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J2 - Med Surg > Exam 3 - Hypertension & Heart Failure > Flashcards

Exam 3 - Hypertension & Heart Failure Flashcards

1
Q

Through which veins is deoxygenated blood from the body returned to the heart ?

A

The superior and inferior vena cava

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2
Q

Where does deoxygenated blood get dumped after entering the superior and inferior vena cava’s ?

A

the right atrium

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3
Q

Once deoxygenated is dumped into the right atrium, where does it flow next ?

A

The Right ventricle

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4
Q

From the Right ventricle, where does the deoxygenated blood get pumped to next?

A

Into the pulmonary artery and out to the lungs to circulate and become oxygenated.

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5
Q

Once the deoxygenated blood in the lungs circulates and becomes oxygenated, that freshly oxygenated blood then enters from both lungs into where ?

A

Enters through the pulmonary veins into the Left atrium

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6
Q

From the left atrium, the newly oxygenated blood then flows to where next ?

A

Down into the left ventricle

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7
Q

From the left ventricle, the oxygenated blood gets pumped to where next ?

A

Gets pumped up and out through the aorta to the body

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8
Q

Where does oxygen exchange occur ?

A

Lungs !

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9
Q

What cardiac valve is located between the R atrium and R ventricle ?

A

Tricuspid valve

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10
Q

What cardiac valve is the last valve before blood enters into circulation ?

A

Aortic (semilunar) valve

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11
Q

What cardiac valve is located between the L atrium and L ventricle ?

A

Mitral valve

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12
Q

What are two major coronary arteries of the heart ?

A
  • Right coronary artery

- Left coronary artery

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13
Q

Both the Right coronary artery and the left coronary artery branch off into what ?

A

Smaller descending arteries

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14
Q

What is the medical term for the Heart muscle ?

A

Myocardium

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15
Q

The myocardium has its own what ?

A

Blood supply/circulation

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16
Q

What supplies blood/circulation to the heart itself ?

A

The coronary arteries and veins

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17
Q

Blockage of what coronary artery can result in serious defects in cardiac conduction, because it supplies the bundle of hiss, AV node, etc.

A

R coronary artery

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18
Q

What is Systole defined as ?

A

Contraction of the myocardium

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19
Q

What is Diastole defined as ?

A

Relaxation of the myocardium

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20
Q

_______________ is the amount of blood pumped by each ventricle in 1 minute ?

A

Cardiac output

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21
Q

What is the equation for determining the Cardiac Output (CO) ?

A

CO = SV x HR

  • Cardiac output = stroke volume x Heart rate *
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22
Q

What is the Cardiac index ?

A

CO divided by body surface area

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23
Q

What is a normal cardiac output for an Adult at rest ?

A

4-8 Liters per minute

  • 1 IV bag = 1L *
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24
Q

_____________ is the volume of blood in the ventricles at the end of diastole ?

( the amount of blood in ventricles before the next contraction)

A

Preload

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25
Q

In what types of patients do we tend to see a higher incidence of preload ?

A

Patients with HTN & Hypervolemia

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26
Q

What is Contractility ?

A

How strong the muscles contract to provide movement of that fluid (preload fluid) ?

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27
Q

____________ is the peripheral resistance against which the left ventricle must pump ?

(How hard the left ventricle has to keep pumping to maintain circulation and cardiac output)

A

Afterload

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28
Q

Afterload is affected by what ?

A
  • The size of the ventricle
  • The wall tension
  • Arterial BP
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29
Q

A principle of hemodynamics is that blood always goes where ?

A

Always goes to where there is less pressure

*If theres an area of high pressure, it will find areas of low pressure to fill it and even it out

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30
Q

A patient is receiving a drug that decreases afterload. To evaluate the effect of the drug, the nurse monitors the patient’s ?

A

Blood pressure

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31
Q

What is Blood Pressure defined as ?

A

The Measurement of arterial blood pressure

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32
Q

What does MAP stand for ?

A

Mean Arterial Pressure

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33
Q

What MAP pressure is needed to perfuse vital organs ?

A

MAP > 60mmHg

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34
Q

What does a MAP of < 60mmHg mean ?

A

Means that theres not enough blood getting to the vital organs.
(Ex: Brain, Heart, Lungs, Kidneys, Liver, etc.)

