Heart Failure Flashcards
1
Q
What is heart failure?
A
Heart failure is an abnormal condition involving impaired cardiac pumping/filling.
- A progressive syndrome
- Reduced cardiac output: amount of blood pumped per minute; normal cardiac output ranges 4-8L/min
- Increased venous pressure
- Underlying molecular changes that result in the death of cardiac muscle cells
- Heart is unable to produce an adequate cardiac output to meet metabolic needs
- Heart cannot maintain adequate circulation to meet tissue needs for oxygen and nutrients
2
Q
Heart Failure Statistics
A
- Affects about 6.5 million people in the United States-projected to increase by 40% by 2030
- The most common reason for hospitalization in adults >65 years old
- About 25% are readmitted to hospital within 30 days
3
Q
Primary Risk Factors for Heart Failure
A
- Coronary Artery Disease (CAD)
- Hypertension
4
Q
Contributing Risk Factors for Heart Failure
A
- Advancing age
- Diabetes
- Tobacco use
- Obesity
- High serum cholesterol
- Genetic predisposing factors
5
Q
Heart Failure in Minorities
A
- Black and Hispanic Americans: develop HF at an earlier age; are admitted to the hospital; have higher mortality rates related to HF as compared to whites
- Hispanic Americans have more CVD risk factors: are 25% less likely to die of heart disease than whites
6
Q
Left Sided Heart Failure
A
- Most common
- From left ventricular dysfunction (i.e. MI, HTN, CAD, cardiomyopathy)
- Symptoms are due to blood backing up
- Backup of blood into the left atrium and pulmonary veins: pulmonary edema, pulmonary congestion
- “Left:Lungs”
Left ventricle is not pumping out, fluids will back up into the lungs - Will hear crackles
- SOB
- Respiratory type symptoms
7
Q
Right Sided Heart Failure
A
- Right sided HF from left sided HF (cor pulmonale): a condition that causes the right side of the heart to fail; backup of blood into the right atrium and venous systemic circulation
- Clinical manifestations: jugular venous distension, hepatomegaly (enlarged liver), splenomegaly (enlarged spleen), portal HTN ( Portal veins drain GI tract after liver and spleen but when it gets backed up it builds tension), vascular congestion of GI tract, peripheral edema
- Blood is backing up into the veins, may see distension of legs, ankles, and abdomen; going into the body
8
Q
Acute Decompensated Heart Failure (ADHF)
A
- An increase (usually sudden) in symptoms of HF
- Decrease in functional status, often requiring rapid escalation of therapy and hospital admission
- Typically includes signs and symptoms related to pulmonary congestion and volume overload
- Most common cause of hospitalization for older Americans
9
Q
Stages of Heart Failure
A
- The American College of Cardiology Foundation and the American Heart Association (ACCF/AHA) staging system (A–D)
- Emphasizes the evolution, progression, and treatment of HF
- Identifies people at risk for developing HF who do not currently have heart disease (stage A)-encourages providers to address the patient’s risk factors
- Patients advance to a higher (worse) stage as the disease progresses.
- A: pre-heart failure, means you are at a high risk because you have a family history or one or more of the following conditions - HTN, DM, CAD, metabolic syndrome, hx of alcohol abuse, hx of rheumatic fever, family hx of cardiomyopathy, hx of taking drugs that can damage your heart muscle, such as some cancer drugs
- B: pre-heart failure, your provider has given you a diagnosis of systolic left ventricular dysfunction but you’ve never had symptoms of heart failure; have an echocardiogram (echo) that shows an ejection fraction (EF) of 40% or less; this category includes people who have heart failure and reduced EF (HF-rEF) due to any cause
- C: have a heart failure diagnosis and currently have or previously had signs and symptoms of the condition; most common symptoms are SOB, fatigue, less able to exercise, weak legs, waking up to urinate, edema
- D: heart failure with advanced symptoms that don’t get better with treatment; this is the final stage of heart failure.
10
Q
Clinical Manifestations of Heart Failure
A
- Jugular vein distention: evidence that blood if backing up from the right atrium, sitting at 45 degrees
- Dependent edema: may be pitting in nature - recall how to measure; sudden weight gain of > 3 lbs. (1.4kg) in 2 days may indicate an exacerbation of HF
- Weight changes: anorexia (loss of appetite), nausea, fluid retention
- Fatigue
- Dyspnea, orthopnea (SOB when lying down), paroxysmal nocturnal dyspnea (SOB that awakens patient after 1-2 hrs of sleep and is usually relieved in the upright position; buildup of fluid in lungs)
- Persistent cough, white or pink blood-tinged sputum
- Tachycardia (trying to compensate for lack of oxygen being pumped around)
- Restlessness, confusion, decreased memory
- Less oxygen = hypoxia of heart and brain
- Chest pain (angina)
- Atrial fibrillation (most common dysrhythmia)
11
Q
Diagnostic Studies for Heart Failure
A
- Chest X-ray (CXR)
- Electrocardiogram (ECG)
- Cardiac enzymes (troponin), electrolytes, arterial blood gasses (abg’s)
- B-Type natriuretic peptide (BNP): hormone secreted from ventricles in response to changes in pressure
- Echocardiogram: right ventricular ejection fraction: The volume of blood pumped from the right ventricle to the lungs upon each beat. Expected reference range is 45% to 60%; Left ventricular ejection fraction: Volume of blood pumped from the left ventricle into the arteries per beat. Expected reference range is 55% to 70%.
- Transesophageal echocardiogram (TEE)
12
Q
Complications of Heart Failure
A
- High risk of fatal dysrhythmias: sudden cardiac death, ventricular tachycardia with HF, ventricular fibrillation
- HF can lead to severe hepatomegaly, especially with RV failure: fibrosis and cirrhosis can develop over time (Liver becoming full of scar tissue causing it to not work properly because it can’t filter or metabolize anything)
- Renal insufficiency or failure (now think about fluid and electrolyte issues)
- Die off due to injury therefore leading to more fluid build up
13
Q
Assessment for Heart Failure
A
- Subjective data: health hx, functional health patterns, and medications
- Objective data: physical examination, priority focus
- physical:
o Circulatory
o Respiratory
o Pulmonary
o Heart and lungs
o Edema
14
Q
Nursing Diagnoses for Heart Failure
A
- Impaired gas exchange
- Fluid volume excess
- Activity intolerance
- Anxiety
- Knowledge deficit
15
Q
Goals for Heart Failure
A
- Decrease patient symptoms
- Improve cardiac function
- Reverse ventricular remodeling
- Improve quality of life
- Decrease mortality and morbidity
- Compliance with the medical regimen
- No complications related to HF
17
Q
Nutritional Therapy for Heart Failure
A
- Diet and weight reduction: Individualize recommendations and consider cultural background
- Recommend Dietary Approaches to Stop Hypertension (DASH) diet
- Sodium is usually restricted to 2.5 g per day
- Fluid restriction not generally required
- Daily weights are important: same time, same clothing each day
- Report to Provider: Weight gain of 3 lb. (1.4 kg) over 1-2 days and 3-5-lbs. (2.3 kg) gain over a week
19
Q
Pulmonary edema
A
o Entered alveoli causing gas exchange problem as they fill up with fluid
o Clients come in with acute decompensating heart failure because they come in wheezing with severe SOB
o We give diuretics (furosemide) to get rid of fluid
o2,500 mg of sodium is daily value but most Americans eat 4,500-5,000mg
