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Critical Care Nursing > Complications from Heart Disease > Flashcards

Complications from Heart Disease Flashcards

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1
Q

What is heart failure?

A

inability of the heart to pump sufficient blood to meet the needs of the tissues

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2
Q

Can right sided HF cause left sided HF?

A

No, but left sided HF can cause right sided HF

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3
Q

What is Left Sided HF?

A

Congestive HF

Blood flows back into lungs and will start showing pulmonary symptoms

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4
Q

What are the 2 types of LT sided HF?

A

Systolic HF

Diastolic HF

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5
Q

Causes of LT sided HF

A
  • HTN
  • CAD
  • valvular disease
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6
Q

Systolic Heart Failure

A

alteration in ventricular contraction characterized by weakened heart muscle

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7
Q

Diastolic Heart Failure

A

stiff and non-compliant heart muscle, making is difficult for the ventricle to fill

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8
Q

.S/S of Left Sided HF (DROWNING)

A 
D-dyspnea
R-rales/crackles
O-orthopnea
W-weakness
N-nocturnal paroxysmal dyspnea
I-increased HR
N-nagging cough (frothy/bloody)
G-gaining weight
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9
Q

Causes of Right Sided HF

A
  • Left ventricle failure
  • Right ventricular MI
  • pulmonary HTN
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10
Q

S/S of Right sided HF (SWELLING)

A 
S-swelling of hands, legs, liver
W-weight gain
E-edema
L-large neck veins
L-lethargy
I-irregular HR (afib)
N-nocturia
G-girth
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11
Q

What causes High Output Heart Failure?

A

increased metabolic needs of hyperkinetic conditions

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12
Q

Types of Conditions that would lead to High Output HF

A
  • septicemia
  • anemia
  • hyperthyroidism
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13
Q

Systolic HF causes the sympathetic nervous system to stimulate the release of what?

A

epinephrine and norepinephrine

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14
Q

Sympathetic stimulation will also cause vasoconstriction of what?

A
  • skin
  • GI tract
  • kidneys
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15
Q

A decrease in renal perfusion b/c of low CO and vasoconstriction causes the kidneys to release what?

A

Renin

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16
Q

Renin promotes the formation of what?

A

Angiotensin 1

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17
Q

Angiotensin I is converted to what?

A

Angiotensin II

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18
Q

What does Angiotensin II do for the body?

A
  • potent vasoconstrictor

- stimulates the release of aldosterone

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19
Q

Aldosterone secretion results in what?

A

Retention of sodium and fluid, excretion of potassium, and stimulation of thirst
-leads to fluid volume overload in HF

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20
Q

Interventions for Impaired Gas Exchange

A
  • ventilation assistance
  • positioning
  • oxygen
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21
Q

Interventions for Decreased Cardiac Output

A
  • improve/increase cardiac pump effectiveness
  • Hemodynamic regulation
  • drugs that reduce afterload
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22
Q

What are some drugs that will reduce the Afterload?

A
  • ACE inhibitors
  • ARB
  • human B-type natriuretic peptides
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23
Q

Interventions that will reduce Preload are?

A
  • nutrition therapy
  • drug therapy
  • enhancing contractility
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24
Q

What drugs might be used to reduce preload?

A

Diuretics and venous vasodilators

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25
Q

What drugs will enhance contractility?

A
  • digoxin/other inotropic drugs

- beta-adrenergic blockers

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26
Q

What are some nonsurgical options for treating HF?

A
  • continuous positive airway pressure
  • cardiac resynchronization therapy
  • gene therapy
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27
Q

What are some surgical management techniques for HF?

A
  • heart transplant
  • ventricular assist device
  • partial left ventriculectomy
  • endoventricular circular patch
  • acorn cardiac support device
  • myosplint
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28
Q

What happens first with a heart transplant?

A
  • Recipient is placed on cardiopulmonary bypass and their heart is removed
  • the posterior walls of the left and right atria are left
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29
Q

How is the recipients new heart attached?