  • Don’t want our vital organs to become ischemic *
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35
Q

What is ischemia ?

A

Happens when theres not enough blood flow or perfusion to vital organs

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36
Q

______ is one of the greatest risk factors for cardiovascular disease ?

A

Age

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37
Q

In the gerontologic population, what is the most common type of cardiovascular disease that we tend to see ?

A

CAD

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38
Q

What is the leading cause of death in those age 65 and older ?

A

Cardiovascular Disease

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39
Q

_____ alters the cardiovascular response to physical and emotional stress ?

A

Age

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40
Q

With the Gerontologic population, Heart valves become what ?

A

Thick and stiff

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41
Q

With the Gerontologic population, there is a frequent need for what ?

A

Pacemakers

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42
Q

Which population is less sensitive to B-andrenergic agonist drugs ?

A

Gerontologic population

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43
Q

What do B-andrenergic agonist drugs typically do ?

A
  • Relax muscles of the airway

- Widen airways and make it easier to breathe

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44
Q

In the Gerontologic population, what is a common cause of the heart valves becoming thick and stiff ?

A
  • Lipid accumulation

Fibrosis can occur of the valves also

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45
Q

In the Gerontologic population, There is an ____________ in SBP and a ___________ or ___________________ in DBP ?

A
  • INCREASE in SBP
  • DECREASE OR NO CHANGE in DBP
  • The vessels start to loose elasticity with age *
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46
Q

Why is there a frequent need for pace makers in the Gerontologic population ?

A

Older individuals are more at risk for disrythmias because they just don’t have those natural SA nodes firing

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47
Q

In regards to heart valves becoming thick and stiff in the gerontologic population, what happens if the heart valves aren’t working properly and don’t have good closure ?

A

Can result in the regurgitation of blood. So we see a back flow of blood if we don’t have a well closed valve.

  • this is when we start hearing heart murmurs
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48
Q

In regards to the “Lub-dub” sound of the heart; which sound is S1 ?

A

Lub

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49
Q

In regards to the “Lub-dub” sound of the heart; Which sound is S2 ?

A

Dub

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50
Q

Which heart sound is the closure of the tricuspid and mitral valves (beginning of systole) ?

A

S1

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51
Q

Which heart sound is the closure of the aortic and pulmonic valves (beginning of diastole) ?

A

S2

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52
Q

On an ECG, what does the P wave indicate ?

A

Contraction of the atria

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53
Q

On an ECG, what does the QRS spike indicate ?

A

Contraction of the ventricle

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54
Q

On an ECG, what does the T wave indicate ?

A

Repolarization of the cardiac cycle

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55
Q

What are examples of Noninvasive studies of the Cardiovascular system ?

A
  • Blood studies
  • Chest x-ray
  • Electrocardiogram
  • Echocardiogram
  • Stress test
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56
Q

What Lab is the most sensitive for cardiac damage ?

A

Troponin !

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57
Q

What labs fall under “Cardiac enzymes” ?

A
  • Troponin
  • CK-MB
  • hs, CRP
  • BNP
  • Lipids
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58
Q

What does the lab CK-MB stand for ?

A

Creatinine Kinase

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59
Q

What cardiac enzyme, is found primarily in heart muscles ?

A

CK-MB

  • Not as specific as Troponin, as it can also be found in the brain, skeletal muscles, and heart*
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60
Q

What cardiac enzyme can also be found in the brain, skeletal muscle, and heart ?

A

CK-MB

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61
Q

What does the cardiac enzyme, CRP stand for ?

A

C-reactive protein

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62
Q

What cardiac enzyme (lab) indicates inflammation ?

A

CRP

  • it can be an indicator of cardiac damage, BUT its not specific to just cardiac muscle. If theres inflammation anywhere else in the body, it can also rise
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63
Q

What does the cardiac enzyme/lab BNP stand for ?

A

Brain Naturetic Peptide

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64
Q

What lab should be looked at when assessing for Heart Failure ?

A

BNP

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65
Q

What lab should you look at if your patient is in fluid overload or HF ?

A

BNP

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66
Q

What Noninvasive test will give rhythm information ?

A

Electrocardiogram

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67
Q

What Noninvasive test gives us pictures of the heart ?

A

Echocardiogram

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68
Q

What Noninvasive test is the test of choice to find out what an injection fraction is for a patient ?

