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Adult Health I Test III > Day III > Flashcards

Day III Flashcards

1
Q

what is HF?

A
  • HF occurs when the heart muscle is unable to pump effectively which causes inadequate cardiac output, myocardial hypertrophy, and pulmonary/systemic congestion
    • Heart is unable to maintain adequate circulation to meet tissue needs
    • It is the result of an acute or chronic cardiopulmonary problem, such as systemic HTN, MI, pulmonary HTN, dysrhythmias, valvular heart dz, pericarditis, or cardiomyopathy
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2
Q

New York Heart Assoc’s functional classification scale for HF

A
  • indicates the level of activity it takes to make the client symptomatic (client pain or shortness of breath)
    • Class I: no symptoms w/ activity
    • Class II: symptoms with ordinary exertion
    • Class III: displays symptoms with minimal exertion
    • Class IV: symptoms at rest
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3
Q

American College of Cardiology and AHA staging HF

A
  • A: high risk for developing HF
  • B: cardiac structural abnormalities or remodeling but no heart failure symptoms
  • C: current or prior symptoms of HF
  • D: refractory end stage HF
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4
Q

left sided heart failure

A
  • results in inadequate left ventricle (cardiac) output and consequently in inadequate tissue perfusion
    • Systolic heart (ventricular) failure: ejection fraction below 40%, pulmonary and systemic congestion
    • Diastolic heart (ventricular) failure: inadequate relaxation or “stiffening” prevents ventricular filling
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5
Q

right sided heart failure

A
  • results in inadequate right ventricle output and systemic venous congestion (peripheral edema)
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6
Q

health promotion and dz prevention for HF

A
  • Maintain exercise routine to remain physically active
  • Diet: low in sodium, fluid restrictions
  • Refrain from smoking
  • Follow med regimen
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7
Q

what are 2 risk factors for all types of heart failure?

A
  • SBP is elevated in older adults, putting them at risk for coronary artery dz and HF
  • Some meds inc the risk of HF or worsen manifestations in older adult clients
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8
Q

risk factors for left sided HF

A
  • HTN
  • Coronary artery dz, angina, MI
  • Valvular dz
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9
Q

risk factors for right sided HF

A
  • Left sided HF
  • Right ventricular MI
  • Pulmonary problems (COPD, pulmonary fibrosis)
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10
Q

risk factors for cardiomyopathy

A
  • Coronary artery dz
  • Infection or inflammation of the heart muscle
  • Various cancer tx
  • Prolonged alcohol use
  • Heredity
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11
Q

expected findings of left sided HF

A
  • Dyspnea, orthopnea (SOB while laying down), nocturnal dyspnea
  • Fatigue
  • Displaced apical pulse (hypertrophy)
  • S3 heart sound (gallop)
  • Pulmonary congestion (dyspnea, cough, bibasilar crackles)
  • Frothy sputum (can be blood tinged)
  • Altered mental status
  • Manifestations of organ failure, such as oliguria (dec in urine output)
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12
Q

expected findings of right sided HF

A
  • JVD
  • Ascending dependent edema (legs, ankles, sacrum)
  • Abdominal distention, ascites
  • Fatigue, weakness
  • Nausea and anorexia
  • Polyuria at rest (nocturnal)
  • Liver enlargement (hepatomegaly) and tenderness
  • Weight gain
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13
Q

what is cardiomyopathy?

what are the 4 types?

A
  • Blood circulation to the lungs is impaired when the cardiac pump is compromised
    • can lead to HF
  • 4 types:
    • dilated: most common
    • hypertrophic
    • Arrhythmogenic right ventricular
    • Restrictive
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14
Q

manifestations of cardiomyopathy

A
  • Fatigue, weakness
  • HF (left with dilated type & right with restrictive type)
  • Dysrhythmias (heart block)
  • S3 gallop
  • Cardiomegaly
  • Angina (hypertrophic type)
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15
Q

lab test for HF

A
  • Human B type Natriuretic peptides (hBNP)
    • In clients who have dyspnea, elevated hBNP confirms a diagnosis of HF rather than a problem originating in the respiratory system. hBNP levels direct the aggressiveness of treatment interventions
      • Less than 100: no HF
      • 100-300: suggests HF is present
      • >300: mild HF
      • >600: moderate HF
      • >900: severe HF
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16
Q

what are the diagnostic procedures for HF?