A

Left atrium of donor heart is anastomosed to recipients posterior atrial wall, other atrial walls, the atrial septum, and the great vessels are joined

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30
Q

Activity Intolerance Interventions

A
  • balance activity and rest
  • naps to restore energy
  • recognize limits
  • conserve energy
  • adapt lifestyle to changes
  • report adequate endurance
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31
Q

What are the causes of Heart Failure? think F.A.I.L.U.R.E.

A 
F-faulty heart valves 
A-arrhythmia's 
I-infarction
L-lineage (family hx)
U-uncontrolled hypertension
R-recreational drug use
E-evaders (infections)
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32
Q

What is the problem w/ Left Sided Systolic HF?

A

The left ventricle is having problems w/ contraction which causes low rejection fraction

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33
Q

What is ejection fraction?

A

amount of flood that fills in left ventricle that will be pumped out
used to diagnose HF

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34
Q

Normal Ejection Fraction

A

> 50%

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35
Q

What is the problem w/ Left Diastolic HF?

A

The ventricle is unable to fill properly because it has become too stiff, but contracts normally

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36
Q

Drug Mnemonic “Always Administer Drugs Before A Ventricle Dies”

A 
A-Ace Inhibitors 
A-ARB's
D-diuretics 
B-Beta Blockers
A-anticoagulants
V-vasodilators
D-Digoxin
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37
Q

ACE Inhibitors (end in “pril”)

A
  • Usually first line of treatment
  • blocks the conversion of Angiotensin I to Angiotensin II
  • causes vasodilation and secretion of sodium
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38
Q

Side Effects of ACE Inhibitors

A
  • hyperkalemia
  • dry nagging cough
  • hypotension
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39
Q

ARB’s (end in “Sartan”)

A
  • block Angiotensin II receptors
  • vasodilation
  • secretes sodium
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40
Q

Diuretics (Loop or Potassium Sparing)

A
  • helps decrease fluid and sodium retention
  • helps the heart pump easier
  • will increase urine output
  • monitor BUN and Creatinine
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41
Q

Loop Diuretic

A

Lasix

-potassium wasting

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42
Q

Potassium Sparring Diuretic

A

Aldactone

  • will keep potassium
  • monitor w/ ACE Inhibitors and ARB
  • limit foods high in potassium
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43
Q

Beta Blockers (end in “Lol”)

A
  • work by blocking the norepinephrine effects on the heart muscle
  • slow down HR
  • negative inotropic effect
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44
Q

Examples of Potent Diuretics

A
  • Bumex
  • Lasix
  • Edicrine
  • Demidex
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45
Q

Examples of Mild Diuretics

A
  • midamar
  • aldactone
  • dyrenium
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46
Q

Side Effects of Beta Blockers

A
  • bradycardia
  • mask hypoglycemic side effects
  • respiratory probs
  • do NOT take w/ grape fruit juice
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47
Q

Digoxin

A
  • Positive Inotropic increases hearts ability to contract stronger
  • Negative Chronotropic causes the heart to beat slower
  • allows heart to rest and pump more blood
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48
Q

What increases the risk for Dig Toxicity?

A

Hypokalemia

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49
Q

Normal Digoxin Level

A

0.5-2

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50
Q

S/S of Dig Toxicity

A
  • N/V
  • visual changes = Halo effect
  • bradycardia/dysrhythmias
  • anorexia
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51
Q

What is the antidote for Digoxin?

A

Digibine

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52
Q

Before giving Digoxin you should always check what first?

A

The HR is 60 bpm or more

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53
Q

What is a normal calcium level?

A

8.5-10.5

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54
Q

A severe form of treatment for HF would be what?

A

A phlebotomy

55
Q

What is Pulmonary Edema?

A

condition caused by excess fluids in the lungs making it difficult to breath

56
Q

In most cases Pulmonary Edema is caused by what?

A

Heart problems; Heart Failure

57
Q

What is Cardiogenic Pulmonary Edema?

