Exam 2 Review: Heart Failure

Question 1

What is the priority problem for a patient with congestive heart failure?

Answer 1

Decreased cardiac output (low perfusion to vital organs)

Question 2

Left-sided HF related to systolic failure results from? Diastolic failure results from?

Answer 2

Systolic failure: the inability of the heart to pump effectively
Diastolic failure: the inability of the heart’s ventricles to relax and fill during diastole

Question 3

Mixed (systolic and diastolic failure) left-sided HF results in? (2)

Answer 3

• Low ejection fraction (35% or less)

- Poor systolic function, causing dilated LV to not relax

Question 4

Compensatory mechanisms of HF (3)

Answer 4

• neurohormonal response: RAAS system and SNS (release of epi/norepinephrine)
• dilation: chamber enlargement to increase blood volume
• hypertrophy: increase in mass and wall thickness for strength

Question 5

What is a universal finding in acute decompensated HF?

Answer 5

Pulmonary and systemic congestion due to elevated left atrium and right atrium filling

Question 6

Signs of pulmonary edema, alveoli filling with fluid? (4)

Answer 6

• dyspnea
• orthopnea
• jugular vein distension
• anxiety

Question 7

Why might patients with acute decompensated HF have problems during the night?

Answer 7

Lying flat in supine position will cause more fluid reabsorption from the legs, resulting in too much fluid for the heart to pump

Question 8

Patients with a history of chronic HF comes in with a dry, hacking cough and severe dyspnea. What should be done first?

Answer 8

Auscultate the breath sounds

Question 9

The patient states that they “feel too tired to get out of bed.” They have ankle edema, a k-kg weight gain over the past 2 days. What is the best nursing dx for the patient?

Answer 9

Activity intolerance related to fatigue

Question 10

What are the main goals of treatment for chronic HF? (3)

Answer 10

• treat underlying cause
• maximize CO and reduce s/s
• improve ventricular function

Question 11

In drug therapy for HF, what must be monitored for patients taking potassium-sparing drugs such as spironolactone (aldosterone antagonist)?

Answer 11

Elevated levels of potassium

Question 12

What must be monitored/assessed for in patients taking digoxin? (6)

Answer 12

• hypo/hyperkalemia
• toxicity
• visual changes
• headache
• EKG changes
• hold medication if HR is below 60

Question 13

What are signs of digoxin toxicity? (4)

Answer 13

• nausea
• vomiting
• visual hallucinations
• colored halos

Question 14

What are the two most common reasons for readmissions of HF patients to the hospital? (2)

Answer 14

• poor adherence to low sodium diet

- failure to take prescribed drugs

Question 15

What is the sodium restriction for most HF patients? Patients with moderate to severe HF will also be restricted to how much fluid?

Answer 15

• 2 grams

- 2 liters

Question 16

Daily weight parameters to report to the HCP for patients with HF?

Answer 16

• 3 lbs weight gain over 2 days

- 3-5 lbs weight gain over a week

Question 17

Nursing diagnosis for HF? (3)

Answer 17

• IMPAIRED GAS EXCHANGE related to increased preload and alveolar-capillary membrane changes
• DECREASED CARDIAC OUTPUT
• EXCESS FLUID VOLUME related to increased venous pressure

Question 18

What are indications of heart transplantation? (4)

Answer 18

• end-stage HF
• severe decompensated state
• recurrent life-threatening diseases
• heart abnormalities that limit normal function

Question 19

Contraindications of heart transplantation? (4)

Answer 19

• over 70 years old
• life-threatening illness
• advanced cerebral/peripheral vascular disease
• active infection

Question 20

Patients who have had a heart transplant have a permanent medication adherence to?

Answer 20

Decrease the chances of infection

Question 21

What is a priority nursing dx for a patient with CHF feeling too tired to perform ADLs?

Answer 21

Activity intolerance

Question 22

Which of the following are s/s of an MI?

Answer 22

cool, clammy skin