A
  • hemodynamic monitoring
  • ultrasound
  • transesophageal echocardiography (TEE)
  • CXR
  • ECG, cardiac enzymes, electrolytes, and ABGs: use to assess factors contributing to HF and/or the impact of HF
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17
Q

explain hemodynamic monitoring to diagnose HF

A
  • HF generally results in inc central venous pressure (CVP), inc pulmonary wedge pressure (PAWP), inc pulmonary artery pressure (PAP), and dec CO
  • Mixed venous O2 sats (SvO2) are directly related to CO.
    • Drop in SvO2 indicates worsening cardiac function
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18
Q

explain ultrasound to diagnose HF

A
  • 2D or 3D
    • Left ventricular ejection fraction: volume of blood pumped from the left ventricle into the arteries upon each beat
      • Expected reference: 55-70%
    • Right ventricular ejection fraction: volume of blood pumped from the right ventricle to the lungs upon each beat
      • Expected reference: 45-60%
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19
Q

explain transesophageal echocardiography (TEE) to diagnose HF

A
  • Uses a transducer placed on the esophagus behind the heart to obtain a detailed view of cardiac structures
  • Nurse prepares client in same manner as upper endoscopy
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20
Q

explain CXR to diagnose HF

A
  • can reveal cardiomegaly and pleural effusions
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21
Q

nursing care involved with HF

A
  • Monitor daily weight and I&O
  • Assess for SOB and dyspnea on exertion
  • Administer O2
  • Monitor V/S and hemodynamic pressures
  • Put client in high Fowler’s
  • Check ABGs, electrolytes, SaO2, and CXR
  • Assess for signs of med toxicity
  • Encourage bed rest
  • Encourage energy conservation
  • Maintain dietary restrictions as prescribed (restricted fluid intake, restricted sodium intake)
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22
Q

what are the classes of meds used to tx HF?

A
  • diuretics
  • afterload reducing agents
  • inotropic agents
  • beta blockers
  • vasodilators
  • human B type natriuretic peptides
  • anticoagulants
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23
Q

diuretics to tx HF

A
  • use to decrease preload
  • Loop: furosemide, bumetanide
  • Thiazide: HCTZ
  • Potassium sparing diuretics: spironolactone
  • Nursing considerations:
    • Administer furosemide IV no faster than 20 mg/min
    • Loop and thiazide diuretics can cause hypokalemia, and potassium supplementation can be required
  • Client edu: teach clients taking loop or thiazide diuretics to ingest foods and drinks that are high in potassium to counter the effects of hypokalemia
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24
Q

afterload reducing agents to tx HF

A
  • help the heart pump more easily by altering the resistance to contraction
  • Contraindicated for clients who have renal deficiency
    • ACE inhibitors: enalapril, captopril
    • ARBs: losartan
    • CCBs: diltiazem, nifedipine
    • Phosphodiesterase 3 inhibitors: milrinone
  • Nursing considerations:
    • ACE inhibitors: first dose hypotension, angioedema, dec sense of taste, skin rash
    • Monitor for inc levels of potassium
  • Client edu: ACE Inhibitors
    • Teach client about dry cough
    • Notify provider if rash or dec sense of taste
    • Notify provider if swelling of face occurs
    • Remind client that BP needs to be monitored for 2 hours after initial dose
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25
Q

intropic agents to tx HF: meds, action, nursing considerations

A
  • digoxin, dopamine, dobutamine, milrinone
  • Used to inc contractility and thereby improve cardiac output
  • Nursing considerations:
    • For a client taking digoxin, take apical HR for 1 min, and hold if pulse is <60/min
    • watch for n/v
    • Dopamine, dobutamine, and milrinone are administered via IV.
    • Closely monitor ECG, BP, and urine output
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26
Q

