Exam 3 Flashcards
Heart Failure (HF)
a disorder that impairs the ability of the ventricle to fill or eject blood; thus, the heart is unable to pump enough blood to meet the body’s metabolic demands or needs.
Right Sided HF
Right side ROCKS the body with fluid
- Right side is TOO WEAK TO PUMP USED BLOOD TO the LUNGS.
- Peripheral Edema
- Weight Gain= water gain
- Hepatomegaly (big liver)
- Splenomegaly (big spleen)
- JVD (big neck veins)
- Ascites
Left-sided HF
Lung Fluid
Caused by damage to the myocardia heart muscle.
Left side of your heart pumps FRESH BLOOD to the rest of your body THROUGH YOUR CIRCULATORY SYSTEM. The left ventricle is larger and stronger than the right because it must pump blood through your whole body.
-Pulmonary Edema
- Crackles (rales) in the lungs
- Dyspnea and Orthopnea (SOB lying flat)
- S3 or ventricular gallop
- pink frothy sputum
- low O2
- oliguria
- non productive cough
- Cyanosis
Meds for pulmonary edema
both end in IDE so the body is DRY
Diuretics!
Furosemide
Bumetanied
HOPE to treat HF
H= Raise the head of bed to 45+ degree angle (semi fowlers, high fowlers, orthopneic position)
O= Oxygen
P= Push furosemide and morphine (decreases the work load on heart
E= end sodium and fluids
NO drinking extra fluids and stop all IV fluids
Hydrochlorothiazide
Is a POTASSIUM SPARING DIURETIC
Cycle of HF
1: HF. Low cardiac output. Less oxygen out to the body.
2: Kidney get less blood flow and falsely thinks the body has low BP/ low blood volume
3: so it mistakely increases the already high blood volume and increased the SNS to increase the HR and constrict blood vessels
4: increases the RAAS system (renin angiosensin aldosterone system) which retains fluid.
Weak pump, increasingly high blood volume leading to higher pressure
Medications that increase/ spare potassium
ACEs (end in PRIL) Lisinopril
ARBS ( end in SARTAN) Losartan
Diuretic ( end in actone) Spironolactone
B-Type Natriuretic Peptides (BNP) Lab
Diagnosing HF
BNP BULGING VENTRICLES
100 & Less is Normal
300+ Mild
600+ Moderate
900+ Severe
Echocardiogram
Measures the size of the left ventricle and the dejection fraction (amount of blood being ejected from the Left Ventricle in one pump)
55%-70% is normal
40% or less is bad
Hemodynamic Monitoring (Swan Ganz Cath or Pulmonary Artery Catheter)
Measures Central Venous Pressure (CVP)
Normal 2-8
Over 8 is NOT GREAT
Life Style Changes for HF
DRBEDSS
D: Diet. low sodium and low fluid.
- no fried foods, canned foods, packaged foods, no OTC meds ( Colds/flu, acetaminophen, antacids, nsaids)
R: Risk for falls. Slow position changes getting out of bed
B: BP and BNP (should not be incresing)
E: Elevate Legs: with pillows high fowlers
D: Daily Weights
S: Sex. only after thy can climb 2 flights of stairs with no SOB
S: Stockings. Ted hose. decreases blood pooling and remove daily
PHARM: ABCDDD
All can cause orthostatic hypotension or low blood pressure and dizziness standing EXCEPT DIGOXIN
A: Ace and Arbs (lower s BP) lisinopril, Losartan GOLD STANDARD FOR HF
B: Beta Blockers (lowers HR and BP) Atenolol
C: Calcium CB (lowers HR and BP) Nifedipine, Cardizem, Verapamil
D: Digoxin (lowers HR) Cardiac Glycoside
Digs for a deeper contraction
It is a TOXIN and does NOT affect BP
D: Dilators (vasodilators) Nitroglycerin
D: Diuretics (lowers BP) Potassium wasting and sparing
MILRINONE: inotropic drug. LAST LINE therapy. palliative care
Slow position Changes: When BP is low, you have to go slow.
-pril, -sartan
ACEs and ARBS
- ACT to lower BP ONLY (not HR)
- ACE first choice. (lisinopril: CHILL PRIL)
- ARBS second choice (losartan: RELAX MAN)
Can you give ACEs and ARBs if the HR is under 60?
YES it only affects BP only, not the HR. Only hold for low BP
Side effects of ACEs and ARBS
AACE
- A: Avoid Pregnant ( can be damaging to fetus)
- A: Angioedema ( swelling of face and tongue) Airway Risk. ONLY ACE (PRILLS PUFF up the tongue).
