s position for intervention of ADHF

A

decreases PRELOAD (vol) and workload, opens airway

39
Q

Intervention priorities for HF (3)

A
  • decrease mortality and morbidity
  • minimize side effects
  • dietary therapy: written plan, read labels for sodium, no added salts, daily weights, smaller/more frequent meals
40
Q

Diuretic therapy for ADHF

  • purpose
  • example
  • side effect
  • nursing consideration
A
  • decreases volume overload (preload)
  • loop diuretics: furosemide (Lasix)
  • s/e: dysrhythmias
  • monitor potassium levels (potassium wasting or sparing)
41
Q

Vasodilator therapy for ADHF

  • purpose
  • route and forms (3)
A
  • reduces blood volume and improves coronary artery circulation, improving afterload (pressure)
  • IV nitroglycerin, sodium nitroprusside, nesiritide
42
Q

Morphine for ADHF

- purpose

A

reduces preload and afterload, relieving dyspnea and anxiety

43
Q

Positive inotropes

- purpose

A

improves cardiac contractility and stimulates CO without overloading, leading decrease HR and increase in BP

44
Q

Lasix + digitalis

  • nursing consideration
  • s/s of digoxin toxicity (4)
A
  • take HR before and after administration (slows HR)
  • if below 60 bpm, hold medication
  • digoxin toxicity: nausea, vomiting, ABD pain, diarrhea
45
Q

RSHF (2)

A
  • occurs when the right ventricle does not pump effectively, causing fluid to back into the venous system, moving fluid into peripheral tissues and organs
  • s/s: peripheral edema (ex: ankle swelling), ABD ascites, hepatomegaly, JVD
46
Q

LSHF (2)

A
  • most common form of HF from left ventricular dysfunction

- blood backs into the LA, into the pulmonary veins, causing pulmonary congestion and edema

47
Q

End-stage HF goal and treatment

A
  • goal: maintain comfort and reduce number of exacerbations that need hospitalization
  • treatment: heart transplantation
48
Q

Heart transplant is used to treat

A

a variety of terminal or end-stage heart conditions

49
Q

Early complications of heart transplantation (3)

A
  • acute rejection
  • risk for sudden cardiac death
  • infection
50
Q

Patient teaching for heart transplantation (5)

A
  • avoid gardens/public places (exposure to infections)
  • check HR and BP
  • manage lifestyle changes
  • no hiking (strain)
  • no excessive activity
51
Q

_____ is required for heart transplantation

A

life-time immunosuppression

52
Q

Endomyocardial biopsies are obtained for heart transplanted patients from the right ventricle _____ for the first month, then ______ for the next 6 months, and _____ to detect rejection

A
  • weekly for the first month
  • monthly for the next 6 months
  • yearly to detect rejection
53
Q

Monitor post transplant (4)

A
  • acute rejection
  • infection
  • malignancy
  • cardiac vasculopathy
54
Q

Nutritional Therapy for HF (6)

A
  • low sodium diet: DASH diet
  • sodium restricted to 2 g/day
  • foods to avoid: canned soups/tuna, prepackaged foods, preserved foods
  • fluid restriction (not generally required): <2 L/day
  • use ice chips, gum, hard candy, ice pops to quench thirst
  • daily weights are important (same time, same clothing)
55
Q

Fibrinolytic Therapy is indicated for patients with

A

a STEMI

56
Q

what is the goal of fibrinolytic therapy for patients with a STEMI

A

dissolve the thrombus in the coronary artery to reperfuse the heart muscle

57
Q

2 examples of fibrinolytic medications

A
  • tenecteplase

- alteplase

58
Q

exclusion criteria/contrandications of fibrinolytic therapy (5)

A
  • active internal bleeding (excluding menstruation)
  • hx of intracranial hemorrhage
  • current use of oral anticoagulants
  • major surgery < 3 weeks
  • recent internal bleeding (within 2-4 weeks)
59
Q

What are major and minor bleeding complications of fibrinolytic therapy?

A

Major: drop in BP, increase in HR, change in LOC, blood in the urine/stool

Minor: gingival or bleeding at the IV site is expected and managed by applying pressure and ice packs

60
Q

Protocol for fibrinolytic therapy (2)

A
  1. draw blood to obtain baseline labs

2. start 2-3 lines for IV therapy

Advanced MedSurg (11 decks)

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