inotropic agents to tx HF: client edu

A
  • If client self administering digoxin:
    • Count pulse for 1 min before taking, and if less than 60 or greater than 100, then hold
    • Take dose at same time each day
    • Do not take at same time as antacids–>separate other meds by 2 hours
    • Toxicity: fatigue, muscle weakness, confusion, and loss of appetite
    • Check digoxin and K levels regularly
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27
Q

beta blockers to tx HF

A
  • carvedilol and metoprolol
    • Can be used to improve the condition of the client who has sustained increased levels of sympathetic stimulation and catecholamines
      • Includes clients who have chronic HF
  • Nursing considerations:
    • Monitor BP, pulse, activity tolerance, and orthopnea
    • Check orthostatic BP readings
  • Client edu:
    • Instruct client to weigh daily
    • Advise client to regularly check BP
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28
Q

vasodilators to tx HF

A
  • nitroglycerin and isosorbide mononitrate
    • Prevent coronary artery vasospasm and reduce preload and afterload, decreasing myocardial O2 demand
  • Nursing considerations:
    • Given to tx angina and help control BP
    • Use cautiously with other anti HTN meds
    • Can cause orthostatic hypoTN
  • Client edu:
    • HA is common SE
    • Sit and lie down slowly
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29
Q

human B type natriuretic peptids (hBNPs) to tx HF

A
  • nesiritide
    • Used to treat acute HF by causing natriuresis (loss of Na and vasodilation)
    • Administered IV
  • Nursing considerations:
    • Can cause hypoTN, v tach, and bradycardia
    • BNP levels will inc on this med
    • Monitor ECG, BP
  • Client edu:
    • Client may be asymptomatic with a low BP
    • Remind client to sit and lie down slowly
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30
Q

anticoagulants to tx HF

A
  • warfarin
    • Use if pt has hx of thrombus formation
  • Nursing considerations:
    • Contraindications: active bleeding, PUD, hx of CVA, recent trauma
    • Monitor PT, aPTT, INR, CBC
  • Client edu:
    • Teach client risk for bruising and bleeding
    • Teach about getting blood monitored
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31
Q

interprofessional care to help with HF

A
  • cardio/pulmonary services: to manage HF
  • Respiratory services: for inhalers, breathing tx, suctioning
  • Cardiac rehab: for client with prolonged weakness
  • Nutrition: for diet with low sodium and low saturated fat food choices
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32
Q

therapeutic procedures for HF

A
  • ventricular assist device (VAD)
  • heart transplantation
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33
Q

ventricular assist device as a therapeutic procedure for HF

A
  • mechanical pump that assists a heart that is too weak to pump blood thru the body
    • Used in clients who are eligible for heart transplants or who have severe end stage HF and are not candidates for heart transplants
    • Heart transplantation is the tx of choice for clients who have severe dilated cardiomyopathy
  • Nursing actions:
    • Prepare client with NPO status and informed consent
    • Monitor post-op: V/S, SaO2, incision drainage, and pain mgmt
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34
Q

heart transplantation as a therapeutic procedure to tx HF

A
  • option for clients who have end stage HF
  • Immunosuppressant therapy is required post transplantation to prevent rejection
  • Eligibility for transplant depends on life expectancy, age, psychosocial status, absence of drug and alcohol use disorders
  • Nursing actions:
    • Prepare client for NPO and informed consent
    • Monitor post op: V/S, SaO2, incision drainage, pain mgmt
    • Monitor for complications: organ transplant recipients are at risk for infection, thrombosis, and rejection
  • Client edu: instruct client to:
    • Take meds
    • Take diuretics in early morning and early afternoon
    • Maintain fluid and Na restriction
    • Inc dietary intake of potassium if client is taking K losing diuretics
    • Check weight daily at the same time: notify provider for weight gain of 2 lb in 24 hr or 5 lb in 1 week
    • Schedule follow up
    • Get vaccines for pneumonia and flu
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35
Q

what are the complications of HF?

