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Adult Nursing II Exam 3 > Heart Failure > Flashcards

Heart Failure Flashcards

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1
Q

What is Ejection Fraction?

KNOW THIS!!!…in red

IN RED

A

(Stroke Volume) / (End Diastolic Volume)

The percentage of diastolic volume ejected from the heart during diastole

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2
Q

What is normal EF at the end of diastole & at the end of systole?

KNOW THIS!!!…in red

In Red

A

End of Diastole = 120

End of Systole = 50 (aim for 70)

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3
Q

What is the ejection fraction in Heart Failure with Reduced Ejection Fraction (HFrEF) / Systolic?

KNOW THIS!!!…in red

In Red

A

< 50%

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4
Q

What is normal ejection fraction in Heart Failure with Preserved Ejection Fraction (HFpEF) / diastolic?

KNOW THIS!!!…in red

In Red

A

50 - 70%

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5
Q

What are precipitating causes of Heart Failure?

KNOW THIS!!!…in red

In Red

A

Faulty heart valves

Arrhythmias (a-fib & tachycardia)

I – myocardial Infarction / CAD

Lineage (genetic)

Uncontrolled HTN

Recreational drugs

Evaders (infections)

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6
Q

Signs & Symptoms of Left sided Heart Failure

KNOW THIS!!!…in red

In Red

A

Dyspnea
Rales
Orthopnea
Weakness
Nocturnal paroxysmal dyspnea (gasp for air when sleeping; it wakes you)
Increased heart rate – increased volume (heart works harder & faster to try & meet the demand)
Nagging cough
Gaining weight

DROWNING

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7
Q

Signs & Symptoms of Right sided Heart Failure

KNOW THIS!!!…in red

In Red

A

Swelling of legs
Weight gain
Edema
Large neck veins
Lethargic
Irregular heart beat
Nocturia
Girth (ascities)

SWELLING

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8
Q

Explain cardiogenic shock

KNOW THIS!!!…in red

In Red

A

Failure to pump blood adequately

  • Most common cause of MI
  • Ineffective pumping can be caused by mechanical defects, arrhythmias, ventricular aneurysm or valve dysfunction

S&S: S3, JVD, decreased MAP, SOB, weak pulse, pale skin, cool hands & feet, decreased urine output

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9
Q

What are signs & symptoms of cardiogenic shock?

KNOW THIS!!!…in red

In Red

A
  • S3
  • JVD
  • Decreased MAP
  • Shortness of breath
  • Weak pulse
  • Pale skin
  • Cool feet & hands
  • Decreased urine output
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10
Q

What can be used to diagnose heart failure?

A
  • BNP: indicates how the heart is functioning (normal < 100)
  • Echocardiography (checks EF % right away) (Gold Standard)
  • 12 Lead EKG
  • Chest X-ray
  • Cardiac catheterization
  • Stress Test
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11
Q

Nursing Interventions for Heart Failure

KNOW THIS!!!…in red

In Red

A
  • Assess worsening symptoms
  • Labs: Potassium, BUN, Troponin, Dig level, BNP, Creatinine
  • Fluid Status (monitor I&Os + fluid restriction)
  • Cardiac status
  • Diet (low sodium)
  • Edema
  • Response to medications
  • Safety
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12
Q

How to remember drug classes for heart failure
What medications can be used for heart failure?

KNOW THIS!!!…in red

In Red

A

Always Administer Drugs Before A Ventricle Dies

  • Ace inhibitors
  • ARBs (Angiotensin II receptor blockers)
  • Diuretics
  • Beta blockers
  • Anticoagulatns
  • Vasodilators
  • Digoxin
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13
Q

What are the significant six of patient education?

KNOW THIS Per Hayley

A
  • Smoking cessation
  • Weight monitoring
  • Symptoms to report
  • Diet
  • Activity
  • Medications
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14
Q

What is Hypertrophic Obstructive Cardiomyopathy (HCM)?

KNOW Per Hayley

A

Enlarged heart muscle

  • genetically enherited

Enlarged muscle surrounding the heart

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15
Q

What is Dilated Cardiomyopathy?

KNOW Per Hayley

A

Entire heart is enlarged

  • idiopathic
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16
Q

What is an S3 Heart Sound / When is it produced?

KNOW THIS!!!…in red

In Red

A

Produced by passive filling stage of diastole

  • Normally inaudible
  • Represents overloaded ventricle (when heard)
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17
Q

What is endocarditis?

KNOW per Hayley

A

Bacteria in the bloodstream that enters the heart

  • Bacterial: vegetative areas cover the valve (common w/ artifical valve)
  • Infective: vegetative lesions around the heart

Abx for treatment

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18
Q

What is mitral regurgitation? What are signs & symptoms?

