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MED SURG 2 > Chapter 32 Heart Failure > Flashcards

Chapter 32 Heart Failure Flashcards

Exam 2

1
Q

the priority concept for this chapter

A

perfusion

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2
Q

an interrelated concept of this chapter is IMMUNITY, why?

A

expends too much energy to stay in homeostasis, that it lowers the body’s energy to fight off diseases

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3
Q

What is heart failure?

A
  • the heart can’t pump enough blood to meet the metabolic needs of the body
  • results from several acute & chronic cardiovascular problems
  • classification system A to D based on physical exam, diagnostic tests, symptoms
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4
Q

comorbitities/ progression

A

the more issues you have the more diagnostic testing you will need.. the more progressed you are…

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5
Q

the most common cause of heart failure
-other causes of heart failure

A

CAD

(HTN, cardiomyopathy, substance abuse, valve disease)

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6
Q

What results from common chronic health problems with acute exacerbations requiring multiple hospitalization?

A

heart failure

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7
Q

Types of heart failure

A
  • Left-Sided Heart Failure
    -systolic dysfunction
    -diastolic dysfunction
  • Right-Sided Heart Failure
  • High-Output Heart Failure
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8
Q

ejection fraction

A

:the percentage of blood ejected from the heart during systole

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9
Q

Normal ejection fraction?

A

50%- 70%

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10
Q

cardiomyopathy

A

:a subacute or chronic disease of cardiac muscle, and the cause may be unknown.

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11
Q

Preload

A

:volume of blood in ventricles at end of diastole (end diastolic pressure)
-right side

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12
Q

Afterload

A

:resistance left ventricle must overcome to circulate blood
-left side

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13
Q

contractility

A

:the heart strength with pumping and its force

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14
Q

Heart Failure Causes Mneumonic

A
  • Faulty heart valves (floppy or stiff)
  • Arrhythmias (any rhythm that is not normal sinus)
  • Infarction (MI) (heart attack)
  • Lineage (family line) (genes; family hx)
  • Uncontrolled HTN
  • Recreational Drug Use [cigarettes (1= 4hrs); caffiene]
  • Envaders (instead of Invaders) (infections, bacteria, viruses)
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15
Q

The most common type of heart failure

A

left-sided heart failure (aka: Congestive Heart Failure, CHF)

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16
Q

The 2 types of Left-Sided Heart Failure are?

A
  1. Systolic
  2. Diastolic
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17
Q

systolic

A

the squeeze; resistance; pumping out

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18
Q

diastolic

A

relaxation to receive

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19
Q

Left-Sided HF=

A

Left ventricle cannot pump blood out efficiently

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20
Q

Left-Sided HF

As the left ventricle (LV) continues to fail, what happens to the cardiac output (CO)?

A

it drops

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20
Q

Left-Sided HF

When blood is not effectively pumped out into the body and it backs up into the lungs, what does this cause?

A
  • pulmonary congestion
  • dyspnea
  • activity intolerance
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20
Q

Left-Sided HF

Blood is not effectively pumped out into the body so…

A

it backs up into the left atrium then into the lungs

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21
Q

Left-Sided HF

If LV failure persists:

A
  • pulmonary edema
  • right-sided heart failure
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22
Q

Left-Sided HF

systolic dysfunction:

A
  • occurs when the LV can’t pump enough blood out to the systemic circulation
  • EF% falls
  • Blood backs up into the pulmonary circulation causing increased pressure in the pulmonary venous system
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23
Q

Causes of Systolic Dysfunction:

A
  • MI
  • Dilated cardiomyopathy arrhythmias
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24
Q

ICD

A

internal cardiac defibrillator

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25
Q

the harder/ longer your heart works..

A

the weaker the heart gets –> overworked –> tired –> can’t resist lethal arrhythmias

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26
Q

the weaker the heart, more of a risk of?

A

for having Vfib or pulseless

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27
Q

ICD shocks pt into what?

A

normal sinus rhythm

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28
Q

Who qualifies for an ICD?

A

pt who has low EF (<30%)

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29
Q

2nd subtype of Left-Sided HR?

A

Diastolic Dysfunction

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30
Q

With Diastolic Dysfunction the left ventricle loses its ability to what?

A

relax normally

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31
Q

Why does the LV lose it’s ability to relax during Diastolic Dysfunction?

