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Nursing 210 > Exam 4: heart failure > Flashcards

Exam 4: heart failure Flashcards

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1
Q

what is heart failure?

A
  • a cardiovascular condition

- heart is unable to pump an adequate amount of blood to meet the metabolic needs of the body’s tissues

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2
Q

how is heart failure characterized?

A
  • left ventricular dysfunction
  • reduced exercise tolerance
  • diminished quality of life
  • shortened life expectancy
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3
Q

what are the 7 risk factors of heart failure?

A
  • CAD
  • advancing age
  • HTN
  • DM
  • tobacco use
  • obesity
  • high cholesterol levels
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4
Q

what is the etiology of heart failure?

A

any interference with the normal mechanisms regulating cardiac output

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5
Q

what are the 4 mechanisms that regulate cardiac output?

A
  • preload
  • afterload
  • myocardial contractility
  • heart rate
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6
Q

what are the 9 precipitating factors of heart failure?

A
  • anemia
  • infection
  • thyrotoxicosis
  • hypothyroidism
  • arrhythmias
  • bacterial endocarditis
  • pulmonary disease
  • nutritional deficiencies
  • hypervolemia
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7
Q

what is systolic failure? what is this aka? what does this cause?

A
  • a defect in the ability of the cardiac myofibrils to shorten
  • HFeEF
  • causes a decrease in the muscles ability to contract (pump)
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8
Q

how is systolic failure characterized? who experiences this more often?

A

low forward blood volume

men

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9
Q

what are the 4 causes of systolic failure?

A
  • impaired contractile function
  • increased afterload
  • cardiomyopathy
  • mechanical abnormalities
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10
Q

how is diastolic failure characterized? what is it aka? who experiences this more often?

A
  • high filling pressures
  • venous engorgement in both pulmonary and systemic systems
  • HFpEF (heart failure with preserved ejection fraction
  • women
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11
Q

how is mixed failure characterized?

A
  • low blood pressure
  • low CO
  • poor renal perfusion
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12
Q

what are the 5 compensatory mechanism for heart failure?

A
  • SNS activation
  • neurohormonal response
  • ventricular remodeling
  • dilation/hypertrophy
  • natriuretic petides
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13
Q

how does SNS activation compensate for heart failure? when does this happen?

A
  • release of catecholamines
  • increase heart rate
  • increase myocardial contractility
  • peripheral vasoconstriction
  • first thing that happens
  • works but after awhile, the heart overworks itself and it ends up detrimental
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14
Q

how do neurohormonal responses compensate for heart failure?

A
  • RAAS
  • low CO causes a decrease in cerebral perfusion pressure, ADH is released
  • arterial vasoconstriction
  • increased contractility
  • hypertrophy
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15
Q

what effect does a pro-inflammatory cytokines release have on the heart?

A
  • depressed cardiac function

- over time, cardiac wasting, muscle myopathy, and fatigue

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16
Q

what triggers natriuretic peptides to be released? what effect do these have on the heart?

A
  • released in response to atrial volume and ventricular pressure
  • promotes venous and arterial vasodilation
  • enhances diuresis
  • blocks effects of RAAS
  • may have inflammatory effects
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17
Q

what does nitrous oxide do for the heart?

A

relaxes arterial smooth muscle, resulting in vasodilation and decreased afterload

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18
Q

what is left sided heart failure?

A

increased blood in the left atrium and pulmonary vein

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19
Q

what is right sided heart failure?

A

back flow of blood into the right atria and venous circulation

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20
Q

s/s of left sided heart failure?

A 
fatigue
paroxysmal noturnal dyspnea
orthopnea  
tachycardia
restlessness
confusion
exertional dyspnea
cyanosis
increased pulmonary capillary wedge pressure
pulmonary congestion
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21
Q

s/s of right sided heart failure?

A 
may be secondary
distended jugular veins 
anorexia 
GI distress
weight gain
dependent edema
fatigue
hepatomegaly
splenomegaly 
increased peripheral venous pressure 
ascites
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22
Q

s/s of pulmonary congestion?

A 
cough
crackles
wheezing
bloody sputum
tachypnea
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23
Q

s/s pf acute decompensated HF?