A

type of PE caused by increased pressures in the heart

58
Q

Causes of Cardiogenic Pulmonary Edema

A
  • Coronary Artery Disease
  • Cardiomyopathy
  • Heart valve probs
  • High BP
59
Q

Coronary Artery Disease

A

The heart is weakened either due to a heart attack from a blood clot that was caught in the narrowed vessels or the narrowed arteries weakened the LV muscle

60
Q

Cardiomyopathy

A

your heart muscle has been damaged so it may not be able to respond to conditions requiring it to work harder

61
Q

What is Aortic or Mitral Stenosis?

A

the valves that regulate blood flow in the left side of your heart may not open wide enough

62
Q

What is Aortic or Mitral Regurgitation?

A

that valves may not close completely, allowing blood to flow backwards through the valve

63
Q

Non-Heart related causes of Pulmonary Edema

A
  • ARDS
  • High Altitudes
  • Nervous system conditions
  • Adverse drug reactions
  • Negative pressure pulmonary edema
  • Pulmonary embolism
  • Viral infections
  • Toxins/Smoke
  • Near Drowning
64
Q

Complications of Cardiogenic Pulmonary Edema

A
  • pulmonary hypertension that leads to right sided HF
  • lower extremity/abdominal swelling
  • pleural effusion
  • congestion and swelling of liver
  • death if left untreated
65
Q

What are ways to prevent pulmonary edema?

A
  • prevent cardiovascular disease
  • control high BP
  • watch blood cholesterol
  • don’t smoke
  • eat heart healthy diet
  • limit salt
  • exercise
66
Q

S/S of Pulmonary Edema

A
  • dyspnea
  • feeling of suffocating/drowning
  • wheezing/gasping
  • cold, clammy skin
  • anxiety/restlessness
  • cough w/ frothy, blood tinged sputum
  • blue tinged lips
  • rapid irregular HR
67
Q

When should patients w/ Acute pulmonary edema see a doctor? S/S

A
  • immediately
  • SOB especially if occurs suddenly
  • dyspnea
  • bubbly, wheezing, gasping sound w/ breathing
  • pink frothy sputum w/ cough
68
Q

Acute pulmonary edema is considered a what?

A

Medical emergency

-life threatening

69
Q

When should patients see a doctor w/ Chronic Pulmonary Edema see a doctor?

A
  • breathing difficulty w/ profuse sweating
  • blue/gray skin tone
  • confusion
  • significant drop in BP causing lightheaded, dizzy, weakness, or sweating
  • sudden worsening of any symptoms
70
Q

What is Aortic Stenosis?

A

“tight” aortic valve

-does not open all of the way

71
Q

Causes of Aortic Stenosis

A
  • bicuspid aortic valve
  • age related calcification
  • rheumatic heart disease
72
Q

S/S of Aortic Stenosis (SAD)

A
  • syncope
  • angina
  • dyspnea
  • small/weak slow pulse
  • Systolic Ejection Murmur
73
Q

What type of murmur is heard w/ Aortic Stenosis?

A

Systolic Ejection Murmur

74
Q

Systolic Ejection Murmur

A
  • heard at right 2nd ICS
  • feel slight vibration up into neck
  • loud, hard murmur
75
Q

When does an Aortic Stenosis murmur occur?

A

during systole

76
Q

What is Aortic Regurgitation?

A

“floppy”/”leaky valve

-blood flows back through aortic valve into left ventricle

77
Q

Causes of Aortic Regurgitation

A
  • widening of valve
  • endocarditis
  • Rheumatic fever
78
Q

S/S of Aortic Regurgitation

A
  • fatigue
  • syncope
  • orthopnea
  • SOB
  • palpations
79
Q

When and where is an Aortic Regurgitation murmur heard?

A
  • early diastole
  • 2nd ICS right sternal border
  • soft high pitch blowing sound
80
Q

What is Mitral Stenosis?

