Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medsurg 2.0: Exam 1 > Chap 25: Heart Failure/ Pulmonary edema: > Flashcards

Chap 25: Heart Failure/ Pulmonary edema: Flashcards

1
Q

Heart Failure (HF)

A
  • A clinical syndrome resulting from structural or functional cardiac disorders that impair the ability of the ventricles to fill or eject blood
  • In the past, HF was often referred to as congestive heart failure (CHF), because many patients experience pulmonary or peripheral congestion with edema
  • HF is recognized as a clinical syndrome characterized by signs and symptoms of fluid overload or inadequate tissue perfusion
  • The term heart failure indicates myocardial disease, in which there is a problem with the contraction of the heart (systolic failure) or filling of the heart (diastolic failure)
  • Some cases are reversible depending on the cause
  • Most HF is a chronic, progressive condition managed with lifestyle changes and medications
  • Fluid overload and decreased tissue perfusion result when the heart cannot generate cardiac output (CO) sufficient to meet the body’s demands for oxygen and nutrients.
  • Heart failure is the inability of the heart to maintain adequate cardiac output to meet the metabolic needs of the body because of the impaired pumping ability.
  • *Diminished cardiac output results in inadequate peripheral tissue perfusion
  • *Congestion of the lungs and periphery may occur; the client can develop acute pulmonary edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Chronic V. Acute HF

A
  • Acute heart failure occurs suddenly
  • Chronic heart failure develops over time. A person with chronic heart failure can and does develop an acute episode.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ECHOCARDIOGRAM

A

An assessment of the ejection fraction (EF) is performed by echocardiogram to assist in determining the type of HF.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ejection fraction:

A
  • EF is calculated by subtracting the amount of blood present in the left ventricle at the end of systole from the amount present at the end of diastole and calculating the percentage of blood that is ejected.
  • A normal EF is 55% to 65% of the ventricular volume; the ventricle does not completely empty between contractions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pathophysiology of Heart Failure

A
  • Myocardial dysfunction and HF can be caused by a number of conditions, including:
    — coronary artery disease
    — hypertension
    — cardiomyopathy
    — valvular disorders
    — renal dysfunction with volume overload.
  • Patients with diabetes are also at high risk for HF.
  • Atherosclerosis of the coronary arteries is a primary cause of HF, and coronary artery disease is found in the majority of patients with HF.
  • Ischemia causes myocardial dysfunction because it deprives heart cells of oxygen and causes cellular damage.
  • MI causes focal heart muscle necrosis, the death of myocardial cells, and a loss of contractility; the extent of the infarction correlates with the severity of HF.
  • Revascularization of the coronary artery may improve myocardial oxygenation and ventricular function and prevent more extensive myocardial necrosis that can lead to HF.
    — percutaneous coronary intervention (PCI)
    — coronary artery bypass surgery (coronary artery bypass graft [CABG])
  • Systemic or pulmonary hypertension increases afterload (resistance to ejection), which increases cardiac workload and leads to hypertrophy of myocardial muscle fibers.
    — This can be considered a compensatory mechanism because it initially increases contractility. However, sustained hypertension eventually leads to changes that impair the heart’s ability to fill properly during diastole, and the hypertrophied ventricles may dilate and fail
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Right ventricular failure:

A

right-sided heart failure (right ventricular failure): inability of the right ventricle to fill or eject sufficient blood into the pulmonary circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Left ventricular failure:

A
  • left-sided heart failure (left ventricular failure): inability of the left ventricle to fill or eject sufficient blood into the systemic circulation
  • Majority of heart failure begins with left ventricular failure and progresses to failure of both ventricles.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Forward failure

A

is an inadequate output of the affected ventricle causes decreased perfusion to vital organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Diastolic heart failure:

A

the inability of the heart to pump sufficiently because of an alteration in the ability of the heart to fill; term used to describe a type of heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Systolic heart failure:

A
  • inability of the heart to pump sufficiently because of an alteration in the ability of the heart to contract; term used to describe a type of heart failure
  • ACE inhibitors play a pivotal role in the management of systolic HF.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Backward failure

A

blood backs up behind the affected ventricle, causing increased pressure in the atrium behind the affected ventricle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Right Sided HF
Clinical Manifestations

