Heart Failure Flashcards
What does CHF stand for?
Congestive Heart Failure
What is CHF?
When the heart is unable to pump sufficient blood to meet the metabolic needs of the body
Where does the blood back up into during CHF?
Pulmonary circuit
Systemic circuit
or both
Why does CHF usually occur?
Secondary to another condition
Is CHF chronic?
YES, but you live with it and it does not go away!
Left Sided Heart Failure: CAUSES
- LV is commonly damaged during an MI
- Chronic hypertension long term effects of having to pump against the increased after load
The right side of the heart ________ during left sided failure.
continues to pump normally
Left sided heart failure: The left side of the heart is _______ from the pulmonary vessels.
Unable to pump the blood
As a result of the left side failing, what happens?
The blood backs up behind the LV and the pressure in the left atrium and pulmonary veins INCREASE
As the pulmonary veins become engorged with blood…..
Serum is forced out of the pulmonary capillaries and into the alveoli
It is a respiratory problem but has a ______!
Cardiac
with Congested heart failure the lungs feel like they are ______ !!
DROWNING
Pt will present with ____ during left sided congestive heart failure
SOB
Hypertensive!!
Restlessness
Agitation
Confusion
Tachypnea
Crackles and possibly wheezes
Frothy, pink sputum
If they are shortness of breath what should you never do?
NEVER LAY THEM DOWN SUPINE! because the fluids will overtake their lungs!!
Increases fluid in the vessels leaks into the interstitial spaces causing narrowing of the bronchioles causing what sound?
Wheezing!
Air passing through the fluid filled alveoli causes what sound in the lungs?
Crackles!!
How do you manage CHF?
Improving oxygenation
Decreasing workload
Reducing the preload so that the LV is less overburdened.
Take VITALS- spo2, etco2, o2, IV, 12 lead ECG
Position up right
What are the effects of nitro?
- vasodilation
- reduces the cardiac workload and improved cardiac output
Wheezes: you should AVOID…. what type of medications?
Bronchodilators (VENTOILIN) should be avoided as they increase tachycardia!!!
What does CPAP do to the lungs?
- Keep the alveoli open due to the fluid
- works to hold the alveoli open through the resp. cycle so that o2 and co2 can diffuse exchange normally
Can the mask be removed for medication adminstration?
YES!!
CHF always presents with LOW blood pressure, true or false?
FALSE CHF n e v e r presents with low blood pressure
What kind of patient do we have to use CPAP on?
Conscious, alert and following commands!!
Severe resp. distress
Acute pulmomary edema or COPD
tachypnea
normotensive
Spo2 <90%
What is paroxysmal nocturnal dyspnea?
- severe attacks of SOB and coughing that typically happen at night
- usually wakes up the person from sleep
- often occurs with LHF where the cause is chronic overload as opposed to an MI
- 1-2 weeks of SOB at night
What is right sided heart failure?
the right side is working harder to pump blood into the enlarged pulmonary arteries
Pulmonary hypertension is…
chronic increased resistance of blood through the lungs- backing blood into the RV= increased workload = failure
Pulmonary embolism is….
forward blood flow through the pulmonary system is blocked by a clot = increased workload on RV = failure
If pulmonary edema is present=
secondary to LHF
If no pulmonary edema is present=
lung or right sided heart problems
When the right side of the heart fails… pressure ____ behind the RV and ______ pressure in the systemic veins causing them to become __________ !!!!
backs up
increases
ENGORGED
What is JVD?
Jugular vein distention
What is one obvious sign of CHF in the body?
PITTING EDEMA in the legs
How do we manage RHF?
make the pt comfortable
monitor
If pt presents w RHF AND LHF what do we do???
Treat the left side congestive heart failure FIRST
When does cardiogenic shock occur?
when the heart is so severely damaged that it can no longer pump sufficient blood to maintain tissue perfusion
When ____ % of the LV myocardium is involved, LHF usually develops
25%
When ___% or more of the LV myocardium involved, it is infarcted
40%
Cardiogenic shock can happen after what?
after resuscitation ROSC
Signs and symptoms of cardiogenic shock:
confusion/comatose
restless and anxious if awake
pale, cold skin
poor sp02 readings due to peripheral shunting
rapid, shallow respirations often crackles
rapid thready pulse
What is relative hypotension?
fluid loss within the body
- dehydration, cannot see the source of fluid loss
What is absolute hypotension?
TRAUMAAAA- you can see the fluid loss/blood
What is the management of CHF?
improve oxygenation and perfusion
100% supplemental O2
place the pt supine unless pulmonary edema is present
cardiac monitor and 12 lead
transport quickly