KNOW THIS!!!…in red

In Red

A

Improper closing of valve causing blood to backflow

S&S:
* Fatigue
* Dyspnea
* Palpitations
* Angina
* S3

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19
Q

What is aortic stenosis?

Know per Hayley

A

Valve becomes very stiff

  • Causes: congenital rheumatic heart disease or classification
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20
Q

What is billowing?

A

Inflammation around the valve making it

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21
Q

What kind of symptoms are associated with right sided heart failure?

KNOW THIS!!!…IN RED

IN RED

A

Peripheral symptoms

  • S3
  • JVD
  • Crackles
  • Cheyne-Stokes Breathing
  • Pulmonary & peripheral edema
  • Frothy sputum
  • Dyspnea
  • Tachycardia
  • Cyanosis
  • RUQ Pain
  • Hepatomegaly
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22
Q

Clinical manifestations of right sided heart failure include whcih of the following?

a.) Elevated central venous pressure (CVP) & sacral edema
b.) Pulmonary congestion & jugular vein distention (JVD)
c.) Hypertension & chest pain
d.) Liver tenderness & pulmonary edema

A

a.) Elevated central venous pressure (CVP) & sacral edema

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23
Q

The patient is scheduled for implantable cardiovert defibrillator (ICD) for treatment of a dysrhythmia. The nurse explains that the action of this procedure is

a.) Trigger electrical impulses in the hart
b.) Take over SA node function
c.) Block AV node transmission impulses
d.) Increase ventricular conduction

A

a.) Trigger electrical impulses in the heart

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24
Q

A measurement of what percent may be evidence of heart failure or cardiomyopathy?

KNOW THIS!!!…IN RED

IN RED

A

under 40%

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25
Q

What is another name for Heart Failure with preserved Ejection Fraction (HFpEF)?

KNOW THIS!!!…IN RED

IN RED

A

Diastolic Heart Failure

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26
Q

What is another name for Heart Failure with reduced Ejection Fraction (HFrEF)?

KNOW THIS!!!…IN RED

IN RED

A

Systolic Heart Failure

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27
Q

What are the KEY symptoms of Systolic Heart Failure / Heart Failure with reduced Ejection Fraction (HFrEF)?

KNOW THIS!!!…IN RED…Per HAYLEY

A
  • Dyspnea
  • Fatigue
  • Decreased urine output
  • Cheyne stokes respirations
  • S3 heart sounds (due to fluid overload)
  • JVD (due to fluid overload)
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28
Q

Explain what is occuring in Systolic Heart Failure or Heart Failure with reduced Ejection Fraction (HFrEF).

KNOW THIS!!!…IN RED..per Hayley

IN RED

A

↓ cardiac output
↓ blood pressure
↓ ejection fraction

29
Q

**Explain the 3 KEY signs or symptoms in diastolic heart failure or Heart Failure with preserved Ejection Fraction (HFpEF).

What signs or symptoms are NOT seen in HFpEF?

KNOW THIS!!!…IN RED…per Hayley

IN RED

A

POSITIVE SYMPTOMS:
* * S4 Gallop (+)
* Hypertension (+)
* Dyspnea (+)

Negative Symptoms:
* NO (-) peripheral edema
* NO (-) JVD

30
Q

What is cardiogenic shock?

KNOW THIS!!!…IN RED

IN RED

A

Failure to pump blood adequately (decreased cardiac output)

  • Most common cause of an MI
  • Ineffective pumping can be caused by mechanical defects, arrhythmias, ventricular aneurysms, or valve dysfunction
31
Q

What is the most common cause of myocardial infarction?

KNOW THIS!!!…IN RED

IN RED

A

Cardiogenic Shock

32
Q

What are signs & symptoms of cardiogenic shock?

KNOW THIS!!!…IN RED

IN RED

A
  • S3
  • JVD
  • decreased MAP
  • SOB
  • Weak pulse
  • Pale skin
  • Cool hands & feet
  • Decreased urine output
33
Q

Which of the following actions is the appropriate initial response to a patient coughing up pink, frothy sputum?

a.) Call for help
b.) Call the physician
c.) Start an IV line
d.) Suction the patient

A

b.) Call the physician

34
Q

Acute pulmonary edema caused by heart failure is usually a result of damage to which of the following areas of the heart?

a.) Left atrium
b.) Right atrium
c.) Left ventricle
d.) Right ventricle

A

c.) Left ventricle

35
Q

A nurse is preparing for the admission of a patient with heart failure who is being sent directly to the hospital from the physician’s office. The nurse would plan on having which of the following medications readily available for use?

a.) diltiazem (Cardizem)
b.) digoxin (Lanoxin)
c.) propranolol (Inderal)
d.) metoprolol (Lopressor)

A

b.) digoxin (Lanoxin)

36
Q

A measurement of what percent may be evidence of heart failure or cardiomyopathy?

