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NUR 201 Week 5 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Heart Failure

  • An abnormal condition involving impaired cardiac pumping/filling
  • Heart is unable to produce an adequate cardiac output (CO) to meet metabolic needs
A
  • Progressive disease is characterized by myocardial cell dysfunction
  • Inability of the heart to pump enough CO to meet the demands of the body
  • Prevalence is high and it’s increasing; we’re living longer and are eating diets that’re full of unhealthy synthetic products & preservatives
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2
Q

Epidemiology - HF Risk Factors

  • CAD
  • HTN producing LVH
  • DM, hyperlipidemia
  • Sedentary lifestyle
  • Obesity
  • Excessive alcohol use, smoking, high sodium dietary intake
A
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3
Q

?

Diastolic HF occurs as a result of __ __

A

filling failure

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4
Q

?

Systolic HF occurs as a result of __ __

A

pump failure

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5
Q

?

Refers to the inability of the ventricles to relax & thereby fill the chambers appropriately

A

Diastolic

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6
Q

?

Refers to the action of contraction in the ventricles or the lower chambers (emptying)

Ventricles don’t have enough systemic vascular resistance (SVR) to exert sufficient pressure & eject the blood to the body in an optimal manner to perfuse the body effectively

A

Systolic

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7
Q

HF classification is based solely on measurement of ejection fraction (EF); is the % of blood that’s ejected from the ventricle w/each contraction

> Normal 55-70%; around 45% - indicates HF

A
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8
Q

HF - Pathophysiology

Characterized by
> Ventricular dysfunction
> Reduced exercise tolerance
> Diminished quality of life
> Shortened life expectancy

A

Compensatory Mechanisms

  • SNS
  • Renin-Angiotensin-Aldosterone
  • Natriuretic peptides (BNP)
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9
Q

SNS is activated first; you see increased HR, contractility of the heart, & peripheral vasoconstriction (why we check pedal pulses & assess the heart)

Mechanisms then start to fail as heart cannot keep up w/workload & need for O2

A
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10
Q

Kidneys act by activating the __ __ __ __. Begins ok, but then retention of fluid to maintain volume & eventually strains the overworked heart w/volume & workload

A

renin-angiotensin-aldosterone system

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11
Q

A neurohormonal mechanism is the body’s release of ___

A

BNP (brain natriuretic peptide)

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12
Q
  • Overstretching of the heart causes this peptide to be released in r/t inc pressure & volume
  • Results in natural diuresis as well as dilation of veins & arteries
  • These decrease __ and __ & therefore workload of the heart
A

preload; afterload

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13
Q

BNP

  • Lab can draw BNP levels and if they’re elevated, then that’s a clear indication of HF
  • Pts can be given a BNP rx that mimics the effects of the body’s natural BNP neurohormonal mechanism
A
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14
Q

___ can be released w/even a minor cardiac muscle stretch

A

ANP (so we look at BNP if there’s a question of HF)

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15
Q

Management

  • Heavily dependent on hx & physical assessment as sx’s nonspecific
  • Lab testing
    > cardiac enzymes, serum electrolytes, CBC, UA, fasting lipid profile, LFT’s,
  • Rx’s
A

Complications

  • Pulmonary edema
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16
Q
  • Goals of HF management are manipulation of the critical components of CO (preload, afterload, contractility) and control of the compensatory mechanisms
A
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17
Q

?

Is an acute complication of HF characterized by rapid accumulation of fluid in interstitial & alveolar spaces of the lung, resulting from elevated filling pressures within the heart

A

Pulmonary edema

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18
Q

?

  • Most common type
  • Results from LVD
    > HTN, CAD, cardiomyopathy
    > Back up of blood into the left atrium & pulmonary veins
  • Pulmonary congestion
  • Edema
A

Left HF

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19
Q

?

Occurs as back up of blood into right atrium and venous systemic circulation

A

Right HF

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20
Q

HF: Where’s the backflow?

Right or Left?

  • Backup of blood into the right atrium and venous systemic circulation
A

Right

21
Q

Left - most common type

  • Results from LVD (HTN, CAD, cardiomyopathy)
  • Backup of blood into the left atrium and pulmonary veins
    > Pulmonary congestion
    > Edema
A

Remember: Left / Lungs (Left-sided HF classically is when the fluid is built up in the lungs)

22
Q

HF Sx’s - ?

  • SOB, dyspnea, fatigue
  • Crackles in lung auscultation
  • Poor color, weak pulses, cool extremities
A

LEFT

23
Q

?

  • Jugular vein distention (JVD)
  • Generalized dependent edema
  • Hepatomegaly
  • Ascites
A

Right

24
Q
  • Left-sided HF can eventually cause right-sided HF & then sx’s can be less clear
  • Severe exacerbations of HF, pt may present w/hypotension, cool extremities, decreased or no urine output, & poor or declining mentation
A
25
Q

?

