chapter 14 exam 3 Flashcards
heart failure diagnostic tests and labs
echo to assess ventricular function, chest xray, 12 lead ECG, right sided catheterization to determine the heart’s preload and pulmonary pressures to determine the degree of HF, cardiac magnetic resonance testing (now considered the gold standard)
labs: BUN, creatinine, liver function tests, TSH, CBC, BNP (important, high levels (>100) indicate abnormal ventricular function or symptomatic HF), and routine urinalysis
right sided HF
viscera and peripheral congestion, JVD, dependent edema, hepatomegaly, ascites, weight gain, generalized weakness
left sided HF
pulmonary congestion, crackles, S3 or “ventricular gallop”, DOE, orthopnea, and paroxysmal nocturnal dyspnea, low O2 sat, dry nonproductive cough initially, oliguria
HF management: lifestyle changes, medical management, patient education
goals: eliminate or reduce any etiologic contributory factors (Afib, excessive alcohol ingestion, uncontrolled HTN), reduce workload on the heart by reducing afterload and preload, optimize all therapeutic regimens, prevent exacerbations of HF
lifestyle: restriction of dietary sodium, avoid excessive fluid intake, alcohol and smoking, weight reduction, regular exercise.
education: recognize signs and symptoms that need to be reported such as weight gain, increasing SOB, worsening orthopnea, fatigue, and edema
medications: diuretics (reduce fluid volume and reduce preload: furosemide), inotropes (affect force of myocardial contraction: digoxin), neprilysin inhibitor, ACEI, ARB, aldosterone receptor antagonist, beta blockers, nitrates
supplemental O2, ICD for EF<35%, cardiac resynchronization therapy, ultrafiltration, cardiac transplantation
HF complications: recognition and priority management of complications from HF
the nurse helps patients identify the impact the illness has had on their quality of life and successful coping skills that they have used.