- C: Cough. ONLY ACE
- E: Elevated K+ (normal 3.5-5.0)
Prils: raise potassium
Sartans: Spare potassium
African Americans: ACEs have been proven to not effectively lower BP.
Diuretics: ARBs can be used alone or with diuretics in the treatment of hypertension or HF.
Beta Blockers -lol
Blocks Beats
Double Ls + Double Lows
- Low HR and BP
Decreases resistance, workload, and cardiac output.
Side Effects for Beta Blockers -lols-
BBBB
B: Bradycardia. hold the drug HR less than 60 or BP systolic 100 or less
B: Breathing problems (wheezing) no asthma or COPD patients)
B: Bad for HF patients. It can worsen HF and worsen EDEMA
B: Blood sugar masking. Hides (hypoglycemia) low sugar symptoms. Monitor sugars.
Calcium CB
CALMS the heart dropping both BP and Heart Rate
-dipine, -zem -amil
Dipine declines the blood pressure, not the HR. zem like zen yoga, relaxed BP and HR. amil calm and chill
Neg. Chronotropic (lower rate)
Neg. Inotropic (less force)
Neg. Dromotropic (less beats)
- can give patients bad headaches.
DIGOXIN (cardiac glyceride) digs for a deeper contraction
Deep contractions.
Decreases the HR
Digoxin is a TOXIN (over 2)
Monitor Kidney functin. Creatine Labs
Monitor potassium if its getting too low. (MONITOR ELECTROLYTES)
- digoxin is used in HF and to control ventricular response to afib. (antiarrhythmic)
Dilators
like, NitrO Opens up the blood vessels to decrease the BP by dilating the blood vessels to decrease resistance.
- less constriction, less pressure, lower BP
More O2 out to the body.
Nitro makes the BP LOW
- NitrOglycerin
- NitrOprusside
- Hydralazine
- IsOsOrbide
- MinOxidil (only sever HF)
Side effects of Vasodialators
Normal SE: Headache, hypotension, hot flashes
**DO NOT TAKE WITH VIAGRA (sildenafil)= DEATH. Afil will kill.
Stop Nitro is systolic is below 100 or drops by 30 or more, (lack of coordination, irritability, pallor, sweating ) low BP
Diuretics
Decrease BP
Draining fluid
Dehydrate
Potassium wasting: end in IDE. Furosemide, hydrochlorothiazide
Potassium Sparing: spironolactone spares and blocks aldosterone.
Digoxin Dose, Side effects and Toxicity
Dose: 0.5-2
Side effects: anxiety, hallucinations, unusual tiredness and fatigue
CV: : dysrhythmias, including bradycardia or tachycardia
CNS: headaches, fatigue, malaise, confusion, convulsions
Poisoning and toxicity:
- Visual Disturbances
- Nausea/vomiting
- Arrhythmias
- Electrolyte imbalances
Antidote: Digibind (digoxin immune fab). It binds to the digoxin molecules.
IV medications: indicated for hospitalized patients admitted for acute decompensated HF
- Dopamine: vasopressor to increase BP and myocardial contractility; adjunct with loop diuretics
- Dobutamine: used for patients with left ventricular dysfunction; increases cardiac contractility and renal perfusion. (INCREASES HOW WE ARE SQUEEZING)
- Milrinone: decreases preload and afterload; causes hypotension and increased risk of dysrhythmias (GOLD STANDARD OF PEOPLE ON HEART FAILURE)
- Vasodilators: IV nitro, nitroprusside, nesiritide; enhance symptom relief (DIALTES SO BLOOD CAN FLOW BETTER RELIEVE PAIN)
Community Questions
Not urgent. Usually require teaching or may ask “what would indicate a need for ADDITIONAL teaching? Or what the Patient can expect long term with…”
Acute Questions
usually will be admitted to the hospital. Med Surg or ICU. they may ask things like “What would be the nurse’s priority action”. So if a patient is having shortness of breath, cough, and increased respiratory rate”. What will you do first? For this patient, you would INCREASE THE HOB, GIVE OXYGEN, ETC..
SUDDEN CARDIAC DEATH OR CARDIAC ARREST
- Emergency management: cardiopulmonary resuscitation
ABCDs
A: Airway (aspiration, vomiting, loss of consciousness, etc)
B: Breathing (Dyspnea, SOB, coughing, etc)
C: Circulation: (BP, HR, Pulses, etc)
D: Defibrillation for VT and VF
Diagnostic Test: CARDIAC CATHETERIZATION
two types: Left or Right.