If this is left untreated, treatment is delayed, or the HF progresses, it can rapidly decline into an acute decompensated state such as severe __ __

A

Pulmonary edema

26
Q
  • Other complications of HF can be pleural effusions, afib (which can cause thrombus/embolus formation & inc pts risk for stroke), fatal dysrhythmias, severe hepatomegaly, renal insufficiency or failure
A
  • As pulmonary edema progresses, it inhibits O2 & CO2 exchange @ the alveolar-capillary interface
27
Q
  • Orthopnea
  • Dyspnea, tachypnea
  • Use of accessory muscles
  • Cyanosis
  • Cool & clammy skin
A
  • Cough w/frothy, blood-tinged sputum
  • Crackles, wheezes, rhonchi
  • Tachycardia
  • Hypo- or HTN
28
Q

Flash Pulmonary Edema

! Fast & sudden
* Pt is usually anxious, pale, & possibly cyanotic
* Skin is clammy & cold from vasoconstriction caused by stimulation of SNS

A
29
Q

Diagnostic Studies | Primary goal: Determine & treat underlying cause

  • History & PE
  • Cxr
  • Lab studies (e.g., cardiac enzymes, BNP, electrolytes, CBC, UA, lipids)
  • Hemodynamic assessment
A
  • Echo
  • Nuclear imaging/stress testing
  • Cardiac cath
  • Ejection fraction (MUGA scans)
30
Q

BNP

Below __ pg/mL indicates no HF

Levels between __ and __ pg/mL suggest HF is present

Level above __ pg/mL indicates mild HF

A

100

100-300

300

31
Q

Level above __ pg/mL indicates moderate HF

Level above __ pg/mL indicates severe HF

A

600

900

32
Q

Electrolytes
- Assess K+ as diuretics might deplete
- Look at BUN as inadequate blood flow to the kidneys may impair kidney function
- H/H in anemia that could result in decreased CO

A

! Be aware of any National Hospital Quality Measures (6 core measures)

  1. Beta-blocker @ discharge
  2. Follow-up within 7 days >d/c
  3. Record of care transmitted to the next level of care within 7 days of d/c
  4. Documentation of advance care planning (adv dir) w/an HCP
  5. Documentation of adv dir within the medical record
  6. F/u d/c eval of pt status & treatment adherence within 72 hrs of d/c (can occur by phone, scheduled OV, or home visit)
33
Q

Classification Systems

  • New York Heart Association Functional Classification of HF: Classes I to IV
    > Patients may progress up & back to any of the classifications @ any time during their dz, depending on treatment & response
A
  • ACC/AHA Stages of HF: Stages A to D
    > A pt can’t go backward in these stages
34
Q

Class ?

No symptoms w/physical activity such as dyspnea or CP

A

Class I

35
Q

Class ?

Marked limitation w/physical activity but comfortable @ rest

A

Class III

36
Q

Class ?

Severe limitation & distress w/physical activity or at rest

A

Class IV

37
Q

Class ?

Mild sx’s w/ordinary activities

A

Class II

38
Q

Stage ?

Refractory HF eligible for heart transplant, inotropic and/or mechanical support

A

D

39
Q

Stage ?

Asymptomatic w/LVH and/or impaired LV function

A

B

40
Q

Stage ?

Pt’s w/risk factors but no LV impairment

A

A

41
Q

Stage ?

Current or past sx’s of HF

A

C

42
Q

Overall objective is to increase CO by effecting the SV (preload, afterload, & contractility)

“UNLOADFAST”

  • Morphine is also used as it decreases preload & anxiety
A
43
Q

“UNLOADFAST”

A
44
Q

Improve Cardiac Output: Preload, Afterload, Contractility

Reduce ___

  • Nutrition therapy
  • Drug therapy
    > Diuretics
    > Venous vasodilators
A

Preload

45
Q

Reduce Afterload

  • Drugs
    > __
    > __
    > __
A

ACE inhibitors
ARB
Human BNP

46
Q

Drugs: Enhance Contractility

  • Inotropic drugs
    > ___
  • Beta adrenergic blockers (usually short-term)
A

Digoxin

47
Q

Treatments: Non-pharmacological

  • Noninvasive ventilatory support (BIPAP)
  • Cardiac resynchronization therapy (CRT) or biventricular pacing
  • Cardiac transplantation
A
  • Intra-aortic balloon pump (IABP) therapy
  • Ventricular assist devices (VADs)
  • AICD - automatic internal cardiac defibrillator
  • Heart transplantation - depending on the cause
48
Q

Nursing Management - HF

Nursing Diagnoses
* Activity intolerance
* Fluid volume excess
* Anxiety
* Deficient knowledge

A

Evaluation
* Respiratory status
* Fluid balance
* Activity tolerance
* Anxiety control
* Knowledge of disease process

NUR 201 Week 5 (5 decks)

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