A
  • Viscera and peripheral congestion
  • Jugular venous distention (JVD)
  • Dependent edema (legs & sacrum)
  • Ascites/ abdominal distention
  • Weight gain/ Increased BP
    — (From fluid volume excess)
  • Or decreased BP (pump failure)
  • Nocturnal diuresis
  • Swelling of the fingers & hands
  • Hepatomegaly
  • Spleenomegaly
  • Anorexia & nausea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Left Sided HF
Clinical Manifestations

A
  • Pulmonary congestion, crackles
  • Dry, hacking, nonproductive cough initially
  • Dyspnea on exertion (DOE)
  • Tachypnea
  • Paroxysmal nocturnal dyspnea
  • Low O2 sat
  • S3 or “ventricular gallop”
  • Oliguria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pharmacologic Therapy for Heart Failure

A
  • Several medications are routinely prescribed for HF, including ACE inhibitors, beta-blockers, and diuretics (see Table 29-3).
    — ACE inhibitors and beta-blockers, improve symptoms and extend survival.
    — diuretics, improve symptoms but may not affect survival.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

HF meds
Classes

A
  • Angiotensin-converting enzyme (ACE) inhibitors:
  • Angiotensin II receptor blockers: ARBs
  • Hydralazine and isosorbide dinitrate:
  • Beta-blockers:
  • Diuretics
  • Digitalis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Angiotensin-converting enzyme (ACE) inhibitors:
Suffix

A

Suffix: -pril
- lisinopril (Prinivil)
— Relieve signs and symptoms of HF
— improve exercise tolerance
— decrease the number of hospitalizations
- Enalapril:
— Prevent progression of HF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Angiotensin-converting enzyme (ACE) inhibitors:
MOA

A
  • ACE inhibitors block the conversion of angiotensin I to angiotensin II
  • Promote vasodilation decreases afterload and preload;
    — Vasodilation reduces resistance to left ventricular ejection of blood, diminishing the heart’s workload and improving ventricular emptying.
  • Promote diuresis (urination)
    — Decrease the secretion of aldosterone, a hormone that causes the kidneys to retain sodium and water.
    reducing left ventricular filling pressure and decreasing pulmonary congestion.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Angiotensin-converting enzyme (ACE) inhibitors:
S/S:

A
  • hypotension
  • *hyperkalemia
    — ACE inhibitors cause the kidneys to retain potassium
    — Patients who are receiving a diuretic may *not need to take oral potassium supplements.
    — Patients receiving potassium-sparing diuretics (spironolactone) must be carefully monitored for hyperkalemia.
    — ACE inhibitors may be discontinued if the potassium level remains greater than 5.5 mEq/L or if the serum creatinine rises.
  • *dry, persistent cough
    — may not respond to cough suppressants.
  • Altered renal function (especially if they are also receiving diuretics)
  • Allergic reaction accompanied by *angioedema.
    — angioedema affects the oropharyngeal area and impairs breathing, the ACE inhibitor must be stopped immediately and emergency care provided.
  • If the patient cannot continue taking an ACE inhibitor because of development of cough, an elevated creatinine level, or hyperkalemia, pt may take:
    — an angiotensin receptor blocker (ARB)
    — Or a combination of hydralazine and isosorbide dinitrate (see Table 25-3)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Angiotensin-converting enzyme (ACE) inhibitors:
Indication

A
  • First medication prescribed for patients in mild failure
    patients with fatigue or DOE but without signs of fluid overload and pulmonary congestion.
    — Prevention of HF in patients at risk due to vascular disease and diabetes
  • Severe Hyperkalemia: iv insulin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Angiotensin-converting enzyme (ACE) inhibitors:
Dose

A
  • Started at a low dose that is gradually increased
  • The final maintenance dose depends on the patient’s blood pressure, fluid status, and renal status, as well as the severity of the HF.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Angiotensin II receptor blockers: ARBs

Suffix

A

Suffix: -sartan
- valsartan (Diovan)
— Relieves signs and symptoms of HF
- Losartan
— Prevents progression of HF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Angiotensin II receptor blockers: ARBs
Indication

A
  • prescribed as an alternative to ACE inhibitors; work similarly/ have similar hemodynamic effects and side effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Angiotensin II receptor blockers: ARBs
MOA

