Exam 2, Deck 3 Flashcards
Acute pulmonary edema is a medical emergency caused by…. (general)
Anything that decreases the ability of the left ventricle to pump
Acute pulmonary edema is a medical emergency caused by…. (specific, 5)
MI HTN Valvular disease Rapid arrhythmias Exposure to cardiotoxic chemicals
Most symptoms with Pulmonary Edema are ______
PULMONARY
Pulmonary symptoms involved with pulmonary edema (6)
Sudden SOB Paroxysmal Nocturnal Dyspnea (PND) Orthopnea Crackles Gurgling Respirations Pink frothy sputum
Non-Pulmonary Symptoms involved with pulmonary edema (4)
Pale –> Cyanosis
ABGs: Decreased PaO2, Increased PaCO2
Tachycardia
Two nursing goals with pulmonary edema
Improve the pump of the left ventricle
Improve respiratory exchange
Nursing interventions for pulmonary edema (7)
1) Oxygen
2) Positive Inotropics
3) Morphine
4) Diuretics
5) Other meds
6) Pulmonary artery line, arterial line
7) Assess for shock
Oxygen during pulmonary edema (3)
1) PEEP helps alveoli re-open
2) Pulse oximeter
3) Test ABGs
CHF: Def
Chronic Heart Failure: The heart cannot pump adequate amounts of blood to meet metabolic demands
What are the top two most common reasons to visit HCP?
1) HTN
2) CHF
Classifications of CHF (4)
I No limitations
II Slight limitations
III No symptoms at rest; some symptoms with activity
IV Symptoms at rest (Poor prognosis, need assistance with ADLs
Pathophysiology of CHF- Causes (4)
- CAD
- Systemic or pulmonary HTN
- Valvular Heart disease
- Increased workload of the heart
What would cause increased workload of the heart
- Arrhythmias
- Hypoxias
- Really high fevers
- Severe anemia
Pathophysiology of CHF: How does it work? (3 parts)
Decreased amount of blood ejected from left ventricle –> Decreased CO –> Increased SNS –> Increased Renin
Effects of renin (2 chains)
1) Produces angiotensin I –> Angiotensin II–> VASOCONSTRICTION
2) Secretion of aldosterone –> Kidneys retain water and sodium
How are pressures altered with CHF?
Slow rise in pressures in Left ventricles –> Left atria –> Pulmonary vessels
What cycle occurs with CHF? (2 compensations)
The body induces vasoconstiction and fluid retension to compensate for CHF, but vasoconstriction increases AFTERLOAD and fluid retention increases PRELOAD
During CHF, when and why is BNP released?
BNP is released from the ventricles of the heart as pressures increased.
Helps reduce angiotensin systems, not enough to overcome, but enough to slow it down.
Symptoms of Left Ventricular Heart Failure (Left-sided CHF) (7)
- Pulmonary symptoms (observed first)
- Restlessness / anxiousness
- Tachycardia
- Pale, clammy
- Nocturia + Decreased daytime output
- Fatigue
- Weight gain
Changing lab values with left sided heart failure (3)
- Increased BUN and creatinine
- ABGs indicated hypoxia, hypercapnia
- BNPs elevated (from 100 to 800 sometimes)
Pulmonary symptoms observed with Left Sided CHF
- Cough (dry or with sputum)
- Crackles
- Dyspnea on Exertion
- Orthopnea
- Paroxysmal Nocturnal Dyspnea
Why does a CHF patient have changes in urine patterns?
Because of altered kidney perfusion. During the day, there is less kidney perfusion (because blood pools in the legs) and at night, the blood moves towards the kidney again (resulting in nocturia).
Pathophysiology of Right Ventricular Heart Failure (R sided failure)
Right ventricle cannot empty fully –> blood in right atrium becomes backed up, –> Congestion of vessels and body organs.
Causes ofo right ventricular heart failure ((3) - which is the most common?
- Left sided failure - most common
- COPD
- Cor Pulmonale