A
  • valve is really tight and does not open completely

- decreases cardiac output

81
Q

What can happen due to Mitral Stenosis?

A

LV can not pump all the blood needed which leads to LA becoming congested which backs up into pulmonary veins causing pulmonary edema leading to HTN leading to HF

82
Q

Causes of Mitral Stenosis

A
  • Rheumatic Fever/Heart disease

- endocarditis

83
Q

S/S of Mitral Stenosis

A
  • fatigue
  • SOB
  • weakness
  • cough
  • Right sided HF
  • recurrent respiratory infections
84
Q

What type of murmur is heard w/ Mitral Stenosis and where?

A

-4th ICS midclavicular line
-low, rumbling sound
During diastole

85
Q

What is Mitral Regurgitation?

A

Valves do not close all the way (leaky valves)

-increase in volume in LA and decreased CO

86
Q

Mitral Regurgitation causes what?

A
  • LA enlargement
  • hypertrophy of cardiac muscle
  • irregular pulses/A-fib
  • blood clots
87
Q

When does Mitral regurgitation occur?

A

Systole

88
Q

Where can Mitral Regurgitation be heard and how does it sound?

A

4th ICS MCL
loud high pitch rumbling
Systole, S1

89
Q

What is mitral valve prolapse?

A

a condition in which the two valve flaps of the mitral valve do not close smoothly or evenly, but instead bulge (prolapse) upward into the left atrium

90
Q

What would a mitral valve prolapse sound like?

A

Clicking sound

91
Q

When would Mitral Valve Prolapse become a problem?

A

When it becomes accompanied w/ regurgitation

92
Q

Nonsurgical Management of Valvular Heart Disease

A
  • drug therapy
  • prophylactic antibiotics
  • management of A-fib
  • anticoagulant
  • rest
93
Q

Surgical Management of Valvular Heart Disease

A
  • balloon valvuloplasty
  • direct or open commissurotomy
  • mitral valve annuloplasty
  • replacement procedures
94
Q

When a patient receives a mechanical valve they must begin taking what?

A

anticoagulants

95
Q

What is Infective Endocarditis?

A

bacterial, viral, or fungal infection enters into the blood stream affecting the heart valves

96
Q

Who is most at risk for developing endocarditis?

A
  • IV drug abusers
  • had valve replacements
  • experienced systemic infections (rheumatic fever)
  • have structural cardiac defects
97
Q

S/S of Endocarditis “PATHOGENS”

A 
P-petechiae 
A-anorexia 
T-tired/weak
H-high fever/HF
O-oster's nodes
G-finGernails (clubbing)
E-embolic events/erythmateus 
N-night sweats/New cardiac murmur
S-splenomegaly
98
Q

What is the most reliable criteria for diagnosing endocarditis?

A
  • positive blood cultures
  • new regurgitant murmurs
  • evidence of endocardial involvement by ECG
99
Q

Nursing Interventions for Endocarditis

A
  • antimicrobials/antibiotics
  • anticoagulants
  • balance patient activities w/ rest
100
Q

Surgical Management for Endocarditis

A
  • removing infected valve
  • repairing or removing congenital shunts
  • repairing injured valves or chordae tindineae
  • draining abscesses
101
Q

What are the 2 types of infective endocarditis?

A

Acute and Subacute

102
Q

Who does Acute IE typically effect?

A

pts w/ healthy heart valves

103
Q

What is the onset of Acute IE like?

A

Sudden and severe

104
Q

Sub Acute IE

A
  • affects patients w/ preexisting heart conditions

- S/S subtle and onset is slow

105
Q

What is Pericarditis?

A

inflammation or alteration of the pericardium layer of the heart

106
Q

Causes of Pericarditis

A
  • illness (virus, bacteria)
  • trauma (MI,heart surgery, physical)
  • Autoimmune (Lupus)
  • unknown-idiopathic
107
Q

Acute Pericarditis

A
  • develops for less than 6 weeks
  • most common
  • usually caused by virus
  • sudden severe, constant pain
108
Q

Chronic Pericarditis

A
  • lasts longer than 6 months

- leads to constrictive pericarditis

109
Q

What is Pericardial Effusion?