A
  • pulmonary edema
  • cardiogenic shock
  • pericardial tamponade
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36
Q

what is cardiogenic shock?

what are the expected findings?

A
  • serious complication of pump failure that occurs commonly following an MI and injury greater than 40% of the left ventricle
  • Findings:
    • Tachycardia
    • hypoTN
    • Inadequate urinary output
    • Altered LOC
    • Respiratory distress (crackles, tachypnea)
    • Cool, clammy skin
    • Dec peripheral pulses
    • Chest pain
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37
Q

nursing actions with cardiogenic shock as it occurs with HF

A
  • Monitor breath sounds: crackles, wheezing
  • Monitor heart sounds
  • Administer O2, intubation and ventilation may be required
  • Administer IV morphine, diuretics, and/or nitro to dec preload
  • Administer vasopressors and/or positive inotropes to inc CO and maintain organ perfusion
  • Provide continuous hemodynamic monitoring
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38
Q

pericardial tamponade as a complication of HF

A
  • Can result from fluid accumulation in the pericardial sac
  • Findings:
    • hypoTN
    • JVD
    • Muffled heart sounds
    • Paradoxical pulse (variance of 10 mmHg or more in SBP b/w expiration and inspiration)
  • Diagnostics: hemodynamic monitoring will reveal intracardiac and pulmonary artery pressures similar and elevated
39
Q

nursing actions for pericardial tamponade as a complication of HF

A
  • Notify provider
  • Administer IV fluids to combat hypoTN
  • Obtain CXR or ECG
  • Prepare for pericardiocentesis: informed consent, gather materials, administer meds
  • Monitor hemodynamic pressures
  • Monitor heart rhythm–changes indicate improper positioning of needle
  • Monitor for reoccurrence of findings after the procedure
40
Q

what is pulmonary edema? what are the expected findings of acute pulmonary edema?

A
  • Pulmonary edema: severe, life threatening accumulation of fluid in the alveoli and interstitial spaces of the lung that can result from severe HF
  • Acute is life - threatening
  • Expected findings
    • Anxiety
    • Tachycardia
    • Acute respiratory distress
    • Dyspnea at rest
    • Change in level of consciousness
    • An ascending fluid level within the lungs (crackles, cough productive of frothy, blood-tinged sputum)
41
Q

nursing actions associated with pulmonary edema

A
  • Administer prescribed medications to improve cardiac output
  • Teach client about measures to improve tolerance to activity, such as alternating periods of activity with periods of rest
  • Prompt response to this emergency includes the following
    • Positioning the client in high-fowler’s position
    • Administration of oxygen, positive airway pressure, and/ or intubation and mechanical ventilation
    • IV morphine (to decrease anxiety, respiratory distress, and decrease venous return)
    • IV administration of rapid-acting loop diuretics, such as furosemide
    • Effective intervention should result in diuresis (carefully monitor output), reduction in respiratory distress, improved lung sounds, and adequate oxygenation
42
Q

what is the most common cause of pulmonary edema?

A
  • Cardiogenic factors are most common cause of pulmonary edema
    • It is a complication of various heart and lung diseases
    • Usually occurs from inc pulmonary vascular pressure secondary to severe cardiac dysfunction
43
Q

noncardiac pulmonary edema

A
  • can occur due to barbiturate or opiate overdose, inhalation of irritating gases, rapid administration of IV fluids, and after a pneumonectomy evacuation of pleural effusion
44
Q

neurogenic pulmonary edema

A
  • develops following a head injury
45
Q

older adults and pulmonary edema

A
  • Inc risk occurs related to dec cardiac output and HF
  • Inc risk for fluid and electrolyte imbalances occurs when older adults receive tx with diuretics
  • IV infusions must be administered at a slower rate to prevent circulatory overload
46
Q

health promotion and disease prevention for pulmonary edema

A
  • Maintain an exercise routine to remain physically active
  • Consume diet low in Na along with fluid restrictions
  • Refrain from smoking
  • Follow medication regimen
47
Q