A
  • ARBs block the vasoconstricting effects of angiotensin II at the angiotensin II receptors.
  • Lowers blood pressure and protects renal function, but it increases the risk for hyperkalemia as well as hypotension.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Angiotensin II receptor blockers: ARBs
S/S:

A
  • Hypotention
  • Hyperkalemia
  • Worsening of renal function
  • Angioedema is a serious adverse effect.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Hydralazine and isosorbide dinitrate:
Indication

A
  • A combination of hydralazine and isosorbide dinitrate is an alternative for patients who cannot take ACE inhibitors.
  • recommended in HF guidelines and may be more effective for African Americans who do not respond to ACE inhibitors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Nitrates:
MOA

A

isosorbide dinitrate
- MOA:
— cause venous dilation, which reduces the amount of blood return to the heart and lowers preload.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Hydralazine
MOA

A

lowers systemic vascular resistance and left ventricular afterload.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Beta-blockers:
Meds

A
  • carvedilol (Coreg)
  • bisoprolol (Zebeta)
  • sustained-release metoprolol (Toprol XL)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Beta-blockers:

Indication

A
  • prescribed in addition to ACE inhibitors; may be several weeks before effects seen (several weeks or even months)
  • recommended for patients with asymptomatic systolic dysfunction, such as those with a decreased EF, to prevent the onset of symptoms of HF.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Beta-blockers:
MOA

A
  • Block the adverse effects of the sympathetic nervous system.
  • Relax blood vessels, lower blood pressure, decrease afterload, and decrease cardiac workload.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Beta-blockers:
S/S:

A
  • dizziness
  • hypotension
  • bradycardia
  • fatigue
  • depression
32
Q

Beta-blockers:
Dose

A

Because of the potential for side effects, beta-blockers are started at a low dose. The dose is titrated up slowly (every few weeks)

33
Q

Beta-blockers:
Nursing considerations:

A

used with caution in patients with:
- A history of bronchospastic diseases such as uncontrolled asthma. (bronchiole constriction)
- lowered blood glucose as it masks the symptoms of hypoglycemia

34
Q

Diuretics

A
  • Loop, thiazide, and aldosterone blocking diuretics may be prescribed for patients with HF.
  • As HF progresses, cardiorenal syndrome may develop or worsen. Patients with this syndrome are resistant to diuretics and may require other interventions to deal with congestive signs and symptoms.
35
Q

Diuretics
Indication

A

remove excess extracellular fluid by increasing the rate of urine produced in patients with signs and symptoms of fluid overload.

36
Q

Diuretics
Dose

A

Use the smallest dose of diuretic necessary to control fluid volume

37
Q

Diuretics
Nursing considerations

A
  • monitor serum electrolytes
  • These drugs are not prescribed for patients with an elevated serum creatinine.
38
Q

Loop diuretics:

A

furosemide (Lasix)

39
Q

furosemide (Lasix):
Indication

A
  • HF patients with severe volume overload are generally treated with a loop diuretic first
  • Loop diuretics are administered IV for exacerbations of HF when rapid diuresis is necessary.
40
Q

furosemide (Lasix):
MOA

A

inhibit sodium and chloride reabsorption mainly in the ascending loop of Henle.

41
Q

furosemide (Lasix):
S/S

A
  • increase potassium excretion;
  • orthostatic hypotension
42
Q

furosemide (Lasix):
Nursing considerations

A
  • monitor potassium
  • Fall risk
  • The need for diuretics can be decreased if the patient
    — avoids excessive fluid intake (e.g., more than 2 qt/day)
    — adheres to a low-sodium diet (e.g., no more than 2 g/day).
  • These drugs are not prescribed for patients with an elevated serum creatinine.
43
Q

Thiazide diuretics:
Meds

A
  • Hydrochlorothiazide
  • metolazone (Zaroxolyn)
44
Q

Thiazide diuretics:
Indication:
MOA:

A

Indication:
- both a loop and a thiazide diuretic may be used in patients with severe HF who are unresponsive to a single diuretic
MOA:
- Inhibit, sodium and chloride resorption in the early distal tubules

45
Q

Thiazide diuretics:
S/S:

A
  • increase potassium excretion
  • Orthostatic hypotension
46
Q

Thiazide diuretics:
Nursing considerations

A
  • Monitor potassium
  • Fall risk
  • The need for diuretics can be decreased if the patient:
    — avoids excessive fluid intake (e.g., more than 2 qt/day
    — and here’s to a low sodium diet (e.g., no more than 2 g/day)
47
Q

Aldosterone antagonists:
Med

A

spironolactone (Aldactone)

48
Q

spironolactone (Aldactone)
MOA:

A

potassium-sparing diuretics that block the effects of aldosterone in the distal tubule and collecting duct.