A

too much fluid fills around the heart in pericardial sac

110
Q

A pericardial effusion can cause what?

A

Pericardial tamponade

111
Q

Treatment for Pericardial effusion

A

Pericardiocentesis

112
Q

Pericardiocentesis

A

procedure to remove excess fluid from pericardial sac

113
Q

S/S of Pericarditis (FRICTION)

A 
F-friction rub/fever
R-radiating substernal pain
I-increased pain in supine position
C-chest pain
T-trouble breathing lying down
I-inspiration/coughing causes pain
O-overall feeling sick
N-noticeable ST segment elevation
114
Q

What does a pericardial friction rub sound like?

A

2 balloons/sandpaper rubbing together

115
Q

Nursing Interventions for Pericarditis

A
  • assess pain
  • keep in high fowler’s position
  • monitor for Cardiac Tamponade
116
Q

What is Cardiac Tamponade

A

accumulation of fluid around the heart causing increased pressure

117
Q

S/S of Cardiac Tamponade

A
  • pulsus paradoxus-drop in BP during inspiration
  • JVD
  • heart sounds muffled
  • tachycardia
  • hypotension
118
Q

Causes of Cardiac Tamponade

A
  • severe chest injury
  • heart attack/aortic aneurysm
  • hypothyroidism
  • pericarditis
  • infection
  • TB
  • kidney failure
  • cancer/lupus
119
Q

The three classic signs of Cardiac Tamponade are known as what?

A

Beck’s Triad

120
Q

Beck’s Triad Symptoms for Cardiac Tamponade

A
  • low BP
  • muffled heart sounds
  • JVD
121
Q

Medications for Pericarditis

A
  • Aspirin or NSAID
  • Colchine
  • Corticosteroids
  • Digoxin
  • Diuretic
122
Q

Treatment for Cardiac Tamponade

A
  • pericardiocentesis
  • pericardiectomy
  • thoracotomy
123
Q

What is Rheumatic Carditis?

A

inflammation in all layers of the heart

124
Q

Rheumatic Carditis causes what?

A
  • impaired contractile function
  • thickening of pericardium
  • valvular damage
  • formation of Aschoff bodies
125
Q

Aschoff Bodies

A

small nodules in Myocardium that are replaced by scar tissue

126
Q

Dilated Cardiomyopathy S/S

A
  • syncope
  • ALOC
  • angina
  • pulmonary edema
  • fatigue
  • cardiomegally
  • hypotension
127
Q

Dilated Cardiomyopathy

A

dysfunction in the heart muscles ability to contract

  • heart chambers are dilated b/c decreased EF
  • systolic failure
128
Q

Caused of Dilated Cardiomyopathy

A
  • genetic
  • infections
  • alcohol/drugs
  • CAD
  • chemo
  • idiopathic
129
Q

Hypertrophic Cardiomyopathy

A

genetic abnormality of muscle cell proteins

  • don’t allow muscle to contract properly
  • heart muscle hypertrophy which means thicker ventricles
  • diastolic HF
130
Q

What type of inherited disorder is Hypertrophic Cardiomyopathy?

A

dominant autosommal inherited

131
Q

S/S of Hypertrophic Cardiomyopath

A
  • asymptomatic
  • dyspnea
  • syncope
  • sudden death
132
Q

What type of heart murmur is heard w/ Hypertrophic Cardiomyopathy?

A

Systolic ejection murmur/mitral regurgitation murmur

133
Q

Restrictive Cardiomyopathy

A
  • prob w/heart muscle:scarring, infiltration, etc
  • ventricles fail to relax (dilate/stretch)
  • decreased output during systole
134
Q

What type of Cardiomyopathy are Nitrates contraindicated?

A

Hypertrophic

Critical Care Nursing (14 decks)

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