risk factors of pulmonary edema

A
  • acute MI
  • Fluid volume overload
  • HTN
  • Valvular heart dz
  • Postpneumonectomy
  • Postevacuation of pleural effusion
  • Acute respiratory failure
  • Left sided HF
  • High altitude exposure or deep sea diving
  • Trauma sepsis
  • Drug overdose
48
Q

expected findings of pulmonary edema

A
  • Anxiety
  • Inability to sleep
  • Persistent cough with pink, frothy sputum (cardinal sign)
  • Tachypnea, dyspnea, and orthopnea
  • Hypoxemia
  • Cyanosis (later stage)
  • Crackles
  • Tachycardia
  • Reduced urine output
  • Confusion, stupor
  • S3 heart sound (gallop)
  • Inc pulmonary A occlusion
49
Q

nursing care with pulmonary edema

A
  • Monitor V/S Q15 min
  • Monitor I/O
  • Monitor hemodynamic status: pulmonary wedge pressures, CO
  • Check ABGs, electrolytes (esp K), SaO2, CXR
  • Patent airway and suctioning
  • Position in high fowler’s to dec preload
  • Administer O2 using high flow rebreather mask
  • Restrict fluids
  • Monitor hourly urine output
50
Q

meds used for pulmonary edema

A
  • Rapid acting diuretics: furosemide, bumetanide
    • Promote fluid excretion
  • Morphine: dec SNS response and anxiety, promotes mild vasodilation
  • Vasodilators: nitro, sodium nitroprusside
    • Dec preload and afterload
  • Inotropic agents: digoxin, dobutamine
    • Improve CO
  • antiHTN: ACE inhibitors, beta blockers
    • Dec afterload
51
Q

client education for pulmonary edema

A
  • Provide emotional support for client
  • Teach effective breathing
  • Teach client to continue to take meds even if feeling better
  • Teach ADRs
  • Instruct to use low sodium diet and fluid restriction
  • Measure weight daily
    • Notify provider if gain of more than 2 lb in 1 day or 5 lb in 1 week
  • Report any swelling of feet/ankles, SOB or angina
52
Q

pericarditis and infective endocarditis

A

Inflammation related to the heart is an extended inflammatory response that often leads to destruction of healthy tissue

53
Q

health promotion and disease prevention for cardiac inflammatory disorders

A
  • Early tx of streptococcal infections can prevent rheumatic fever
  • Prophylactic tx (including Abx for clients who have cardiac defects) can prevent infective endocarditis
  • Influenza and pneumonia immunizations are important for all clients in order to dec incidence of myocarditis
54
Q

risk factors for cardiac inflammatory disorders

A
  • Congenital heart defect/cardiac anomalies
  • IV substance use
  • Heart valve replacement
  • Immunosuppression
  • Rheumatic fever
  • School age children with long streptococcus infections
  • Malnutrition
  • Overcrowding
  • Lower socioeconomic status
55
Q

pericarditis and the expected findings

A
  • inflammation of pericardium
    • Commonly follows respiratory infection
    • Can be due to a MI
  • Findings:
    • Chest pressure/pain aggravated by breathing (mainly inspiration), coughing, swallowing
    • Pericardial friction rub auscultated at left lower sternal border
    • SOB
    • Relief of pain when sitting/leaning forward
56
Q

infective endocarditis and the expected findings

A
  • infection of endocardium due to staphylococci, streptococci, fungi, or other infectious organisms
  • Most common in clients who have structural cardiac malformations, cardiac devices (pacemaker), prosthetic heart valves, IV substance use disorder
  • Invasive procedures, like dental procedures, body piercing, and tattooing, can cause bacteremia, which can lead to infective endocarditis in at risk clients
  • findings:
    • Fever
    • Flu like manifestations
    • Murmur
    • Petechiae (on the trunk and mucous membranes)
    • Positive blood cultures
    • Splinter hemorrhages (red streaks under the nail beds)
57
Q

lab tests for cardiac inflammatory disorders

A
  • Blood cultures: to detect a bacterial infection
  • High WBC: bacterial infection
  • Cardiac enzymes: pericarditis
  • Elevated ESR and CRP: inflammation of the body
  • Throat culture: to detect a streptococcal infection, which can lead to rheumatic fever
58
Q