KNOW THIS!!!…IN RED

IN RED

A

under 40%

37
Q

What is another name for Heart Failure with preserved Ejection Fraction (HFpEF)?

KNOW THIS!!!…IN RED

IN RED

A

Diastolic Heart Failure

38
Q

What is another name for Heart Failure with reduced Ejection Fraction (HFrEF)?

KNOW THIS!!!…IN RED

IN RED

A

Systolic Heart Failure

39
Q

What are the KEY symptoms of Systolic Heart Failure / Heart Failure with reduced Ejection Fraction (HFrEF)?

KNOW THIS!!!…IN RED…Per HAYLEY

A
  • Dyspnea
  • Fatigue
  • Edema
  • Decreased urine output
  • Cheyne stokes respirations
  • S3 heart sounds (due to fluid overload)
  • JVD (due to fluid overload)
40
Q

Explain what is occuring in Systolic Heart Failure or Heart Failure with reduced Ejection Fraction (HFrEF).

KNOW THIS!!!…IN RED..per Hayley

IN RED

A

Decreased cardiac output
Decreased blood pressure
Decreased ejection fraction

41
Q

Explain the 3 KEY signs or symptoms in diastolic heart failure or Heart Failure with preserved Ejection Fraction (HFpEF).

What signs or symptoms are NOT seen in HFpEF?

KNOW THIS!!!…IN RED…per Hayley

IN RED

A

POSITIVE SYMPTOMS:
* S4 Gallop (+)
* Hypertension (+)
* Dyspnea (+)

Negative Symptoms:
* NO (-) peripheral edema
* NO (-) JVD

42
Q

What is cardiogenic shock?

KNOW THIS!!!…IN RED

IN RED

A

Failure to pump blood adequately (decreased cardiac output)

  • Most common cause of an MI
  • Ineffective pumping can be caused by mechanical defects, arrhythmias, ventricular aneurysms, or valve dysfunction
43
Q

What is the most common cause of myocardial infarction?

KNOW THIS!!!…IN RED

IN RED

A

Cardiogenic Shock

44
Q

Which of the following are NOT typical signs & symptoms of right-sided heart failure? (Select all that apply)

a.) Jugular venous distention
b.) Persistent cough
c.) Weight gain
d.) Crackles
e.) Nocturia
f.) Orthopnea

A

b.) Persistent cough
d.) Crackles
f.) Orthopnea

44
Q

What are signs & symptoms of cardiogenic shock?

KNOW THIS!!!…IN RED

IN RED

A
  • S3
  • JVD
  • decreased MAP
  • SOB
  • Weak pulse
  • Pale skin
  • Cool hands & feet
  • Decreased urine output
45
Q

A measurement of what percent may be evidence of heart failure or cardiomyopathy?

KNOW THIS!!!…IN RED

IN RED

A

under 40%

45
Q

What is another name for Heart Failure with preserved Ejection Fraction (HFpEF)?

KNOW THIS!!!…IN RED

IN RED

A

Diastolic Heart Failure

46
Q

What is another name for Heart Failure with reduced Ejection Fraction (HFrEF)?

KNOW THIS!!!…IN RED

IN RED

A

Systolic Heart Failure

47
Q

**Explain the 3 KEY signs or symptoms in diastolic heart failure or Heart Failure with preserved Ejection Fraction (HFpEF).

What signs or symptoms are NOT seen in HFpEF?

KNOW THIS!!!…IN RED…per Hayley

IN RED

A

POSITIVE SYMPTOMS:
* * S4 Gallop (+)
* Hypertension (+)
* Dyspnea (+)

Negative Symptoms:
* NO (-) peripheral edema
* NO (-) JVD

47
Q

Explain what is occuring in Systolic Heart Failure or Heart Failure with reduced Ejection Fraction (HFrEF).

KNOW THIS!!!…IN RED..per Hayley

IN RED

A

Decreased cardiac output
Decreased blood pressure
Decreased ejection fraction

47
Q

What are the KEY symptoms of Systolic Heart Failure / Heart Failure with reduced Ejection Fraction (HFrEF)?

KNOW THIS!!!…IN RED…Per HAYLEY

A
  • Dyspnea
  • Fatigue
  • Edema
  • Decreased urine output
  • Cheyne stokes respirations
  • S3 heart sounds (due to fluid overload)
  • JVD (due to fluid overload)
48
Q

What is cardiogenic shock?

KNOW THIS!!!…IN RED

IN RED

A

Failure to pump blood adequately (decreased cardiac output)

  • Most common cause of an MI
  • Ineffective pumping can be caused by mechanical defects, arrhythmias, ventricular aneurysms, or valve dysfunction
49
Q

What is the most common cause of myocardial infarction?