A

Echocardiogram

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69
Q

Which Noninvasive test is used to evaluate heart response to activity ?

A

Stress Test

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70
Q

What are examples of Invasive diagnostic studies for the cardiovascular system ?

A
  • Transesophageal echocardiogram (TEE test)
  • Cardiac catheterization and coronary angiography
  • Electrophysiology study
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71
Q

What invasive study uses a scope to go down the throat, bypassing the lungs and ribs and ultimately gets a better picture of the heart and whats going on with it ?

A

Transesophageal echocardiogram (TEE)

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72
Q

What invasive cardiovascular test, requires the Pt. to be sedated ?

A

Transesophageal echocardiogram (TEE test)

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73
Q

what invasive cardiovascular study, involves a catheter getting inserted into the heart via a major artery (ex: femoral) to get a better look at the heart ?

A

Cardiac catheterization and coronary angiography

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74
Q

What invasive cardiovascular study involves a catheter(s) getting inserted into the jugular or femoral vein, and entering in on the R side of the heart, and ultimately records electrical activity within the heart ?

A

Electrophysiology study

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75
Q

NCLEX Question: A pt. returns to the cardiac observation area following a cardiac catheterization with coronary angiography. Which of the following assessments would require immediate action by the nurse ?

a. ) Pedal pulses are 2+ bilaterally
b. ) Apical pulse is 54bpm
c. ) MAP is 72mmHg
d. ) Chest pain rate 3/10

A

d. ) Chest pain rate 3/10
* May indicate a myocardial ischemia is present with partial or total occlusion of the coronary artery.
* No matter how minor the chest pain, you will always get a 12 lead EKG, administer morphine and nitroglycerin, and we would notify the health care provider immediately

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76
Q

What are 2 safety precautions we want to follow with coronary artery angiogram(s) ?

A
  • Always want to ask our pt’s. if their allergic to shellfish/iodine
  • Hold Metformin for 48 hrs.
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77
Q

With patients who are on Metformin and having a coronary artery angiogram, why do you want to hold the Metformin for 48 hrs ?

A

Both the dye and the metformin are tough on the kidneys.

  • We don’t want to tax the kidneys more than we need to
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78
Q

Cardiac cath’s use what type of dye ?

A

radio-opaque dye

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79
Q

Radio-opaque dye has a cross allergy to what ?

A

Shellfish/iodine

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80
Q

Persons > 50yrs with a _______ of > __________mmHg, are more at risk for CVD than diastolic ?

A

SBP of > 140mmHg

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81
Q

Risk for CVD, beginning at 115/75 does what with each increment of 20/10 ?

A

Doubles

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82
Q

Persons with a SBP of ___ to ___ or a DBP of ___ to ___ should be considered as prehypertensive & require health-promoting changes ?

A

SBP of 120 to 139

DBP of 80 to 89

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83
Q

What is the Definition of Hypertension ?

A 
Persistent elevation of 
- SBP greater than or equal to 140mmHg
               OR
- DBP greater than or equal to 90mmHg
               OR
- Current use of Antihypertensive medication(s)
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84
Q

What is a Normal BP classified as ?

A
  • SBP < 120 & DBP < 80mmHg
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85
Q

What is Prehypertension classified as ?

A
  • SBP 120-139mmHg OR DBP 80-89mmHg
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86
Q

What classifies Stage 1 Hypertension ?

A
  • SBP 140-159 OR DBP 90-99mmHg
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87
Q

What classifies Stage 2 Hypertension ?

A
  • SBP greater than or equal to 160mmHg OR DBP greater than or equal to 100mmHg
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88
Q

What factors influence Blood Pressure ?

A
  • Cardiac output
  • Systemic Vascular Resistance

BP = Cardiac Output x Systemic Vascular Resistance

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89
Q

______________________ is the force opposing the movement of blood within the blood vessels

A

Systemic Vascular Resistance

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90
Q

What is Isolated systolic hypertension defined as ?

A

SBP > 140mmHg with DBP <90mmHg

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91
Q

Which Subtype of Blood Pressure classification is more common in older adults ?

A

Isolated systolic hypertension

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92
Q

What subtype of Blood Pressure classification is from sclerotic arteries that do not collapse when the cuff id fully inflated ?

A

Pseudohypertension

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93
Q

Primary hypertension is also known as ?