A
  • because the muscle has become stiff (stenotic)
  • the heart can’t properly fill with blood during the resting period between each beat
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32
Q

to maintain cardiac output, what is needed

A

higher volumes in the ventricles

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33
Q

WIth the heart not being able to properly fill with blood during the resting period between each beat results in what?

A

the development of pulmonary congestion & peripheral edema (because of the backing up of fluid)

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34
Q

Diastolic Dysfunction is a what problem?

A

filling problem

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35
Q

Causes of Diastolic Dysfunction?

A
  • LV hypertrophy
  • Hypertension
  • Cardiomyopathy
  • MI
  • Cardiac tamponade
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36
Q

This form of HF is less common due to systolic dysfunction and treatment is not as clear.

A

Diastolic Dysfunction

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37
Q

Left Ventricular Failure causes Decreased Cardiac Output. What are the s/s?

A
  • fatigue
  • weakness
  • oliguria during the day (nocturia at night)
  • angina
  • confusion, restlessness
  • dizziness
  • tachycardia, palpitations
  • pallor
  • weak peripheral pulses
  • cool extremities
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38
Q

Left Ventricular Failure causes Pulmonary Congestion. What are the s/s?

A
  • Hacking cough, worse at night
  • dyspnea/ breathlessness
  • crackles or wheezes in lungs
  • frothy, pink-tinged sputum
  • tachypnea
  • S3/S4 summation gallop
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39
Q

Right-Sided HF=

A

result from ineffective pumping of “used” blood received from the body to get it back into the lungs for O2

40
Q

Right-Sided Heart Failure –>

A

Rest of the body

41
Q

Left-Sided Heart Failure –>

A

lungs (but not always)

42
Q

What is the most common cause of Right-Sided Heart Failure?

A

Left-Sided Heart Failure (right side overworked r/t >fluid pressure from left HF)

43
Q

What are some causes of Right-Sided Heart Failure?

A
  • Left-Sided Heart Failure
  • Right-Sided Ventricular MI or Pulmonary Embolus
  • Arrhythmias
  • Volume overload
  • Mitral & pulmonic valve stenosis
  • cardiomyopathy
44
Q

What’s going on in Right-Sided HF?

A

the left-side isn’t doing it’s part, and causes the right- side to be overworked

45
Q

What happens when blood isn’t pumped effectively through the right ventricle to the lungs?

A

blood backs up into the right atrium and into the peripheral circulation

46
Q

Right-Sided HF

What happens when blood backs up into the peripheral circulations?

A
  • patient gains weight
  • peripheral edema
  • engorgement of the kidney and other organs
  • jugular vein distention
  • ascites
  • essentially backflow to the rest of the body… causing edema/ overload
47
Q

What will the patient present with when experiencing Right-Sided HF?

A
  • weight gain
  • peripheral edema
  • decreases CO
  • distended neck veins (jugular)
  • enlarged liver (built-up pressure congesting the hepatic vein)
48
Q

Right Ventricular Failure causes:

A
  • systemic congestion
  • jugular distention
  • enlarged liver and spleen
  • anorexia and nausea
  • dependent edema (legs and sacrum)
  • distended abdomen
  • swollen hands and fingers
  • polyuria at night
  • weight gain
  • increased blood pressure (from excess volume) or decreased blood pressure (from failure)
49
Q

systolic heart failure problem?

A

pumping problem

50
Q

High-Output Heart Failure

A
  • increased metabolic needs or hyperkinetic conditions
  • rare type of HF
  • occurs when the body’s need for blood is unusually high
  • heart failure symptoms exist even though the heart is working well
  • not enought blood to meet the demand
51
Q

What can cause High-Output HF?

A
  • pregnancy
  • severe anemia
  • hyperthyroidism
  • septicemia
  • high fever
52
Q

Why would severe anemia cause High-Output Heart Failure?

A

requires the heart to pump more blood each minute to deliver enough oxygen to the tissues of the body

53
Q

Why would hyperthyroidism cause High-Output Heart Failure?

A

increases the body’s overall metabolism, thus increasing the demand for blood flow

54
Q

All types of HF eventually lead to reduced CO, which triggers what to improve CO at the expense of increased ventricular work?