KNOW THIS!!!…IN RED

IN RED

A

Cardiogenic Shock

50
Q

What are signs & symptoms of cardiogenic shock?

KNOW THIS!!!…IN RED

IN RED

A
  • S3
  • JVD
  • decreased MAP
  • SOB
  • Weak pulse
  • Pale skin
  • Cool hands & feet
  • Decreased urine output
51
Q

Explaint he New York Heart Association Functional Classes for Heart Failure

Per Hayley

A
  • Class I: no limitations; no symptoms with ordinary activity (only aware due to diagnostic tests)
  • Class II: slight limitations; symptoms with oridnary activity (start meds (ACEs & ARBs); some symptoms present)
  • Class III: marked limitations; symptoms with less than ordinary activity (hard to get up from chair, etc.; interventions = diuretics, digitalis, fluid restrictions, decreased sodium intake, valve replacements, etc.)
  • Class IV: symptoms of cardiac insuficiency at rest (IV inotrope to support the hear; heart transplant)
52
Q

What does an inotrope impact?What does a chronotrope impact?

KNOW THIS!!!…IN RED

IN RED

A

Inotrope = contractility

Chronotrope = heart rate

53
Q

Explain the difference in positive and negative inotropes.

KNOW THIS!!!…IN RED

IN RED

A

Positive Inotrope = ↑contractility

**Negative Inotrope = ↓ contractility

54
Q

Explain the difference in positive & negative chronotropes.

KNOW THIS!!!…IN RED

IN RED

A

Positive chronotrope = ↑ heart rate

Negative chronotrope = ↓ heart rate (heart won’t have to pump as often)

55
Q

How do ACE Inhibitors work on heart failure? What are the most common symptoms associated with ACE Inhibitors?

KNOW THIS!!!…IN RED

IN RED

A

Vasodilates to ↓afterload & ↓ blood pressure

Symptoms:
* Cough
* Angioedema

56
Q

How do beta blockers work on heart failure?

KNOW THIS!!!…IN RED

IN RED

A

↓ BP & ↓ afterload

  • ↑ heart rate & contractility (heart is more effective at having better cardiac output)
  • Usually taken with an ACE inhibitor
  • Can mask hypoglycemia (S/S = tachycardia)
  • No grapefruit juice
57
Q

How do ANRIs (Angiotensin Receptor-Neprilysin Inhibitors) work on heart failure?

KNOW THIS!!!…IN RED

IN RED

A

Increase the effects of ACE Inhibitors (help prevent conversion of angiotensin I to angiotensin II)

  • Can falsely increase BNP
  • Increases survival rate when used with an ACE Inhibitor vs. an ACE inhibitor being used alone
58
Q

When is Digoxin used for heart failure & how does it work on heart failure? What is the hallmark symptom of digoxin toxicity When is dignoxin held?

KNOW THIS!!!…IN RED

IN RED

A

Slows the heart rate by ↓ SA node activity

  • ↑ cardiac output / ejection fraction & gives heart more time to fill
  • only used in Class III or Class IV (NYHAFC)
  • High toxicity due to narrow therapeutic range

Hallmark of Toxicity = patient sees a yellow halo

HELD when HR < 60 BPM

59
Q

How do diuretics work on heart failure?

KNOW THIS!!!…IN RED

IN RED

A

↓ edema / removes fluid (H2O & Na+)

  • preload of the heart goes back to the normal amount
  • Helps heart pump easier
  • Usually used with ACE or ARB
60
Q

What kind of drug is dobutamine & how does it work on heart failure?

KNOW THIS!!!…IN RED

IN RED

A

Positive inotrope = increases contractility

  • ↑ contractility
  • ↑ cardiac output
61
Q

What are non-pharmacological interventions for heart failure?

Per Hayley

A
  • Omega 3 (fish-oil)
  • Thiamine
  • Exercise
  • Cardiac Resynchronoization Therapy (placing a pacemaker)
  • Advanced therapy (gene-based therapy, heart transplant, etc.)
62
Q

What is Cardiac Resynchronization Therapy (CRT)?

A

placing a pacemaker (only in Class III or Class IV)

63
Q

What kind of murmur is heard when there is valve stenosis vs. valve regurgitation?

KNOW THIS!!!…IN RED

A

Stenotic = murmur of blood shooting through a narrow opening (thickened valve)

Regurgitation: murmur due to blood leaking back through a valve that should be closed

64
Q

What are murmurs related to?

KNOW THIS!!!…IN RED ↑ ↓

IN RED

A

Backward flow through a regurgitatnt valve, septal defect, or patent ductus

65
Q

What are the primary causes of aortic stenosis?

KNOW THIS!!!…IN RED

IN RED

A
  • Congenital heart defects
  • rheumatic heart disease
  • Calcification

Adult Nursing II Exam 3 (7 decks)

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