A

Essential or idiopathic hypertension

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94
Q

Which type of Hypertension is most common (primary or secondary) ?

A

Primary Hypertension

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95
Q

What is Primary Hypertension defined as ?

A

Elevated BP WITHOUT an identified cause

96
Q

Primary hypertension makes up _____% to ______% of all cases ?

A

90% to 95%

97
Q

What are contributing factors to Primary hypertension ?

A
  • Increase SNS activity
  • Increase sodium retaining hormones and vasoconstrictors
  • DM
  • > ideal body weight
  • Increased sodium intake
  • Excessive alcohol intake
98
Q

What is Secondary hypertension defined as ?

A

Elevated BP WITH a specific cause

  • A lot of the time it has to do with fluid overload, where we have to much fluid running through our blood stream.
99
Q

Secondary hypertension makes up what % of adult cases ?

A

5% to 10% of adult cases

100
Q

What are contributing factors for Secondary Hypertension ?

A
  • Coarctation of aorta
  • Renal disease
  • Endocrine disorders
  • Neurologic disorders
  • Cirrhosis
  • Sleep apnea
101
Q

Which type of Hypertension will typically go away if you treat the contributing factors ?

A

Secondary Hypertension !

102
Q

What are the Overall risk factors for Primary Hypertension ?

A
  • Age
  • Alcohol
  • Cigarette smoking
  • DM
  • Elevated serum lipids
  • Excess dietary sodium
  • Gender
  • Family history
  • Obesity
  • Ethnicity
  • Sedentary lifestyle
  • Socioeconomic status
  • Stress
103
Q

What is referred to as the “silent killer” because patients are frequently asymptomatic until target organ disease occurs ?

A

Hypertension

104
Q

Symptoms of Hypertension are often secondary to target organ disease and can include ?

A
  • Fatigue
  • Reduced activity tolerance
  • Dizziness
  • Palpitations
  • Angina
  • Dyspnea
105
Q

Most people DO NOT have what if they are Hypertensive ?

A

DO NOT have symptoms

106
Q

In regards to Hypertension complications, Target organ disease occurs most frequently In the what ?

A

Heart

CAD, Left ventricular hypertrophy, HF

107
Q

What are examples of Hypertension Complications ?

A
  • Target Organ disease (Heart most common)
  • Cerebrovascular disease (Stroke)
  • Peripheral vascular disease
  • Nephrosclerosis
  • Retinal damage
108
Q

Why is a Stroke a complication of Hypertension ?

A

If Hypertension gets so high , it can result in a hemorrhagic stroke. Essentially the pressure in the brain gets so high that the vessels in the brain actually burst

109
Q

To avoid Retinal damage from Hypertension, what can we as nurses do ?

A

Recommend primary prevention, such as routine eye exams

110
Q

What are some Diagnostic Studies we can use to diagnose Hypertension ?

A
  • Get a good H&P
  • Bilateral BP measurement
  • Use appropriately sized cuff to ensure accurate readings
  • Obtain at least two measurements
111
Q

When obtaining a Pt’s BP to diagnose Hypertension, Which arm should you always use for subsequent measurements ?

A

Always use the arm with the higher reading for subsequent measurements !

112
Q

BP is ___________ in the Morning, and ___________ at night ?

A

Highest in the morning & Lowest at night

113
Q

How should a patient be positioned to get a good BP reading ?

A
  • Seated quietly for 5 minutes in a chair
  • Feet on floor
  • Arms supported at heart level
114
Q

What do you need to diagnose Hypertension ?

A

Need 2 or more readings on 2 separate occasions unless target organ disease is present

115
Q

What should you do if a Pt. has “white coat hypertension” but you need to rule out true Hypertension ?

A

Have the Pt. keep a log of their BP’s outside of the office

116
Q

What are labs that should be looked at if trying to diagnose Hypertension ?

A
  • Electrolytes
  • Glucose
  • BUN
  • Creatinine
  • lipid profile
117
Q

What Labs are especially important to monitor when trying to diagnose Hypertension ?

A
  • BUN and Creatinine
118
Q

Why are BUN and Creatinine important labs to monitor when trying to identify Hypertension ?

A
  • Because the Kidneys are a Target Organ *
119
Q

Why would the Creatinine specifically, be an important lab to look at in regards to Hypertension ?

