Chapter 20- ❤️ Failure & Circulatory Shock Flashcards
Functions of the heart
The heart moves __________________ blood from the venous system through the __________ ___________ into the ______________ circulation.
- deoxygenated
- right heart
- pulmonary
The heart moves ______________ blood from the pulmonary circulation through the ________ heart into the _______ system.
- oxygenated
- left heart
- arterial
Preload?
Amount of blood coming back to the heart
Afterload?
Amount of blood going out of each ventricle
Acute heart failure develops __________?
Rapidly
*immediately life threatening
Chronic Heart Failure is a condition associated with what?
The heart undergoing adaptive responses
- adaptive responses can make heart failure worse*
- most common today
Patients with cardiomyopathy ultimately need what?
A ❤️ transplant
Frank - Starling mechanism serves to do what?
To match the output of both ventricles
Frank - Sterling mechanism operates through what?
Increase preload
Frank-Starling mechanism can lead to what?
Ventricular wall tension
- results in
- increase in myocardial oxygen requirements leading to ischemia of the heart and further damage
Sympathetic reflexes are “_____ or _____”
Fight or flight
Sympathetic reflexes do what?
- increase HR
- increase BP
What side of the ❤️ is the aortic valve on?
Left side
What side of the ❤️ is the mitral valve on?
Left side
Causes of left sided heart failure?
- Acute myocardial infarction
- Cardiomyopathy
- Mitral valve regurgitation
- Aortic valve stenosis and regurgitation
ALL LEFT SIDED
🤯🤯🤯
Signs and symptoms of left sided heart failure?
- SOB
- Dyspnea (due to fluid in the lungs)
- Cyanosis
- Paroxysmal nocturnal Dyspnea
- Cheyne-stokes
Left sided heart failure affects the _________?
Lungs
Left- Lungs
Symptoms of left sided heart failure?
- cough
- crackles
- wheezes
- blood tinged sputum
- Tachypnea
- restlessness
- confusion
- orthopnea
- tachycardia
- exertional Dyspnea
- fatigue
- cyanosis
Why does left sided heart failure affect the lungs?
Backing up into VENTRICLES
(Ventricles can’t contain)
Flows into ATRIA
(Atria can’t contain)
Backflows into the lungs
What sound does fluid in the lungs produce?
Crackles
In patients with CHF
- sleeping flat= \_\_\_\_\_\_\_ - sleeping with multiple pillows/ in recliner = \_\_\_\_\_\_
Sleeping flat = Good
Sleeping w/multiple pillows/recliner = Bad
Right sided Heart Failure Signs and Symptoms?
- Fluid retention and edema
- Fatigue and limited exercise tolerance
- cachexia and malnutrition
eat or breathe? —> patients would rather breath! - distention of the jugular veins in right sided HF
- Diaphoresis and tachycardia
Increased peripheral venous pressure is seen in what type of CHF?
Right sided heart failure
Ascites?
Fluid in abdomen
Ascites is seen in what type of CHF?
Right sided heart failure
Enlarged liver and spleen is seen in what type of CHF?
Right sided CHF
Distended jugular veins = _____________ CHF?
Right sided
Anorexia and complaints of GI distress are seen with what type of CHF?
Right sided
Swelling in hands and feet is associated with what type of CHF?
Right sided
Dependent edema is seen in patients with what type of CHF?
Right sided CHF
Paroxysmal Nocturnal Dyspnea is seen in what type of CHF?
Left sided
Elevated pulmonary capillary wedge pressure is seen in what type of CHF?
Left sided CHF
Pulmonary congestion is seen in what type of CHF?
Left sided
Restlessness, confusion, fatigue are seen in what type of Congestive Heart Failure?
Left sided heart failure
What is Orthopnea?
Difficulty breathing when lying flat
Orthopnea, Tachycardia, Exertional Dyspnea, and Cyanosis are evident with what type of Congestive Heart Failure?
Left sided heart failure
What is the key diagnostic test to detecting fluid volume?
BNP ( Brain Natriuretic Peptide)
- Great confirmation BECAUSE a chest x-ray showing fluid could be a number of different things such a pneumonia
What are 2 types of Circulatory shock?
Cardiogenic
Hypovolemic
Signs and symptoms of Cardiogenic shock?
INITIALLY
- tachycardia
- tachypnea
- normal BP
LATE
- Cyanosis of lips, nail beds and skin
- Decreased BP
- Decrease urine output
Treatment for Cardiogenic shock?
- Oxygen
- Intra-aortic balloon pump
Hypovolemic shock is caused by what?
LOW VOLUME!
either blood loss or just fluid loss
When do you start to see a decrease in BP and urine output in somebody with Hypovolemic shock?
35% to 45% blood loss
What is the standard urinary output an hour?
30mL an hour
What are the early signs and symptoms of Hypovolemic shock?
- Tachycardia
- Tachypnea
- Thirst ( using your fluid)
- Restlessness (due to lack of O2 to the brain)
- agitation
Parasympathetic Nervous System Does What?
Slowes everything down
What causes Neurogenic Shock?
Spinal cord injury above T6
What is the order of treatment for someone with Hypovolemic shock?
- Crystalloids (.9 NS and Lactate Ringers)—> IV FLUIDS
- Blood products
- Vasopressures (Ex: norepinephrine, epinephrine)
What is the most severe systemic allergic reaction?
Anaphylactic Shock
Signs and symptoms of Anaphylactic shock?
- Rash
- Urticaria (hives)
- Dyspnea
- Life Threatening*
- Laryngeal edema and circulatory collapse
Treatment for Anaphylactic shock (epi pen) should always be given where?
In the thigh
most vascularity
Sepsis and septic shock signs and symptoms?
EARLY
- Tachypnea
- Tachycardia
LATE
- Hypotension
- Warm and flushed skin
- Decreased LOC
- Decreased urinary output
- Elevated serum lactate level
- Metabolic acidosis
Treatment for Sepsis and Septic shock?
- Antibiotics (ASAP)
- Fluids
What does SIRS stand for?
Systemic Inflammatory Response
Sepsis is defined as?
Suspected or proven infection
