Heart Failure Flashcards
heart failure
complex clinical syndrome resulting in insufficient blood supply/oxygen to tissues and organs
decreased cardiac output results in
decreased tissue perfusion which decreases ejection fraction
primary risk factor for heart failure
hypertension (can be reduced by 50% if aggressively treated)
etiology of heart failure
any interference with mechanisms regulating cardiac output
primary causes of heart failure
conditions that directly damage the heart
precipitating causes of heart failure
conditions that increase the work load of the heart
possible conditions that increase work load of the heart
MI, valve damage, viral infection, cardiomyopathy
classification of left sided heart failure
results from inability of left ventricle to empty adequately during systole (working) or fill adequately during diastole (relaxing); bloods back up into left atrium
what occurs from left sided heart failure
increase in pulmonary hydrostatic pressure causing fluid leakage from the pulmonary bed into the interstitium and then the alveoli. this results in pulmonary congestion and edema
clinicial manifestations of left sided heart failure
decreased cardiac output and pulmonary edema
decreased cardiac output s/s
fatigue, weakness; oliguria during the day (nocturia at night); angina, confusion, restlessness; dizziness, tachycardia, palpitations; pallor, weak peripheral pulses, cool extremities
pulmonary congestion s/s
hacking cough, worse at night; dyspnea/breathlessness; crackles or wheezing in lungs; frothy, pink-tinged sputum, tachypnea
right-sided heart failure
right ventricle doesn’t pump effectively; this causes fluid to back up into the venous system which moves into the tissues and organs
clinical manifestations of right-sided heart failure
systemic congestion
systemic congestion s/s
jugular vein distention; enlarged liver and spleen; anorexia and nausea; dependent edema (legs and sacrum); distended abdomen; swollen hands and fingers; polyuria at night; weight gain
what is special about blood pressure r/t systemic congestion
increased is from excess volume; decreased is from failure
chronic heart failure clinical manifestations
fatigue, dyspnea, orthopnea, nocturnal dyspnea; cough, tachycardia, palpitations, edema; changes in urine output; nocturia, skin changes; neurological manifestations; mental status, behavior changes, and sleep problems; chest pain; weight changes
diagnostic studies of heart failure
determine and treat underlying cause; echocardiogram; BNP levels; ECG, ambulatory heart monitors, MRI, cardiac catheterization, angiogram
what does an echocardiogram show
provides information on left ventricle ejection fraction, heart value, presence of effusion or thrombus
interprofessional care for heart failure
continuous monitoring and assessment; high-fowler’s position; hemodynamic monitoring if unstable; supplemental O2, BiPaP; mechanical ventilation if unstable; mechanical cardiac assist devices for patients with deteriorating heart failure; oxygen therapy; physical and emotional rest; structured exercise program; drug therapy
mechanical cardiac assist devices
intraortic balloon pump (IABP) and ventricular assist devices (VADs)
what does oxygen therapy help with heart failure
relieves dyspnea and fatigue
what is important about physical and emotional rest for heart failure
conserve energy and decrease oxygen needs; dependent on severity of heart failure
nutritional therapy for heart failure
low sodium diet; fluid restriction for stage D heart failure; daily weights
low sodium diet for heart failure
individualize recommendations and consider cultural background; Na restricted to 2g/day
warnings of weight gain r/t heart failure
weight gain of 3lbs (1.4kg) over 2 days or a 3-5lbs (2.3kg) gain over a week should be reported to HCP
nursing assessment for heart failure
past health history; drugs; risk factors; nutritional history; subjective and objective data
nursing diagnoses for heart failure
impaired gas exchange; impaired cardiac output; fluid imbalance; activity intolerance
goals for heart failure
decrease in symptoms and peripheral edema; increase in exercise tolerance; adherence in exercise tolerance; no complications r/t heart failure
nursing interventions r/t heart failure
health promotion; monitor respiratory status, hemodynamic status, daily weights, I&O, edema; semi-fowler’s position; administer drugs; collaborate; reduce anxiety; alternate rest and activity; patient teaching
ambulatory care r/t heart failure
transitional care programs: comprehensive discharge planning, collab among providers, follow-ups with HCP
patient teaching r/t heart failure
indications for worsening/recurrent heart failure; drug therapy; home BP monitoring
what are some indications for worsening/recurrent HF?
rapid weight gain; decreased exercise tolerance; cold symptoms; excessive nocturia; development of dyspnea/angina at rest; increased edema in feet, ankles, and hands
what are some expected outcomes of HF?
maintain adequate O2/CO2 exchange to meet O2 needs of the body; maintain adequate blood pumped by the heart to maintain metabolic needs; reduction/absence of edema and stable baseline weight; achieve a realistic program of activity that balances with energy conserving activities
heart failure complications
pleural effusion; dysrhythmias and dyssynchronous contraction; hepatomegaly; cardiorenal syndrome; anemia
pulmonary edema clinical manifestations
anxious, pale, cyanotic; dyspnea, orthopnea, tachypnea; paroxysmal nocturnal dyspnea, use of accessory muscles; cough with frothy, blood0tinged sputum; crackles and wheeze, tachycardia; hypotension and hypertension; abnormal S3 or S4 on ECG
nursing actions for pulmonary edema
high-fowler’s position; oxygen; mechanical ventilation; IV meds (diuretics and morphine)
pericardial tamponade
fluid accumulation in the pericardial sac
pericardial tamponade symptoms
hypotension, muffled heart sounds, jugular vein distention
pericardial tamponade nursing actions
IV fluids, notify provider, connect patient to a monitor