A
  • Would be a great indicator to see if something is going on with the kidneys !
  • An increase, especially in creatinine, may indicate organ involvement !
120
Q

What is a normal Creatinine level ?

121
Q

What are some Lifestyle modifications that can be implemented for Hypertension ?

A
  • Weight reduction
  • DASH diet
  • Sodium reduction
  • Physical activity (at least 30min, most days of week)
  • Avoidance of tobacco products
  • Psychosocial risk factors
  • Moderation of Alcohol consumption
122
Q

What does DASH stand for ?

A

Dietary Approaches to Stop Hypertension

123
Q

For patients with Hypertension what is the hardest change to make ?

A

Lifestyle modifications

  • Becuause it requires change on their part, as opposed to just taking medications
124
Q

A weight loss of 22lbs may decrease a patients BP by what (number) ?

A

May decrease SBP by approx 5-20mmHg

125
Q

What is the recommended amount of Alcohol consumption for Men & Women ?

A

Men : no more than 2 drinks/day

Women: no more than 1 drink/day

126
Q

In regards to Hypertension, ALL people need what ?

A
  • Lifestyle Modifications

and most people also need drug therapy for control. But you STILL NEED LIFESTYLE MODIFICATIONS !

127
Q

in regards to Drug Therapy, most patients with hypertension will require what ?

A

2 or more antihypertensive medications to achieve goal BP

<140/90 or <130/80 for patients with diabetes or CKD

128
Q

What are classifications of drugs used to treat hypertension ?

A
  • Diuretics
  • Adrenergic inhibitors
  • Direct vasodilators
  • ACE inhibitors
  • Angiotension II receptor blockers
  • Calcium channel blockers
129
Q

How do Diuretics work to treat hypertension ?

A

promote sodium and water excretion

130
Q

What drug classification used to treat hypertension, is not recommended to take at night ?

131
Q

__________ drug classification used to treat hypertension, can lower K+ levels (and possibly require supplementation) ?

132
Q

Adrenergic inhibitors, are also known as what ?

A

Beta blockers

133
Q

With Adrenergic inhibitors, what do you need to monitor ?

A

BP & HR

may need to hold, if BP or HR is low

134
Q

What are examples of Direct Vasodilators ?

A
  • Hydrolozine

- Nitroglycerin

135
Q

What is the shortened name for Angiotension-converting enzyme inhibitors ?

A

ACE inhibitors

136
Q

ACE inhibitors can cause _____ retention ? so you need to monitor lab work

A

K+ retention

137
Q

What drug classification are medications that end in “prils” ? (Ex: Lisinopril, Analapril, etc)

A

ACE inhibitors

138
Q

When starting a new medication, and in older adults, what do you want to monitor for ?

A

Orthostatic Hypotension

139
Q

What is the #1 side effect that we see from ACE inhibitors ?

A

A hacking cough

140
Q

What is an example of a loop diuretic ?

141
Q

With loop diuretics like Lasix, what do you want to monitor ?

142
Q

Many side effects of Hypertension drug therapy tens to do what ?

A

Many side effects diminish over time

143
Q

What are important patient teaching points for Hypertension ?

A
  • Its a life-long medication! NEED TO TAKE THEM EVERYDAY !
  • Do not stop or adjust meds on own (abruptly stopping meds can cause withdrawl symptoms)
  • Ways to decrease orthostatic hypotension (change positions slowly!)
  • Do not double up on missed doses
  • Side effects of meds often diminish with time
144
Q

Whats a common cause of Orthostatic Hypotension ?

A

Dehydration

145
Q

When teaching about Hypertension what should you instruct your patient to avoid ?

A

Avoid hot baths (vasodilates), alcohol (vasodilates), and strenuous exercise 3hrs after medication

(because you might fall into a situation where you vasodilate so much that now your Hypotensive)

146
Q

What is a Hypertensive Crisis defined as ?

A

A severe increase in BP (>180/110)

147
Q

Hypertensive Crosses often occur in patients with a history of what ?

A

A history of HTN who have failed to comply with medications OR pt’s who have been undermedicated

148
Q

Those with a history of HTN can tolerate an _________ BP better ?

149
Q

What is Rebound Hypertension ?

A

Occurs when you abruptly stop medications or lower the dose of the drug.