diagnostics for cardiac inflammatory disorders

A
  • ECG: can detect heart block, which is associated with rheumatic fever or demonstrate ST segment elevation in almost all leads in the case of pericarditis
  • Echocardiography: can reveal inflamed heart layers or pericardial effusion
59
Q

nursing actions for cardiac inflammatory disorders

A
  • Auscultate heart sounds: listen for murmur or friction rub
  • Review ABGs, SaO2, and CXR
  • Administer O2
  • Monitor V/S: watch for fever
  • Monitor ECG
  • Monitor for cardiac tamponade and HF
  • Obtain throat cultures to identify bacteria to be tx w/ abx
  • Administer abx and antipyretics
  • Assess pain and administer pain meds
  • Encourage bed rest
60
Q

what are the 4 types of meds used for cardiac inflammatory disorders?

A
  • penicillin
  • ibuprofen
  • prednisone
  • amphotericin B
61
Q

penicillin to tx cardiac inflammatory disorders

A
  • abx to tx infection
    • Monitor for skin rash, hives, electrolyte and kidney levels
    • Instruct clients to report skin rash or hives
    • Med can cause GI distress
62
Q

ibuprofen to tx cardiac inflammatory disorders

A
  • NSAID for fever and inflammation
    • Do not use if client has PUD
    • Watch for signs of GI distress
    • Monitor platelets and liver & kidney function levels
    • Take with food
    • Avoid alcohol
63
Q

prednisone to tx cardiac inflammatory disorders

A
  • glucocorticoid to tx inflammation
    • Use in low doses
    • Monitor BP, electrolytes, blood sugar
    • May have impaired wound healing
    • Take with food
    • Do not d/c abruptly
    • Report unexpected weight gain
64
Q

amphotericin B to tx cardiac inflammatory disorders

A
  • antifungal given to tx fungal infection
    • Monitor liver and kidney fcn
    • May cause GI distress
65
Q

therapeutic procedures to treat pericarditis

A
  • pericardiocentesis is the insertion of a needle into the pericardium to aspirate pericardial fluid
    • Can be done in ED
    • Nursing:
      • Send fluid to lab for culture and sensitivity
      • Monitor for recurrence of cardiac tamponade
66
Q

therapeutic procedures to tx infective endocarditis

A
  • valve debridement, draining abscess, and repairing congenital shunts
    • Nursing: monitor for bleeding, infection, alteration in CO
67
Q

client edu for cardiac inflammatory disorders

A
  • Encourage client to rest
  • Wash hands to prevent infection
  • Avoid crowded areas
  • Good oral hygiene
  • Make sure client can administer IV abx
  • Smoking cessation
  • Prophylactic abx use before invasive dental procedures
  • Care after discharge:
    • Home health serves may be needed if client had surgery or needs IV abx
    • Pharmaceutical services can supply IV supplies
68
Q

complication of cardiac inflammatory disorder and the manifestations it yields

A
  • Cardiac tamponade: can result from fluid accumulation in the pericardial sac
    • Manifestations:
      • Dyspnea
      • Dizziness
      • Report of tightness in the chest
      • Increasing restlessness
      • Pulsus paradoxus (dec of 10 mmHg or more in SBP during inspiration)
      • Tachycardia
      • Muffled heart sounds
      • JVD
    • Hemodynamic monitoring reveals intracardiac and pulmonary artery pressures similar and elevated
69
Q

nursing actions for cardiac tamponade (as a complication of cardiac inflammatory disorders)

A
  • Notify provider
  • Administer IV fluids to combat hypoTN
  • Obtain CXR or echocardiogram to confirm dx
  • Prepare client for pericardiocentesis
    • Monitor hemodynamic pressures
    • Monitor heart rhythm as changes indicate improper needle placement
70
Q

what is cardiac valve disease?

