class 11 heart failure Flashcards by Rebecca Penney

cardiac output formula:

heart rate x stroke volume = cardiac output

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3 things stroke volume depends on:

1.preload
2.afterload
3.contractility

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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

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heart failure mortality rate

40-50% of patients die within 5 yr of dx
-pt tend to have frequent, long hospital stays

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what is ejection fraction

-the volume of blood that the LV ejects out with each contraction
-measured in percentages

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what is a normal ejection fraction

50-70% of the ventricle volume

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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%

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heart failure classification I s&s

-no limitations of physical activity
-ordinary activity does not cause undue fatigue , palpatation, or dyspnea

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heart failure classification II s&s

-slight limittaion of physical activity
-comfortable at rest, but ordinary physical activity causes fatigue, plapatation, or dyspnea

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heart failure classification III s&s

-marked limitation of physical activity
-comfortable at rest, but less than ordinary activity causes fatigue, palpatation, or dyspnea

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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

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primary risk factors for HF

-CAD
-hypertension
-valvular disease

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contributing risk factors for HF

-diabetes
-tobacco use
-obesity
-high serum cholesterol

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manifestations of left sided heart failure

-SOB, dyspnea
-pulmonary edema
-frothy cough, may be blood tinged
-congestion
-fine crackles
-impaired o2 exchange

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manifestations of right sided heart failure

-peripheral pitting edema
-weight gain
-ascites
-hepatomegaly
-nausea
-SOB
-usually caused by left HF d/t inc pressure

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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

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diagnostic test for HF

-echocardiogram
-MUGA scan
-chest x-ray
-EKG
-blood work (CBC, lytes, BUN, creatinine, TSH, BNP (key diagnosic), LFT, urinalysis)

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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