  • The body natural response is to rebound with a really high BP, which can lead a patient into a hypertensive crisis
150
Q

What are Risk Factors that can lead to a Hypertensive Crisis ?

A
  • Rebound Hypertension
  • Drug use
  • Head injury
  • Preeclampsia
151
Q

Hypertensive Urgency is defined as what ?

A

High BP, but NO target organ damage

152
Q

What is Orthostatic Hypotension defined as ?

A

A decrease of 20mmHg in SBP (& the DBP will decrease as well) & an increase in the HR of 20bpm

153
Q

Essentially a positive orthostatic hypotension, is characterized by what ?

A

A decrease in BP & increase in HR

154
Q

Hypertensive Emergency is defined as what ?

A

Evidence of acute target organ damage

hypertensive encephelopathy,(HA, N/V, seizures, coma), Cerebral hemorrhag, aortic dissection, MI, HF

155
Q

What does a Hypertensive emergency require ?

A

Requires hospitalization, IV antihypertensive drugs, and ICU monitoring

156
Q

In regards to a Hypertensive emergency, ____________ are more important to determine severity and management than the specific BP value ?

157
Q

What is an aortic dissection ?

A

a break or split in the aorta

158
Q

In regards to a Hypertensive emergency, anybody who is displaying the signs and symptoms will be what ?

A

will be the FIRST PRIORITY !

Example:
Pt. in room A: has a BP of 190/110, but is asymptomatic
Pt. in room B: has a BP of 180/110, but is having chest pain, or a really bad headache.

—–> Pt. in room B, IS THE FIRST PRIORITY !

159
Q

Treatment for a Hypertensive Crisis, focuses on what ?

A

Decreasing the MAP by no more than 25% within minutes to 1 hour

  • want to lower it quickly but not to quickly. Going to fast will throw off the pt’s hemodynamic balance
160
Q

In regards to Tx for a Hypertensive emergency, lowering the BP too much, may decrease what ?

A

May decrease cerebral, coronary, or renal perfusion and could cause a stroke, MI, or renal failure

161
Q

_____________________ is an abnormal condition involving impaired cardiac pumping/filling ?

A

Heart Failure

162
Q

In what condition is the heart unable to produce an adequate cardiac output (CO) to meet metabolic needs ?

A

Heart Failure

163
Q

HF is associated with numerous types of cardiovascular disease, particularly what ?

A
  • Long-standing Hypertension
  • CAD
  • MI
164
Q

what is the most common reason for hospitalizations in adults >65 years old ?

A

Heart Failure

  • progressive disease that has an increased risk for Re-admission
165
Q

What is the aim of HF ?

A

EDUCATION !

every pt. admitted with HF, gets a packet of information before discharge, in the hospital setting

166
Q

What are Primary Risk Factors of HF ?

167
Q

What are contributing risk factors of HF ?

A
  • Advanced age
  • Diabetes
  • Tobacco use
  • Obesity
  • High serum cholesterol
168
Q

What are the 2 classifications/subgroups of HF ?

A
  • Primary

- Precipitating

169
Q

What subgroup of HF is “direct” (resulting from MI< HTN, Congenital, Cardiomyopathy, Valve disorders, etc) ?

A

Primary HF

170
Q

What subgroup of HF is due from “indirect measures” (anemia, infection, dysrhythmia, nutritional deficiencies, etc.) ?

A

Precipitating HF

171
Q

Left sided HF has lots of _____________ issues ?

A

Respiratory

172
Q

Which type of HF is the most common ? (left sided or Right sided?)

A

Left-sided

173
Q

Left sided HF results from what type of conditions ?

A
  • MI
  • CAD
  • HTN
174
Q

Left-sided HF results from what (pathophys) ?

A

Backup of blood into the L atrium and pulmonary veins. The next site of overflow will be into the Lungs! –> resulting in Pulmonary congestion

175
Q

What is the primary manifestation of Left-sided HF ?

A

Pulmonary congestion

176
Q

Right-sided HF results from what ?

A
  • Left-sided HF (?? don’t really understand hoe??)
  • Cor pulmonale
  • Right ventricular MI
177
Q

What causes Right-sided HF (pathophys) ?

A

Backup of blood into the right atrium and venous systemic circulation (AKA: superior and inferior vena cavas) –> resulting in swelling and edema systemically

178
Q

What are manifestations of Right-sided HF ?