49
Q

spironolactone (Aldactone)
S/S:

A

Hyperkalemia
Hyponatremia

50
Q

spironolactone (Aldactone)
Nursing Considerations

A
  • Serum creatinine and potassium levels are monitored frequently (e.g., within the first week and then every 4 weeks) when spironolactone is first given.
  • These drugs are not prescribed for patients with an elevated serum creatinine.
51
Q

Digitalis
Indication

A
  • IV medications: indicated for hospitalized patients admitted for acute decompensated HF
  • Decreases the symptoms of systolic HF
  • Patients with renal dysfunction
52
Q

Digitalis
MOA:

A
  • Digoxin increases the force of myocardial contraction and slows conduction through the atrioventricular node.
  • It improves contractility, increasing left ventricular output.
53
Q

Digitalis
S/S:

A
  • Visual disturbances, blue/green halos
  • Bradycardia
  • Anorexia
  • Abdominal pain
  • Nausea/vomiting
  • Confusion
54
Q

Digitalis
Nursing Considerations:

A
  • serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity may occur.
  • A serum digoxin level is obtained if the patient’s renal function changes or there are symptoms of toxicity.
  • Check apical pulse prior to administration: must be >60
55
Q

Digitalis
Dose

A

older patients should receive smaller doses of digoxin, as it is excreted through the kidneys.

56
Q

Milrinone

A

decreases preload and afterload; causes hypotension and increased risk of dysrhythmias

57
Q

Dobutamine

A

used for patients with left ventricular dysfunction; increases cardiac contractility and renal perfusion

58
Q

Which classification of medications play a pivotal role in the management of HF caused by systolic dysfunction?

A

A. ACE inhibitors

59
Q

Nursing Process: The Care of the Patient With Heart Failure-Assessment

A
  • Focus
    — Effectiveness of therapy
    — Patient’s self-management
    — S&S of increased HF
    — Emotional or psychosocial response
  • Health history
  • PE
    — Mental status; lung sounds: crackles and wheezes;
    — heart sounds: S3; fluid status or signs of fluid overload; daily weight and I&O;
    — assess responses to medications
60
Q

Nursing Process: The Care of the Patient With Heart Failure-Diagnoses

A
  • Activity intolerance related to decreased CO
  • Excess fluid volume related to the HF syndrome
  • Anxiety-related symptoms related to complexity of the therapeutic regimen
  • Powerlessness related to chronic illness and hospitalizations
  • Ineffective family therapeutic regimen management
61
Q

Collaborative Problems and Potential Complications

A
  • Hypotension, poor perfusion, and cardiogenic shock
  • Dysrhythmias
  • Thromboembolism
  • Pericardial effusion and cardiac tamponade
62
Q

Nursing Process: The Care of the Patient With Heart Failure-Planning
GOALS

A

Goals
- Promote activity and reduce fatigue
- Relieving fluid overload symptoms
- Decrease anxiety or increase the patient’s ability to manage anxiety
- Encourage the patient to verbalize his or her ability to make decisions and influence outcomes
- Educate the patient and family about management of the therapeutic regimen

63
Q

Nursing Process: The Care of the Patient With Heart Failure-Planning
Activity Intolerance

A
  • Bed rest for acute exacerbations
  • Encourage regular physical activity; 30 to 45 minutes daily
  • Exercise training
  • Pacing of activities
  • Wait 2 hours after eating for physical activity
  • Avoid activities in extreme hot, cold, or humid weather
  • Modify activities to conserve energy
  • Positioning; elevation of the head of bed to facilitate breathing and rest, support of arms
64
Q

Nursing Process: The Care of the Patient With Heart Failure-Planning
Support Oxygen

A
  • High Fowler’s/feet down
  • Oxygen 5-6 L (mask)
  • 10-15 non-re-breather with reservoir
  • Pulse ox > 90%
  • CPAP
  • Intubation if necessary
65
Q