A

Compensatory Mechanisms

55
Q

Compensatory Mechanisms

A
  • increased sympathetic activity
  • activation of the RAAS (kidneys)
  • Ventricular dilation [increase in pre-load; makes the heart work harder (stretched out rubber band)]
  • Ventricular hypertrophy (increased ventricular muscle mass allowing the heart ot pumpagainst stronger resistance= weaker heart muscle & increased the O2 demand on the heart)
  • Other:
    -MI (immune response) [increase in inflammation & irritation]
    -B-type natriuretic peptide (BNP) [the more the ventricle has to stretch the more hormone it releases (BNP), increases fluid= increased BNP = increased ventricle stretch= increased BNP= HF]
    -low CO
    -endothelin (potent vasocontrictor)
56
Q

Early signs of Left-Sided HF

A
  • dyspnea (difficulty breathing)
  • orthopnea (short of breath while laying down)
  • paroxysmal nocturnal dyspnea (difficulty breathing at night)
  • fatigue
  • nonproductive cough (congested but not enough to cough it up)
57
Q

Later signs of Left-Sided HF

A
  • crackles on auscultation
  • hemoptysis (coughing up blood/ blood is backed up in the lungs- coughing up blood)
  • displacement of the PMI (apical) toward the left anterior axillary line (point of max impulse- lungs are full so it pushes heart out of the way)
  • tachycardia
  • cool, cynaotic skin
  • confusion (not oxygenated; brain isn’t getting enough O2)
58
Q

Clinical S/S of Right-Sided HF

A
  • neck vein distention
  • hepatojugular reflux & hepatomegaly
  • RUQ pain
  • anorexia and nausea
  • nocturia
  • weight gain
  • pitting edema
  • ascites or anasarca (general swelling of the whole body)
59
Q

LEFT- SIDED HEART FAILURE- mnemonic

A
  • D dyspnea
  • Y yellow secretions (SS=infection)
  • S stridor, decreased SaO2
  • P pulmonary crackles, pulse increased
  • N nasal flaring, grunting, retracting
  • E elevation in the RR
  • A activity intolerance
60
Q

Right-Sided Heart Failure mnemonic

A
  • E enlarged liver (hepatomegaly)
  • D distended neck veins
  • E enlarged spleen
  • M most edema in LE
  • A ascites, anorexia
61
Q

What will a Chest X-ray tell us re: HF?

A

interstitial edema, pleural effusions, cardiomegaly

62
Q

What will a ECG tell us re: HF?

A

may indicate hypertrophy, ischemic changes, or infarction & reveal tachycardia

63
Q

What will LABS tell us re: HF?

A

abnormal liver function, elevated BUN

64
Q

What will ABGs tell us re: HF?

A

may reveal hypoxemia from impaired gas exchange

65
Q

What will ECHO tell us re: HF?

A

may reveal LV hypertrophy, dilation, and abnormal contractility

66
Q

What will a PAP tell us re: HF?

A

increased, decreased CO/ CL

67
Q

What will a LEXI-SCAN (stress test) tell us re: HF?

A

may be <40% in diastolic dysfunction

68
Q

What is the best indicator for EF?

A

Heart Cath

69
Q

What is the goal of therapy?

A

to increase perfusion with adequate cardiac output

70
Q

Medications to treat HF

A
  • Diuretics
    -Loop
    -K sparing
  • Nitrates
  • ACE/ ARBS
  • Beta-Blockers
  • Digoxin
71
Q

Digoxin

A

anti-arrhythmias

72
Q

If electrolyte imbalance Digoxin could causes what? S/S?

A

toxicity; yellow or green halos in their vision

73
Q

Nonsurgical options for treating HF

A
  • continuous positive airway pressure (CPAP) [keeps alveoli open to force out fluid]
  • cardiac resynchronization therapy (CRT) [Bi ventricular pacing - perm pacemaker/ or combined w/ defib]
  • cardioMEMS implantable monitoring system placed in pulm. artery- keeps an eye on pap –> datea downloaded to dr office, who in turn adjusts the med dosage per data]
  • investigative gene therapy [end-stage heart failure; for pts who can’t have other interventions; replaces genes through a series of injections]
74
Q

What’s our plan of action re: HF?