A
  • JVD
  • Hepatomegaly (enlarged liver)
  • Splenomegaly
  • Vascular congestion of GI tract
  • Peripheral edema
  • essentially they all result in: swelling and edema systemically
179
Q

What is a normal EF (ejection fraction) ?

180
Q

What is the Hallmark finding of Systolic failure ?

A

Decreased ability for the ventricles to pump. Seen in a decrease in the EF

181
Q

What is Systolic failure caused by?

A
  • impaired contractile function (ex: MI)
  • Increased after load (ex: Hypertension)
  • Cardiomyopathy
  • Mechanical abnormalities (ex: valve disease)
182
Q

__________ failure, results in an impaired ability of the ventricles to relax and fill during diastole, resulting in decreased SV (stroke volume) and CO (cardiac output)?

A

Diastolic failure

183
Q

What type of failure (Systolic or Diastolic) has a NORMAL EF ?

A

Diastolic failure

184
Q

Diagnosis of Diastolic failure is based on what ?

A
  • presence of pulmonary congestion, pulmonary hypertension, ventricular hypertrophy, and normal EF
185
Q

What is the Hallmark finding of Diastolic failure ?

A

Decreased ability of the ventricles to pump, resulting in a decrease in the EF fraction

186
Q

Mixed Systolic and Diastolic failure is seen in disease states such as what ?

A

Dilated Cardiomyopathy (DCM)

187
Q

What is Biventricular Failure ?

A

Both ventricles may be dilated and have poor filling and emptying capacity

188
Q

In Systolic failure, the typical EF is what ?

A

Typically have an EF less than 45%

189
Q

What type of failure (systolic, diastolic, or mixed) has poor EFs (<35%) ?

A

Mixed systolic and diastolic failure

190
Q

Are dilated or Hypertrophied heart chambers a good or bad thing ?

A

Neither of the two are good! (bad bad bad!! DONT WANT!)

191
Q

What is another term for Dilated heart chambers ?

A

Enlarged ventricles

192
Q

What is another term for Hypertrophied Heart chambers ?

A

Thickened heart muscle

193
Q

Dilated & Hypertrophied Heart Chambers leads to what ?

A
  • poor contractility
  • higher O2 needs
  • poor coronary artery circulation
  • RISK FOR: Ventricular Dysrhythmias
194
Q

What lab do you look at for HF or suspected HF ?

A

BNP (Brain Natriuretic Peptide)

195
Q

An elevated BPN > 100 = ?

A

sign of HF

196
Q

What is the most important thing to monitor for accurate HF information ?

A

Weight changes !

197
Q

Clinical Manifestations such as:

  • Fatigue
  • Dyspnea
  • Cough
  • Tachycardia
  • Edema
  • Nocturia
  • Skin changes
  • Behavioral changes
  • Chest pain
  • weight changes

Are associated with what disease ?

A

Chronic Heart Failure

198
Q

What type of HF results when compensatory mechanisms to maintain CO can no longer keep up, and inadequate tissue perfusion results ?

A

Acute Decompensated Heart Failure (ADHF)

199
Q

What is a symptom that is SPECIFIC to ADHF ?

A

Pink-frothy sputum

  • tell tale, unique sign of Pulmonary Edema*
200
Q

Symptoms such as:

  • Breath sounds: crackles, wheezes, rhonci
  • Pink-frothy sputum,
  • Orthopnea
  • Dyspnea, tachycardia
  • Use of accessory muslces
  • Cyanosis
  • Tachycardia
  • Restlessness, confusion, decreased memory
  • Chest pain (angina)
  • Anorexia, nausea
  • Cool & clay skin

Are associated with what type of HF ?

A

Acute Decompensated Heart Failure (ADHF)

201
Q

In regards to a Pt’s position in bed, how should thy be positioned in the management of ADHF ?

A

High Fowlers position

  • Always raise the HOB right away ! *
202
Q

Why should pt’s with ADHF have continuous ECG monitoring ?

A

Due to Dysrhythmias

203
Q

What type of Noninvasive ventilatory support is used in the management of ADHF ?

204
Q

What type of medications are used the Management of ADHF ?

A
  • Morphine sulfate (decreases pulmonary congestion)
  • IV lasix
  • IV nitro (as vasodilator)
  • IV B-andrenergic agonists (ex: dopamine, dobutamine, levophed)
205
Q

What is the most common dysrhythmia ?