A 
fatigue
dyspnea
tachycardia
edema
nocturia
skin changes
behavior changes
chest pains 
weight changes
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24
Q

how many classes of persons with HF are there?

A

4

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25
Q

at diagnosis of heart failure, the pt knows that they have what percent chance of being alive in 5 years?

A

50%

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26
Q

what is HF preferred over CHF?

A

not everyone has congestion

27
Q

which two risk factors of heart failure are the best indicators?

A

CAD

age

28
Q

what is cardiac output?

A

CO=SVxHR

29
Q

what is preload?

A

volume of blood

30
Q

what is afterload?

A

pressure against the pumping blood

31
Q

what is the eject fraction (EF)?

A

% of blood in the ventricle ejected with every heart beat

32
Q

what is a normal EF?

A

55-60%

33
Q

what is HFrEF?

A

heart failure with reduced ejection fraction

systolic failure

34
Q

what is the hallmark of systolic failure?

A

decreased left ventricular ejection fraction

35
Q

who is at highest risk for diastolic failure?

A

women

diabetics

36
Q

what is the biggest risk factor for diastolic failure?

A

hypertension

37
Q

what is the EF of mixed heart failure?

A

< 35%

38
Q

what are the positive compensatory mechanisms?

A

natriuretic peptides

nitrous oxide release

39
Q

what kind of a problem is HF?

A

a neurohormonal problem

40
Q

does impaired gas exchange and decreased O2 indicate left or right sided heart failure?

A

left sided

41
Q

how should the nurse auscultate for crackles?

A

on each lobe
3 on right, 2 on left
start in the front

42
Q

which clinical manifestations indicate HF?

a. orthopnea
b. dyspnea
c. paroxysmal nocturnal dyspnea
d. crackles/rales

A

a, b, c, d

43
Q

what is orthopnea? as a nurse, what question may you ask a pt?

A

difficulty breathing when laying down

ask pt how many pillows they sleep with at night

44
Q

what is the earliest symptom of chronic heart failure? what often comes with it?

A

fatigue

dyspnea

45
Q

how many times does one with nocturia urinate during the night?

A

6-8 times

46
Q

what skin changes come from heart failure?

A

dusty skin
absent pulses
brown discoloration

47
Q

what causes behavior changes r/t heart failure? c/m of these behavior changes?

A

hypoxemia

confusion, decreased memory, anxiety, depression

48
Q

what does a heart failure pt’s weight change at the end of life?

A

pt may lose a lot of weight right before death

49
Q

what is class 1 HF?

A

no limitation of physical activity

ordinary physical activity doesn’t cause symptoms of HF

50
Q

what is class 2 HF?

A

slight limitation of physical activity

comfortable at rest, but ordinary activity results in symptoms of HF

51
Q

what is class 3 HF?

A

marked limitation of physical activity

comfortable at rest, but less than ordinary activity causes symptoms of HF

52
Q

what is class 4 HF?

A

unable to carry on any physical activity without symptoms of HF, or symptoms of HF at rest

53
Q

what are the 6 diagnostic studies used for HF?

A 
physical exam
chest x-ray
ECG
BNP
echocardiogram
cardiac catheterization
54
Q

which 2 diagnostic tests are most helpful for HF? which is the best?

A

BNP (best)

echocardiogram

55
Q

what does an x-ray show us that is helpful for x-ray?

A

fluid in lungs

size of heart

56
Q

what number for BNP is diagnostic of HF?

A

over 100

57
Q

what race has a higher incidence of HF, develop HF at a younger age, and experience higher mortality rates related to HF?

A

African Americans

58
Q

what race may experience more ACE inhibitor related angioedema

A

African Americans

59
Q

what medication is approved only for treatment of HF in African Americans?

A

Isosorbide dinitrate/hydralazine

60
Q

what race has a high risk (15-50%) for ACE inhibitor related cough

A

Asians

61
Q

what is the most common cause of right sided HF

A

left sided HF

62
Q

5 complications of heart failure

A 
pleural effusion
dysrhythmias
left ventricular thrombus
hepatomegaly
renal failure
63
Q

what is a normal pulmonary artery wedge pressure (PAWP)

A

8-12 mmHg

64
Q

how high can someone with ADHF’s PAWP level be

A

as high as 30 mmHg

Nursing 210 (12 decks)

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