A
  • Valve dz affects the efficiency of the heart as a pump and reduces stroke volume
    • Overtime, the heart may remodel (hypertrophy) and HF may occur
    • w/ age, fibrotic thickening occurs in the mitral and aortic valves
      • The aorta is stiffer in older adults which inc SBP and stress on mitral valve
71
Q

health promotion and dz prevention for valvular heart disease

A
  • Prevent and tx bacterial infections
  • Diet low in sodium and restrict fluids to prevent HF
  • Control chronic DM, HTN, hypercholesterolemia
  • Encourage inc activity and exercise to boost LDL
72
Q

how can valvular disease be classified?

A
  • Stenosis: narrowed opening and impedes blood moving forward
  • insufficiency/improper closure: some blood flows backward
    • Regurgitation
73
Q

congenital vs. acquired valvular heart disease

A
  • Congenital: can affect all 4 valves and cause either stenosis or insufficiency
  • Acquired: 3 types:
    • Degenerative dz: due to damage over time from mechanical stress, atherosclerosis, and HTN
      • Most common in developed countries
    • Rheumatic dz: gradual fibrotic changes, calcification of valve cusps
      • Most common in developing countries
    • Infective endocarditis: infectious organisms destroy the valve
      • Streptococcal infections are a common cause
74
Q

risk factors for valvular heart disease

A
  • HTN
  • Rheumatic fever: mitral stenosis and insufficiency
  • Infective endocarditis
  • Congenital malformations
  • Marfan syndrome
  • Older adults: causes are usually degenerative calcification and atherosclerosis, papillary muscle dysfunction, infective endocarditis
75
Q

expected findings with valvular heart disease

A
  • Clients who have valvular heart dz are often asymptomatic until late in dz
  • Murmur: heard w/ turbulent blood flow
    • Location of murmur and timing helps determine valve involved
  • Left sided valve damage causes: inc pulmonary A pressure, left ventricular hypertrophy, & dec CO which cause orthopnea, paroxysmal nocturnal dyspnea (PND), and fatigue
76
Q

findings associated with mitral stenosis

A
  • apical diastolic murmur
  • dyspnea on exertion
  • orthopnea
  • atrial fibrillation
  • palpitations
  • fatigue
  • JVD
  • pitting edema
  • hemoptysis
  • dry cough
  • repeated respiratory infections
  • PND
  • hepatomegaly
77
Q

findings associated with mitral insufficiency

A
  • systolic murmur at the apex
  • S3 sounds
  • fatigue and weakness
  • atrial fibrillation
  • dyspnea on exertion
  • orthopnea
  • atypical chest pain
  • palpitations
  • JVD
  • pitting edema
  • crackles in lungs
  • possible diminished lung sounds
  • PND
  • hepatomegaly
78
Q

findings associated with aortic stenosis

A
  • systolic murmur
  • dyspnea on exertion
  • S4 sounds
  • angina
  • syncope
  • fatigue
  • orthopnea
  • PND
  • narrowed pulse pressure
79
Q

findings associated with aortic insufficiency

A
  • diastolic murmur
  • sinus tachycardia
  • exertional dyspnea
  • orthopnea
  • palpitations
  • fatigue
  • nocturnal angina with diaphoresis
  • widened pulse pressure
  • bounding arterial pulse on palpation (Corrigan’s pulse)
  • elevated systolic and diminised diastolic pressures
  • PND
80
Q

diagnostic procedures with valvular heart disease

A
  • CXR: shows chamber enlargement and pulmonary congestion
  • 12 lead ECG: chamber hypertrophy
  • Echocardiogram: shows chamber size, hypertrophy, specific valve dysfunction, ejection function, and amount of regurgitant flow
  • Transesophageal echocardiography (TEE)
  • Exercise tolerance testing/stress echocardiography: used to assess impact of the valve problem on cardiac functioning during stress
  • Radionuclide studies: determine ejection fraction during activity and rest
  • Angiography: used to evaluate the coronary arteries and degree of atherosclerosis
  • Cardiac cath may be used as a diagnostic tool in valvular dz
81
Q

nursing care with valvular heart disease

A
  • Monitor current weight and note any changes
  • Assess heart rhythm: can be irregular, bradycardic; assess for murmur
  • Administer O2 and meds
  • Hemodynamic monitoring, fluid and Na restrictions
82
Q

what are the classes of meds used to tx valvular heart disease?

A
  • diuretics
  • afterload reducing agent
  • inotropic agents
  • anticoagulants
83
Q

diuretics used to tx valvular heart dz

A
  • used to tx HF by removing excessive ECF
  • Nursing:
    • Administer furosemide IV slow over 1-2 min
    • Loop and thiazide diuretics can cause hypokalemia, and potassium supplement might be required
  • Client edu:
    • If taking loop/thiazide diuretics: ingest foods and drinks high in K (dried fruits, nuts, spinach, citrus fruits, bananas, potatoes
84
Q

afterload reducing agents to tx valvular heart disease

A
  • help the heart pump more easily by altering the resistance to contraction
    • ACE inhibitors: enalapril, captopril, lisinopril
    • ARBs: losartan, valsartan
    • Beta blockers: metoprolol, carvedilol
    • CCB: felodipine, nifedipine, amlodipine
    • Vasodilators: hydralazine
      • Nursing considerations: monitor clients taking ACE Inhibitors for first dose hypoTN
85
Q

inotropic agents to tx valvular heart dz

A
  • digoxin
    • Used to inc contractility and thereby improve CO
  • Client edu:
    • If administering digoxin:
      • Count pulse for 1 min before taking and hold dose if outside of 60-100 bpm
      • Take at same time everyday
      • Do not take at same time as antacids–>separate by at least 2 hours
      • Toxicity: fatigue, muscle weakness, confusion, visual changes, loss of appetite
86
Q

anticoagulants to tx valvular heart dz

A
  • used for clients with mechanical valve replacement, a fib, or severe left ventricle dysfunction
87
Q

post surgery care for valvular heart dz

A
  • post surgery care is similar to coronary artery bypass surgery–>care for sternal incision, activity limited for 6 weeks, report fever
88
Q

therapeutic procedures to tx valvular heart dz

A
  • percutaneous balloon valvuloplasty
  • valve replacement
  • miscellaneous surgical mgmt
89
Q

percutaneous balloon valvuloplasty to tx valvular heart dz

A
  • can open aortic or mitral valve affected by stenosis
    • Catheter is inserted thru the femoral artery and advanced to the heart
      • Balloon is inflated at the stenotic lesion to open the fused commissures and improve leaflet mobility
90
Q

valve replacement to tx valvular heart dz

A
  • replacement of heart valves with mechanical xenograft (from other species), allografts (from cadavers), or autografts (formed from client’s pulmonic valve and a portion of the pulmonary A
    • Can use open heart approach or minimally invasive surgery
    • Requires lifelong anticoagulant therapy
    • Tissue valves need to be replaced every 7-10 years
91
Q

surgical management of valvular heart disease

A
  • Other surgeries include chordae tendinae reconstruction, commissurotomy (relieve stenosis on leaflets), annuloplasty ring insertion (correct dilation of valve annulus by narrowing the opening), and leaflet repair
  • Surgery is done when manifestations interfere with daily activities
92
Q

client education for valvular heart disease

A
  • Prophylactic Abx before invasive dental or respiratory procedure
  • Weigh daily ad notify provider of 3 lb gain in 1 day or 5 lb gain in 1 week
  • Plan rest periods in with activity
  • Follow prescribed exercise program
  • Avoid caffeine and alcohol
  • Open wounds should be cleaned carefully and Abx ointment used
  • Report fever immediately
  • Petechial rash or SOB should be reported to HCP
  • Avoid OTCs with alcohol, ephedrine, epinephrine which may cause dysrhythmias
  • Teach S/S of HF
93
Q

complications of valvular heart disease

A
  • Heart Failure: inability of heart to maintain adequate circulation to meet tissue needs for O2 and nutrients
    • Ineffective valves result in HF
    • Nursing actions: monitor client’s HF class to gauge for surgical intervention

Adult Health I Test III (5 decks)

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