206
Q

__________ promotes thrombus/embolus formation, increasing the risk for stroke ?

207
Q

What is pleural effusion ?

A

Fluid building up in the plural cavity

208
Q

What does pleural effusion do & cause ?

A

What does it do: Puts pressure on the lungs

What does it cause: causes chest pain, etc.

209
Q

HF can lead to severe _________________ ?

A

Hepatomegaly (especially with RV failure)

  • Fibrosis and cirrhosis can develop over time
210
Q

What are complications of HF ?

A
  • Pleural effusion
  • A fib
  • High risk for fatal dysrhythmias
  • Can lead to sever heaptomegaly
  • Renal insufficiency or failure
211
Q

In regards to HF complications, what are examples of fatal dysrhythmias ?

A
  • Sudden cardiac death

- ventricular tachycardia

212
Q

What is the main treatment goals for Chronic HF ?

A
  • Treat the underlying cause and contributing factors
  • Maximize CO
  • Provide treatment to alleviate symptoms
  • Preserve target organ damage (heart, liver, brain, kidneys, etc.)
  • O2 administration
  • Physical and emotional stress
213
Q

What is the primary drug of choice for blocking the RAAS system ?

A

ACE inhibitors (“pails”)

214
Q

In regards to HF, What class of drugs are used for patients who can’t tolerate ACE inhibitors ?

A

Angiotensin II receptor blockers (ARBs)

215
Q

________ - Cause vasodilation by acting directly on the smooth muscle of the vessel wall ?

216
Q

What class of drugs, block the negative effects of the SNS on the failing heart ?

A

Adrenergic blockers (“lols”)

217
Q

What vitals MUST you monitor with Beta Blockers ?

218
Q

What is a normal potassium (K+) range ?

219
Q

What is a normal sodium (Na+) range ?

220
Q

What do Thiazide diuretics and loop diuretics do ?

A

Decreases fluid build up, venous return, and preload

221
Q

With Thiazide diuretics and loop diuretics what do you want to monitor for (lab) ?

A

Monitor for K+ depletion

222
Q

What is another name for the drug Digitalis ?

223
Q

What Medication, increases the force of contraction and decreases the conduction speed within the heart to slow the HR, allowing for more complete emptying of the ventricles ?

A

Digitalis (Digoxin)

224
Q

With the drug Digoxin, what VS MUST you monitor ?

225
Q

With the drug Digoxin, what do you need to monitor for ?

A

Digoxin toxicity !

226
Q

With the drug Digoxin, you need routine _______ ?

227
Q

What are S/S of Digoxin toxicity ?

A
  • N/V
  • “yellow vision”
  • blurred vision
  • dysrhythmias
  • fatigue
  • drowsiness
  • HA
228
Q

What is the most common cause of Digoxin toxicity ?

A

Hypokalemia from potassium-depleting diuretics

229
Q

What is an important teaching point regarding medication use for HF ?

A
  • Medications will be lifelong ! & they need to be taken everyday !
230
Q

In regards to Medication patient teaching for HF, what should pt in regards to taking the pulse rate ?

A

Take for a full minute

231
Q

What kind of diet is recommended for patients with HF ?

A 
DASH diet (Dietary approaches to stop hypertension)
&amp; 
Reduce sodium intake
232
Q

What is the most clear indication of how well HF is being managed ?

A

Daily Weights !

  • same time & same clothing each day
233
Q

With HF, what weight changes should be reported to the HCP ?

A
  • A weight gain of 3lbs over 2 days
    OR
  • A weight gain of 3 to 5lbs over a week
234
Q

Why is it important to teach about Sodium restrictions to patients with HF ?

A

Helps to control fluid overload

235
Q

For pt’s with HF, what Is Sodium usually restricted to per day ?

A

2.5g

such as a cardiac diet

236
Q

What is the primary complication of Cardiac Transplantation ? and what is it followed by ?

A
  • Primary complication = Infection

- Followed by = Acute rejection, in the first year after transplantation

237
Q

With cardiac transplantation, what are the major causes of death after the first year?

A
  • Malignancy (especially Lymphoma)
    &
  • Coronary artery vasculopathy

J2 - Med Surg (16 decks)

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