class 11 heart failure Flashcards
cardiac output formula:
heart rate x stroke volume = cardiac output
3 things stroke volume depends on:
1.preload
2.afterload
3.contractility
what is heart failure
a clincial syndrome resulting from structural or functional cardiac disorders that impair the ability of the ventricles to fill or eject blood
heart failure mortality rate
40-50% of patients die within 5 yr of dx
-pt tend to have frequent, long hospital stays
what is ejection fraction
-the volume of blood that the LV ejects out with each contraction
-measured in percentages
what is a normal ejection fraction
50-70% of the ventricle volume
ejection fraction and heart failure
a low EF is a hallmark of HF
-the severity of HF is frequently classified according to the patient’s symptoms
-<40%
heart failure classification I s&s
-no limitations of physical activity
-ordinary activity does not cause undue fatigue , palpatation, or dyspnea
heart failure classification II s&s
-slight limittaion of physical activity
-comfortable at rest, but ordinary physical activity causes fatigue, plapatation, or dyspnea
heart failure classification III s&s
-marked limitation of physical activity
-comfortable at rest, but less than ordinary activity causes fatigue, palpatation, or dyspnea
heart failure classification IV s&s
unable to carry out any physical activity without discomfort
-symptoms of cardiac insufficiency at rest
-if any physical activity is undertaken, discomfort is increased
primary risk factors for HF
-CAD
-hypertension
-valvular disease
contributing risk factors for HF
-diabetes
-tobacco use
-obesity
-high serum cholesterol
manifestations of left sided heart failure
-SOB, dyspnea
-pulmonary edema
-frothy cough, may be blood tinged
-congestion
-fine crackles
-impaired o2 exchange
manifestations of right sided heart failure
-peripheral pitting edema
-weight gain
-ascites
-hepatomegaly
-nausea
-SOB
-usually caused by left HF d/t inc pressure
clinical manifestations of chronic heart failure
-fatigue
-dyspnea, orthopnea, paroxysmal nocturnal dyspnea
-persistent dry cough, unrelieved with position change or OTC cough suppressants
-tachycardia
-dependent edema
-sudden weight gain of >2kg in 2 days may indicate exacerbation of HF
-nocturia
-dusky, cool, damp skin
-skiny swollen legs with dimished/absent hair growth
-restlessness, confusion, decreased memory
-chest pain (angina)
-weight changes
diagnostic test for HF
-echocardiogram
-MUGA scan
-chest x-ray
-EKG
-blood work (CBC, lytes, BUN, creatinine, TSH, BNP (key diagnosic), LFT, urinalysis)
use of medications for HF
-eliminate or reduce etiologic or contributory factors
-reduce the workload of the heart by reducing afterload and preload
-optimize all therapeutic regimens
-prevent exacerbations
medications prescribed for HF
-ACE inhibitors
-angiotensin II receptor blockers
-beta-adrenergic blockers
-diuretics
-digitalis
-entresto (valstartan and sacubitril)
-selective sodium glucose cotransporter 2 inhibitor
-anticoagulants, antiarrhythmics,statins
nursing considerations for HF
-medications
-low sodium diet and fluid restriction
-monitor signs of excess fluid, hypotension, exacerbation, weight gain, lung sounds
-daily weights
-exercise and activity program
-stress management
-prevention of infection
-family teaching
-diet
what is pulmonary edema
-acute heart failure
-abnormal accumulation of lfuid in the interstitial spaces and alveoli of the lungs
-can lead to acute respiratory failure and death
pulmonary edema manifestations
-restlessness, poor sleep
-anxiety
-dyspnea
-cool and moist skin
-cyanosis
-weak and rapid pulse
-cough
-lung congestion (moist, nosy resp)
-inc sputum production (frothy, blood-tinged)
-decreased LOC
pulmonary edema assessment
resp assessment
-vital signs (>88% o2 may be a normal order)
-cardiac monitor
pulmonary edema diagnostics
-ABGs, lytes, BUN, creatinine
-CXR
-medicatiosn (codiene/antitussives for cough)
pulmonary edema management
-directed toward reducing volume overload, improving ventricular function, decreasing afterload, and increasing respiratory exchange
-o2
-morphine (dec RR, inc comfort)
-diuretics
-IV infusions
-prevent/early recognition
-sitting upright & dangle legs
-minimize exertion and stress
what is peripheral vascular disease
includes disorder of arterial, venous and lymphatic system
-caused primarily by athersclerosis
-acute ot chronic
-superficial femoral and popliteal arteries most common
causes for peripheral venous disease
-bad valves
-blood cant get back from extremities so it pools
causes for peripheral arterial disease
-blood isnt GETTING to the extremities
-inc cholesterol
-inflammation/IV drug use
-diabetes
-HTN
what is coronary athersclerosis
abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen
- progressive blockages and narrowing of the coronary vessels reduce blood flow to the myocardium
-most common cause of cardiovascular disease in canada
clinical manifestations of peripheral arterial disease
-cool
-dependent rubor, pale on elevation
-hairlessness of extremity
-dec peripheral pulses
-tissue atrophy
-delayed wound healing
-gangrene
-intermittent claudication
-rest pain
-“arterial steal” aka pins n needles
-thick toenails
clinical manifestations of peripheral venous disease
-warm
-thick skin
-brown “splotchy tan” colour from pooling in extremities
-scaly skin
medical management of peripheral vascular disease
-control co-morbid disease
-smoking cessation (vasoconstriction)
-prevent injury
-exercise
-diet
-promote arterial blood flow
increased risk for peripheral venous disease
immobility
birth control
pregnancy
age
nursing interventions for peripheral vascular disease
-neurovascular assessments
-promote arterial blood flow (dangle legs) and venous (elevate legs)
-prevent vasoconstriction (dec cold & stress)
-education
-pain management
-injury prevention
-risk for cellulitis
surgical intervention for peripheral vascular disease
-not everyone is a candidate
-endovascular: angioplasty, atherectomy, and stent, laser angioplasty
-arterial bypass
-amputation
what is a balloon angioplasty
balloon inserted into vessel to widen it where the narrowing is
what is laser angioplasty
laser destroys the plaque narrowing the vessel
what is a stent
piece inserted into vessel to hold it open
what is atherectomy
blade or laser removes plaque from vessel walls
nursing management for peripheral vascular disease
-maintaining circulation
-monitoring and managing complications
-promoting independence and management
what are arterial ulcers
-skin breakdown in areas of an ischemic foot or leg
-painful
-usually: medial/lateral metatarsal heads and tips of toes
-sharp edge (usually round); pale base surrounded by atrophic tissue
-poor healing if any
-most require revascularization or grafting
management of venous stasis ulcers
-leg elevation
-wound care
-moist dressings
-support stockings (dec pooling & inc blood return)
-ambulation
-antibiotics (if infected or cellulitis)
-debridement
-Unna boot
characteristics of venous stasis ulcers
painful and red
-irregular border
-drainage and discharge common
-shallow
-commonly over bony prominiences
