Heart Failure

Question 1

HF pathophysiology

Answer 1

insufficient blood supply to tissues and organs due to decreased contraction

Question 2

decreased cardiac output leads to:

Answer 2

• decreased tissue perfusion
• impaired gas exchange
• fluid volume imbalance
• decreased functional ability

Question 3

ejection fraction

Answer 3

amount of blood pumped out of the left ventricle with the next systole

Question 4

cardiac output

Answer 4

stroke volume x heart rate

Question 5

risk factors of heart failure

Answer 5

• history of HTN
• coronary artery disease
• previous MI
• elderly
• noncompliance with medication

Question 6

primary factors of HF

Answer 6

• cardiomyopathy
• congenital heart defects
• coronary artery disease
• valvular disorders
• hyperthyroidism
• myocarditis – inflammation of the heart
• pulmonary hypertension
• rheumatic heart disease

Question 7

diastolic heart failure

Answer 7

• inability of the ventricles to relax and fill (normal ejection fraction)

Question 8

systolic heart failure

Answer 8

• inability of the heart to pump blood effectively (low ejection fraction, less than 40%)

Question 9

left sided heart failure

Answer 9

• Blood/fluid backs up into the left atrium
• Increased pulmonary hydrostatic pressure causes fluid leakage from the pulmonary capillary bed into the interstitium and then the alveoli
• Results in pulmonary congestion

Question 10

complications of left sided heart failure

Answer 10

• pulmonary edema
• right sided heart failure
• pleural effusion
• dysrhythmias
• pneumonia
• abnormal S3 and S4

Question 11

right sided heart failure

Answer 11

• Fluid backs up into venous system
• Right ventricle does not pump effectively
• Fluid moves into the tissues and organs

Question 12

complications of right sided heart failure

Answer 12

• edema in lower extremities
• enlarged liver
• enlarged spleen
• pulmonary hypertension

Question 13

labs and diagnostics

Answer 13

• BNP – brain natriuretic peptide, regulates circulation and act on blood vessels causing them to dilate or widen, when the heart chamber is stressed it will release more BNP
  a) Less than 100 is normal, over 100 is abnormal
• ABGs – arterial blood gas, can tell us patient’s oxygenation status, if they are retaining CO2, can see if there is fluid in the lungs
• BMET/CMET – to check for electrolyte imbalances, fluid overload – diuretics can cause hypokalemia
• Creatinine – to check kidney function, decreased perfusion, creatinine will be elevated
• BUN – also to check kidney function, BUN would be elevated because kidneys aren’t working because of decreased perfusion, can also be elevated due to high dose of diuretic
• Urinalysis – to see if protein is being excreted, this can show kidney dysfunction
• Chest X-ray – to see if the heart is enlarged, if fluid is in the lungs
• ECG/EKG – can show dysrhythmias, PVCs present – can lead to V-tach
• Echocardiogram – can see the ejection fraction

Question 14

collaborate care measures

Answer 14

• rest
• oxygen
• medications

Question 15

diuretics

Answer 15

• furosemide, spironolactone, hydrochlorothiazide
• decreases fluid volume from the lungs and peripheries
• can be potassium sparing or wasting

Question 16

beta blockers

Answer 16

• metoprolol, carvedilol
• help improve the left ventricular ejection fraction, increase exercise tolerance, help slow progression of heart failure, reduce hospitalization, prolong survival

Question 17

Cardiac Glycosides

Answer 17

• digoxin
• increases force, increases cardiac output

Question 18

ACE inhibitors

Answer 18

• lisinopril, captopril
• helps with dilation of the arterioles, which helps improve blood flow to the kidneys and other tissues, dilates the veins to help reduce venous pressure for the heart
• ultimately helps reduce pulmonary edema

Question 19

Vasodilators

Answer 19

• isosorbide dinitrate/hydralazine – administer in a combination
• decrease venous return and preload/afterload

Question 20

nursing interventions

Answer 20

• monitor vitals
• apply oxygen
• auscultate lungs
• daily weight
• intake/output
• alternate rest with activity
• reduce anxiety
• low sodium diet
• fluid restriction
• collaborate with PT/OT
• administer medications

Question 21

Main treatment goals

Answer 21

• maximize cardiac output
• improve ventricular function
• improve quality of life
• preserve target organ function
• optimize fluid volume
• support oxygenation and ventilation
• symptom management
• identify and treat underlying cause

Question 22

patient education

Answer 22

• home oxygen
• monitor weight
• medication regimens
• rest and pace activity
• monitor for S/S of HF
• nutritional therapy – decreased sodium, fluid restriction, increase oral intake of potassium if potassium wasting diuretic

Question 23

evaluation

Answer 23

• improving O2 saturation, less SOB
• listen to lungs
• teach back after education
• checking lab values
• check for improvement in edema
• intake and output
• daily weights

Question 24

expected outcomes

Answer 24

• maintaining adequate oxygenation
• adequate amount of blood flow – met the metabolic demands of the heart, reduction of symptoms