A
  • Diuretics (to reduce fluid volume)
  • Vasodilators (decrease preload & afterload {svr})
  • Inotropes (augment contractility {cardiac output})
75
Q

Inotropes

A
  • Digatalis
  • Carvedilol
  • Metoprolol [suc (EXT REL) and tartrate]
76
Q

Nonpharm Measures to treat HF

A
  • limit salt intake to 2g/ daily (approx. 1 tsp)
  • decrease and/or avoid alcohol intake (no more than 1 drink/ daily)
  • possible fluid intake restriction
  • avoid smoking
  • mild exercise is encouraged (in general)
  • weight loss (if applicable) healthy bmi encouraged
77
Q

Surgical Management of HF

A
  • CABG
  • CABG, VAD, ICD, or Biventricular pacemaker
78
Q

Coronary Artery Bypass Graft (CABG)

A

:Surgical procedure in which occluded arteries are bypassed with the patient’s own venous or arterial blood vessels or synthetic grafts

79
Q

Nursing Considerations: HF

A
  • sit pt in fowler’s position
  • monitor O2 sat/ ABGs
  • cardiac monitoring: note any changes in rate/ rhythm (irregular- AFIB, PVCs)
  • assess respiratory status frequently (changes quickly; flash pulm. edema –> frothy pink sputum= emergency)
  • daily weights (1-2 lbs overnight or 3lbs wkly; fluid retention) (same time of day, same type of clothing, same weighing method)
  • hourly I&Os
  • Labs (BNP, ABG, BUN/ Creatitine, electrolyes (esp. potassium levels)
80
Q

Heart Failure Self-Management Health Teaching (MAWDS)

A

Medications:
* take meds as prescribed & do not run out
* know the purpose & side effects of each drug
* avoid NSAIDs to prevent sodium and fluid retention

Activity:
* stay as active as possible but don’t overdo it
* know your limits
* be able to carry on a conversation while exercising

Weight:
* weigh each day at the same time on the same scale to monitor for fluid retention

Diet:
* limit daily sodium intake to 2-3g/ day as prescribed
* limit daily fluid intake to 2L

Symptoms:
* Note any new or worsening symptoms & notify the health care provider immediately

81
Q

Nursing Safety Priority- Education HF S/S

A

Teach the patient and caregiver to immediately report to the primary health care provider the occurrence of any of these symptoms, which could indicate worsening or recurrent heart failure:
* rapid weight gain (3lb in a week or 1-2lb overnight)
* decrease in exercise tolerance lasting 2-3 days
* cold symptoms (cough) lasting more than 3-5 days
* excessive awakening at night to urinate
* development of dyspnea or angina at rest or worsening angina
* increased swelling in the feet, ankles, or hands

82
Q

frothy, pink-tinged sputum

A

a sign of life-threatening pulmonary edema

83
Q

impaired tissue perfusion and pulmonary congestion are associated with which ventricular failure?

A

left ventricular failure

84
Q

systemic venous congestion and peripheral edema are associated with which ventricular failure?

A

right ventricular failure

85
Q

Left ventricular failure is associated with decreased cardiac output and elevated pulmonary venous pressure. It appears as:

A
  • weaknes
  • fatigue
  • dizziness
  • acute confusion
  • pulmonary congestion
  • breathlessness
  • oliguria (scant urine output)
86
Q

An irregular heart rhythm resulting from premature atrial contractions (PACSs), premature ventricular contractions (PVCs), or atrial fibrillation (AF) is come in what?

A

heart failure

87
Q

What is often the first sign of HF?

A

a third heart sound called S3 gallop- which is an early diastolic filling sound indicating an increase in left ventricular pressure

88
Q

What is the most reliable indicator of fluid gain and loss?

A

weight (daily weights)

89
Q

Any impairment of renal function resulting from inadequate perfusion causes what?

A

elevated blood urea nitrogen & serum creatinine; decreased creatinine clearance levels

90
Q

Hemoglobin & hematocrit tests should be performed to indentify HF resulting from anemia. If the patient has fluid volume excess, the hematocrit levels may be what?

A

low as a result of hemodilution

91
Q

BNP is used for dxing which HF in particular?

A

diastolic HF

92
Q

BNP is the body’s response to what?

A

decreased cardiac output (CO) from either left or right ventricular dysfunction

93
Q

What will a UA reveal? (heart failure lab assessment)

A

proteinuria, high specific gravity; microalbuminuria

94
Q

What is microalbuminuria (UA) a early indicator of?

A

decreased compliance of the heart and occurs BEFORE the BNP rises; serves as an “early warning detector” that lets the primary health care provider know that the heart is experiencing early signs of decreased compliance long before symptoms occur

95
Q

What diagnostic imaging is considered the best tool in dxing heart failure?

A

echocardiography

96
Q

PAP

A

pulmonary artery pressure

97
Q

Which drug class is the drug class of choice in the treatment of HR?

A

ACE inhibitors

98
Q

All types of HF lead to reduced CO, which triggers what?

A

compensatory mechanisms that improve CO at the expense of increased ventricular work

MED SURG 2 (12 decks)

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