Test is used to show blockages and heart function. It can also be used to place a cardiac stent in the heart valves IF there is a blockage or a MI.
Nursing CONCERNS:
-Circulation (check peripheral pulses)
- Hematoma/ Bleeding
- hypotension due to loss of blood
- Evaluate temperature, color, and capillary refill of affected extremity
- Screen for arrhythmias
- Maintain bed rest 2 to 6 hours
Components of the Immune System
Bone marrow: T cells and B cells
Lymphoid tissue: spleen and lymph nodes
Maturity of lymphocytes
B lymphocytes mature in the bone marrow
T lymphocytes mature in the thymus
Natural Immunity
nonspecific response to any foreign invader
White blood cell action: release cell mediators such as histamine, bradykinin, and prostaglandins and engulf (phagocytize) foreign substances
Inflammatory response
Physical barriers, such as intact skin, chemical barriers, and acidic gastric secretions or enzymes in tars and saliva
Examples: COVID-19
Acquired Immunity
specific against a foreign antigen
Result of prior exposure to an antigen (Vaccines, etc.)
active or passive
Active Immunity
Immunologic defenses developed by person’s own body
Lasts many years; may last a lifetime
Passive Immunity
Temporary : Results from transfer of a source outside of the body that has developed immunity through previous disease or immunization
Examples: transfer of antibodies from mother to infant through breast feeding; receiving immune globulin through injections
HIV Human Immune Deficiency Virus
Immune deficiency is acquired:
-Due to medical treatment such as chemotherapy
-Infection from agents such as HIV
Despite advances in treating HIV, acquired immune deficiency syndrome (AIDS) remains a public health issue
Prevention, early detection, and ongoing treatment are important aspects for care
PLWHA—persons living with HIV/AIDS
Treatments/ Medications: Anti-Virals, Antiretroviral Drugs (used in combination).
Modes of Transmission of HIV
HIV-1 transmitted in body fluids that contain infected cells:
Blood and blood products
Seminal fluid
Vaginal secretions
Mother-to-child: Amniotic fluid, breast milk
Not through casual contact
Post exposure to viruses
Postexposure prophylaxis
Antiretroviral medications within 72 hours of exposure
2 to 3 drugs prescribed for 28 days
Cancer that is opportunistic to HIV
Kaposi sarcoma in the mouth and back.
Bodies response to allergies
the HISTAMINE response
give them antihistamine.
end in ines
Anaphylactic Type 1
MOST SEVERE
Most common allergy: antibiotics like penicillin
Treatment: Epinephrine.
Symptoms are sudden in onset
and progress in severity over
minutes to hours ABCDs
If airway is affected you might have to intubate to get oxygen down.
* Flushing
* Urticaria
* Angioedema
* Hypotension
* Bronchoconstriction
Diagnostic Tests for allegies
CBC: eosinophil count
Total serum IgE
Skin tests: prick, scratch, and intradermal
Prevention and Management of Anaphylaxis
Screen and prevent
* Treat respiratory
problems, oxygen,
intubation, and
cardiopulmonary
resuscitation as needed
* Epinephrine 1:1000
subcutaneously
* Auto injection system:
EpiPen
* May follow with IV
epinephrine
* IV fluids
-Rebound anaphylaxis can happen within 4 hours
- Stay for about 30 mins to see if anything goes wrong.
Vancomyacin
Red man syndrome
Allergic Rhinitis
Hay fever, seasonal allergic
rhinitis
Potential complications
* Anaphylaxis
* Impaired breathing
* Nonadherence to
therapeutic regimen
Patients weight gain to contact the provider
3 pounds a day or 5 pounds a week
acceptable amount of sodium
2k-3k grams /day
BNP
500 and up is CHF exacerbation.
100 or less is Normal
300+ mild
600+ moderate
900+ severe
Lipid Panel what to do
NPO the night before so cholesterol is not altered.
Bfore any cardiac catheritization
Patient is NPO
Cardiac Catheter site Interventions
- observe catheter site for bleeding, hematoma
- rest 2-6 hours
Anaphylaxis
what to assess
Airway
Breathing
Circulation
HIV Associated neurocognitive disorders
HANDS
Confusion
concentration
memory loss
depression
slow movement
KIDD with HIV
Opportunistic Illnesses
Where giving epi pen
- Thigh
-over the clothes - check for proper expiration date