Nursing Process: The Care of the Patient With Heart Failure-Planning
Fluid volume excess

A
  • Assessment for symptoms of fluid overload
  • Daily weight
  • I&O
  • Diuretic therapy; timing of meds
  • Fluid intake; fluid restriction
  • Maintenance of sodium restriction
66
Q

Nursing Process: The Care of the Patient With Heart Failure-Planning
Patient education

A
  • Medications
  • Diet: low-sodium diet and fluid restriction
  • Monitoring for signs of excess fluid, hypotension, and symptoms of disease exacerbation, including daily weight
  • Exercise and activity program
  • Stress management
  • Prevention of infection
  • Know how and when to contact health care provider
  • Include family in education
67
Q

End of life considerations

A

HF is a chronic and often progressive condition
- Need to consider issues related to the end of life
- When palliative or hospice care should be considered

68
Q

What evaluation most illustrates that the patient with HF has met outcomes for the nursing diagnosis “Activity intolerance related to decreased CO?”

A

A. Exhibits decreased peripheral edema
B. Maintains heart rate, blood pressure, respiratory rate, and pulse oximetry within the targeted range
C. Avoids situations that produce stress
D. Performs and records daily weights
B?

69
Q

Pulmonary Edema

A
  • Acute event results in LV failure
  • As LV begins to fail, blood backs up into the pulmonary circulation, causing pulmonary interstitial edema
  • Results in hypoxemia, often severe
70
Q

Pulmonary Edema
Clinical manifestations:

A
  • restlessness
  • anxiety
  • dyspnea
  • cool and clammy skin
  • cyanosis
  • weak and rapid pulse
  • cough, lung congestion (moist, noisy respirations)
  • increased sputum production (sputum may be frothy and blood tinged)
  • decreased level of consciousness
71
Q

Management of Pulmonary Edema

A
  • Easier to prevent than to treat
  • Early recognition: monitor lung sounds and for signs of decreased activity tolerance and increased fluid retention
  • Minimize exertion and stress
  • Oxygen; nonrebreather
  • Medications
    — Diuretics (furosemide)
    — vasodilators (nitroglycerin)
72
Q

Nursing Management of Pulmonary Edema

A
  • Positioning the patient to promote circulation
  • Positioned upright with legs dangling
  • Providing psychological support
  • Reassure patient and provide anticipatory care
  • Monitoring medications
  • I&O
73
Q

A 51-year-old Hispanic man came to the hospital 2 days ago for recurrent exacerbation of heart failure. He weighs 237 lbs and is 5’ 8” tall. He has IV access in his left forearm and is on oxygen at 2 L per nasal cannula. When you assess the patient, he is sitting on the side of the bed and appears to be short of breath. He tells you that he has just returned from the bathroom. He is sweating and his nasal cannula is laying on the bedside table.

Which action should you take first?

A

A. Replace the oxygen.
B. Take his vital signs.
C. Call the Rapid Response Team
D. Sit him up in a bedside chair
A.

74
Q

Fifteen minutes after the oxygen is replaced and he has rested, the patient denies being short of breath. You obtain an oxygen saturation and it is 96%.

Based on this result, what should you do next?

A

A. Call the provider as soon as possible.
B. Continue the assessment because 96% is acceptable.
C. Increase the oxygen level to 5 L per nasal cannula.
D. Encourage the patient to take some deep breaths.
B.

75
Q

After assessing the patient, you document the following:
- Jugular venous distention
- 2+ edema in feet and ankles
- Swollen hands and fingers
- Distended abdomen
- Bibasilar crackles on auscultation
- Productive cough with pink-tinged sputum

What is your best interpretation of these findings?

A

A. Right-sided heart failure
B. Left-sided heart failure
C. Biventricular failure
D. Class IV heart failure

76
Q

During the evening shift, the patient has a bedside echocardiogram which reveals an ejection fraction of 30%.
- Based on this finding, which medications might the provider order? (Select all that apply.)

A

A. Lisinopril (Zestril) 5 mg PO daily
B. Ibuprofen (Advil) 200 PO mg twice daily
C. Multivitamin 1 PO each day
D. Furosemide (Lasix) 20 mg IV push daily
E. Digoxin (Lanoxin) 0.25 mg PO daily
A,D,E

Medsurg 2.0: Exam 1 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions