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NRSG 200: Med Surg 3 > [Exam 2] Chapter 29: Management of Patients with Complications from Heart Disease > Flashcards

[Exam 2] Chapter 29: Management of Patients with Complications from Heart Disease Flashcards

1
Q

What is HF?

A

Inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients.

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2
Q

HF: This syndrome is characterized by what?

A

Fluid overload or inadequate tissue perfusion

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3
Q

HF: This term indicates myocardial disease, which measn what

A

there is a problem with the contraction of the heart (systolic failure) or filing of the heart (diastolic failure)

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4
Q

HF: Can this be reversed?

A

Yes

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5
Q

HF: How does this usually progress?

A

Is usually a progressive, lifelong disorder managed with lifestyle changes and medications

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6
Q

HF: What does it mean if the heart cannot squeeze properly?

A

Systolic failure

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7
Q

HF: What does it mean if the heart cannot fill properly?

A

Diastolic failure

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8
Q

HF Patho: What are some examples of Myocardial Dysfunction?

A 
Ischemic Heart Disease
Hyperthyroidism
MI
Valve Disease
Alcohol/Cocaine Abuse
Hypertension
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9
Q

HF Patho: Myocardial dysfunction (HF) can lead to what changes in body?

A

Decreased CO
Decreased systemic blood pressure
decreased perfusion to kidneys

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10
Q

HF Patho: When there is a decrease blood pressure or cardiac output, what is activated?

A

Baroreceptors (Aortic Arch and Carotid Sinus)

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11
Q

HF Patho: After activation of the baroreceptors, what system is activated next?

A

The sympathetic nervous system which increases catecholamines (Epinephrine and norepinephrine)

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12
Q

HF Patho: The release of Catecholamines (Epinephrine and Norepinephrine) causes what?

A

Vasoconstriction, which increased afterload, blood pressure, and heart rate.

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13
Q

HF Patho: Decreased Cardiac Output or Blood Pressure of perfusion to kidneys activated what?

A

RAAS sysem

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14
Q

HF Patho: How does RAAS system work?

A

Angiotensin released from liver, and forms Angiotensin 1.

Renin combines with lungs to form Angiotensin II

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15
Q

HF Patho: Increase release of aldosterone causes what changes?

A

Sodium/Water retention
Arginine Vasopressin
Cytokines
Endothelin

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16
Q

HF Patho: What disease can cause the heart to not pump properly?

A

CAD

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17
Q

HF Patho: Why is the RAAS being activated a viscious cycle?

A

When activated, the patients retain fluid because kidneys think we are not getting enough perfusion. Need to hold onto more fluid which is the opposite of what we want in this situation

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18
Q

HF Patho: Why is activation of baroreceptors a problem?

A

We do not want vasoconstriction because the heart is already struggling with pumping blood to rest of body. Increases afterload heart must overcome.

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19
Q

HF Patho: What may happen to heart if this is prolonged?

A

Ventricular remodeling, where there is hypertrophy and dilation of ventricles and turn into large cells and impaired contractility.

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20
Q

HF Patho: In simple terms, why is HF a viscous cycle?

A

Because bodies mechanisms cause us to retain fluid which is what we don’t want a long with vasoconstriction. Heart works harder.

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21
Q

HF CMs: What are some signs of right sided heart fialure?

A

Viscera and Peripheal Congestion

Jugular Venous Distention (JVD)

Dependent Edema

Hepatomegaly

Ascites

Weight Gain

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22
Q

HF CMs:What are some signs of left sided heart failure?

A

Pulmonary Congestion, Crackles
S3 or Ventricular Gallop

Dyspnea on Exertion (DOE)

Orthopnea

Dry, Nonproductive Cough

Oliguria (Small Urine)

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23
Q

HF CMs: How should we view right-sided heart failure?

A

Rest of body. Manifestated by backing up of blood into body.

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24
Q

HF Right-Sided CMs: Why is Hepatomegaly seen with Right sided HF

A

Because the fluid is pushing back on the liver

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25
Q

HF Left-Sided CMs: What should we think for these CMs?

A

Lungs

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26
Q

HF Left-Sided CMs: Why will they have dyspnea?

A

Because of the congestion in the lungs

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27
Q

HF Left-Sided CMs: Why will they have orthopnea?

A

Because of the fluid in the lungs, and have to sit up to breathe

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28
Q

HF Left-Sided CMs: RIght-Sided HF goes where?

A

Back into the body

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29
Q

HF Right-Sided CMs: How will this patient appear?

A

Will have distended jugular veins, dependent edema in lower body, and wil have ascites

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30
Q

HF Left-Sided CMs: How will this person appear?

A

Will be skinner. Will have cyanosis on lips, feet, and fingertips. Aren’t getting enough oxygen.

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31
Q

HF Right-Sided CMs: Are they fatigued?

A

Yes, because they are now holding onto all that extra fluid

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32
Q

HF Left-Sided CMs: Auscultation will reveal what?

A

Fluids in the lungs.

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33
Q

HF Left-Sided CMs: How will their cough progress?

A

Will be dry originally, and then the person will cough of blood-tinged sputum.

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34
Q

HF Left-Sided CMs: Respirations increased why

A

because they can’t breathe properly because of lung buildup.

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35
Q

HF Left-Sided CMs: What will happen to Pulmonary Capillary Wedge Pressures?

A

Will be elevated because of HF. This pressure tells us what the left ventricle is doing.

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36
Q

HF Left-Sided CMs: They will have Paroxysmal Noctural Dyspnea, which is what

A

Condition that triggers sudden SOB during sleep

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37
Q

HF Medical Mx - Medication: How do Angiotensin-Converting Enzyme Inhibitors and Angiotensin II REceptor BLockers work?

A

Will decrease blood pressure and decrease afterload.

Includes Lisinopril

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38
Q

HF Medical Mx - Medication: How do Beta Blockers work?

A

They decrease BP and take stress off of heart and help so heart doesn’t work as hard.

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39
Q

HF Medical Mx - Medication: What do these medications end in?

A

Lol , like metoprolol, carvedilol (common for patients with HF)

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40
Q

HF Medical Mx - Medication: How do diuretics work?

A

Going to get fluid off so fluid volume overload doesn’t happen. Includes Brosimine.

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41
Q

HF Medical Mx - Medication: How does Digitalis work?

A

Digoxin, improves cardiac contractility to help that heart squeeze better

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42
Q

HF Medical Mx - Medication / IV Infusions: What to know for Dobutamine and Milrinone?

A

They are both inotropes .

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43
Q

HF Medical Mx - Medication / IV Infusions: What does Dobutamine help with?

A

Helps with contractility , helping heart squeeze better.

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44
Q

HF Medical Mx - Medication / IV Infusions: What does Milrinone help with?

A

Has a little vasodilation effect. Decreases preload and afterload so heart doesn’t have to work as heard.

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45
Q

HF Medical Mx - Medication / Other Meds: What do Hydralazine and Isosorbide do?

A

They vasodilate. Can be added if patient has SE from ACE or ARB

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46
Q

HF Medical Mx - Medication / Other Meds: What problems may ACE Inhibitors cause?

A

Dry cough, angioedema (swelling of upper airway, eyes).

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47
Q

HF Medical Mx - Nutritional Therapy: What diet will they be on?

A

2 gram sodium per day diet to help decrease fluid retention

48
Q

HF Medical Mx: Why is Supplemental Oxygen given?

A

Often become Hypoxic as HF progresses.

49
Q

HF Medical Mx: What to know for ICD?

A

Installed in patients with HF because if their EF is less than 35%, they are much more likely to have dysrhythmias.

50
Q

HF Medical Mx: Why would Cardiac resynchronization Therapy be prescribed?

A

Different leads help pace the heart and help the electrical acivity of heart. Keeps them out of ventricular dysrhythmias

51
Q

HF Medical Mx - Gerontologic Considerations: What changes may occur as they progress?

A

Increased ventricular wall thickness, myocardium becoming fibrotic

52
Q

HF Medical Mx - Gerontologic Considerations: Why are these people more resistant to diuretics

A

As you get older, kidney function starts to fail so diuretics don’t wokr as well. Can’t pull fluid off by voiding.

53
Q

HF Medical Mx - Gerontologic Considerations: What big intervention must be done for this patient daily

A

We must remind them daily to weight themselves daily at the same time everyday in same clothing.

54
Q

HF Medical Mx - Gerontologic Considerations: Why is monitoring weight important

A

Because if they gain more than 2-3 lbs in a day, they’re holding onto fluid. Or if they gain 5 lbs in a week.

55
Q

Treating Congestive HF: What Acronym is used to remember this?

A

Unload Fast

56
Q

Treating Congestive HF: (U)nload Fast

A

Upright Position

57
Q

Treating Congestive HF: U(n)load Fast

A

Nitrates (Vasodilation helps heart not overcome pressure)

58
Q

Treating Congestive HF: Un(l)oad Fast

59
Q

Treating Congestive HF: Unl(o)ad Fast

60
Q

Treating Congestive HF: Unlo(a)d Fast

A

Ace Inhibitors

61
Q

Treating Congestive HF: Unloa(d) Fast

A

Digoxin (Helps with contractility)

62
Q

Treating Congestive HF: Unload (F)ast

A

Fluid (decrease)

63
Q

Treating Congestive HF: Unload F(a)st

A

Afterload (decrease)

64
Q

Treating Congestive HF: Unload Fa(s)t

A

Sodium Restriction

65
Q

Treating Congestive HF: Unload Fas(t)

A

Test (Digoxin Level, ABGs, Potassium Levels)

66
Q

Treating Congestive HF: What should you always check before giving Lasix?

A

Potassium levels, electrolytes because it is potassium depleting

67
Q

Treating Congestive HF: Why must blood pressure be checked before lasix?

A

Because they are going to start voiding and don’t want top drop blood pressure.

68
Q

Nursing Process - HF - Assessment: This includes what/

A

How is their breathing, do they need to sleep upright, able to get mail without SOB?

69
Q

Nursing Process - HF - Assessment: Physical assessment will include what?

A

Edema, JVD, Crackles , do they seem like they have decreased perfusion or cyanotic?

70
Q

Nursing Process - HF - Nursing Diagnosis: This includes what?

A

Fluid volume excess, impaired gas exchange, decreased CO.

71
Q

Nursing Process - HF - Goals focus on what?

A

Decreasing excess fluid volume , monitoring their oxygen saturation , maintain clear lung sounds.

72
Q

Nursing Process - HF - Interventions: This includes what?

A

Make sure all meds administered, monitor patient for fluid volume excess, adequate fluid output?

73
Q

Nursing Process - HF - Eval: : This includes?

A

Trying to reach goal, such as trying to reduce edema or ensuring that patient had clear lung sounds.

74
Q

HF Complications: What are the major complications?

A

Pulmonary edema, Cardiogenic shock, Thromboembolism,

Pericardial Effusion and Cardiac Tamponade

75
Q

HF Complications - Pulmonary Edema: What is this?

A

Excess accumulation of fluid, the backup of fluid in the lungs. Can be sudden onset or can develop

76
Q

HF Complications - Pulmonary Edema: Why must we be careful if giving HF patient a blood transfusion?

A

They can easily fluid overload the patient, and fluid will end up in the lungs and accumulate in alveoli.

77
Q

HF Complications - Pulmonary Edema: What kind of CMs will they have?

A

Difficulty breathing, pink frothy sputum, crackling lungs, coarse lungs

78
Q

HF Complications - Pulmonary Edema: How do we know that this is happening?

A

Assess patient. Pink frothy sputum, crackly lungs, Trouble maintaining O2 saturation.

79
Q

HF Complications - Pulmonary Edema: What diagnostics can be performed to assess this?

A

Simple Chest X-Ray

80
Q

HF Complications - Pulmonary Edema: How to prevent this?

A

Usually easier to prevent than treat. Give Lasix between blood treatments. Can also set patient upright and dangle feet to decrease amount of fluid going into heart.

81
Q

HF Complications - Pulmonary Edema, Med Mx: This will include what?

A

Oxygen therapy
Diuretics
Vasodilators

82
Q

HF Complications - Pulmonary Edema, Med Mx: Why is oxygen therapy given?

A

Often see Oxymask to deliver high flow oxygen. If not can be put on bipap which will force air into lungs. Then diuretic given to grab water pushed into capillary.

83
Q

HF Complications - Pulmonary Edema, Med Mx: Why are vasodilators given?

A

Given to help take stress off of the heart so it doesn’t work as heard.

84
Q

HF Complications - Pulmonary Edema, Nurse Mx: What nurse management can be done?

A

Positioning (Legs dangle at bedside)

Provide psychological support

Monitor meds like vasodilators.

85
Q

HF Complications - Cardiogenic Shock: What is this?

A

Decreased cardiac output leads to decreased tissue perfusion.

86
Q

HF Complications - Cardiogenic Shock: How is this treated?

A

To correct that underlying problem. Will often see this develop after MI.

87
Q

HF Complications - Cardiogenic Shock: What happens in the body due to an MI occuring?

A

Decreased contractility -> decreased cardiac output -> decreased blood pressure -> decreased coronary artery perfusion - MI.

88
Q

HF Complications - Cardiogenic Shock: Decreased cardiac output leads to what

A

decreased tissue perfusion that leads to shock.

89
Q

HF Complications - Intra-Aortic Balloon Pump: Wht is this?

A

Way for the heart to rest after they have an MI and LV takes a hit. Inflates during diastole and push blood back toward heart to help reperfuse heart. Takes workload off of heart.

90
Q

HF Complications - Intra-Aortic Balloon Pump: When does this reflate?

A

During systole

91
Q

HF Complications - Intra-Aortic Balloon Pump: Where is this usually inserted?

A

Through the femoral artery, and will be treated like cath lab patient. Monitor for bleeding , hemorrhage, rectoperitoneal bleeding, and neurovascular checks of lower extremity.

92
Q

HF Complications - Intra-Aortic Balloon Pump: What to know about head of bed?

A

Cannot be raised more than 30 degrees since treating like cath lab patient.

93
Q

HF Complications - Cardiac Tamponade: What is this?

A

Acute accumulation of fluid in the pericardial sac. Known as pericardial effusion. Increased pressure put on heart, and cannot adequately squeeze.

94
Q

HF Complications - Cardiac Tamponade: What test is performed to check for this?

A

Echocardiogram that can immediately see that there is fluid present in pericaridal sac.

95
Q

HF Complications - Cardiac Tamponade: How will the patients heart sound?

A

It will become more muffled.

96
Q

HF Complications - Cardiac Tamponade: What physical things may we see on this patient?

A

JVDs, Dyspnea, Parodoxial Pulse (Exaggerated fall in systolic blood pressure with inspiration).

97
Q

HF Complications - Cardiac Tamponade: Why would this patient be hypotensive?

A

Because the heart cannot pump effectively.

98
Q

HF Complications - Cardiac Tamponade: How will this be treated?

A

They will go in and perform a pericardial synthesis and drain the fluid.

99
Q

HF Complications - Cardiac Tamponade: How is a pericardial synthesisi performed?

A

Will go in and take a needle and evacuate the fluid in the pericaridal space.

100
Q

HF Complications - Cardiac Tamponade: Pericardictomy can also be performed, which is what?

A

They go in and cut away some of the thickened pericardium and let it drain.

101
Q

HF Complications - Cardiac Tamponade: What is a Pericardial Windowo?

A

A chest tube will be placed in there and it will drain continuously.

102
Q

HF Complications - Cardiac Tamponade: What must we know about this?

A

Fluid buildip in pericaridal sac, and we must remove this fluid to ensure that the heart can pump effectively so pericardial synthesis performed to remove the fluid through needle.

103
Q

HF Complications - Sudden Cardiac Death/Cardiac Arrest: What is Cardiac Arreest?

A

Heart stops beating as they go into ventricular dysrhythmia and they cardiac arrest.

104
Q

HF Complications - Sudden Cardiac Death/Cardiac Arrest: What doese this require us to do?

A

CPR, and follow CABD

105
Q

HF Complications - Sudden Cardiac Death/Cardiac Arrest: What is CABD?

A

C - Circulation
A - Airway
B - Breathing
D - Defibrillation for VT or VF

106
Q

HF Complications - Sudden Cardiac Death/Cardiac Arrest, Meds Used: step to do when patient goes into this following BLS method?

A
  1. Annie Annie, are you okay?
  2. Check for pulse
  3. Start Compressions
107
Q

HF Complications - Sudden Cardiac Death/Cardiac Arrest, Meds Used: What medications are used?

A 
Epinephrine
Vasopressin
Norepinephrine
Dopamine
Atropine
Sodium Bicarbonate
Magneisum
108
Q

HF Complications - Sudden Cardiac Death/Cardiac Arrest, Meds Used: What does Epinephrine do?

A

It’s the go-to drug to get a rhythm back, get the blood pressure up

109
Q

HF Complications - Sudden Cardiac Death/Cardiac Arrest, Meds Used: Why is vasopressin given

A

Clamps down on the vessels , and hope to get blood pressure up

110
Q

HF Complications - Sudden Cardiac Death/Cardiac Arrest, Meds Used: why is norepinephrien given?

A

vasopressor as well. Clamps down and hopes to get blood pressure up

111
Q

HF Complications - Sudden Cardiac Death/Cardiac Arrest, Meds Used: Why is dopamine given

A

This is given to icnrease BP for hypotension

112
Q

HF Complications - Sudden Cardiac Death/Cardiac Arrest, Meds Used: Atropine given to who/

A

Those who are asymptomatic for bradycardia . Those who are Sinus Brady

113
Q

HF Complications - Sudden Cardiac Death/Cardiac Arrest, Meds Used: Why is Amiodarone given?

A

USed to treat pulseless VT and V Fib. Tried to shock patient , defib and not able to convert them. Then give this.

114
Q

HF Complications - Sudden Cardiac Death/Cardiac Arrest, Meds Used: Why is sodium bicarbonate given

A

Used to correct metabolic acidosis. Have low pH, low bicarb so we give bicarb

115
Q

HF Complications - Sudden Cardiac Death/Cardiac Arrest, Meds Used: Why is magneisum given?

A

Torsades Day point is a form of Vt and V-Fib, and this is given to treat that.

NRSG 200: Med Surg 3 (46 decks)

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