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Critical Care > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Heart failure definition

A

Heart’s inability to meet the oxygenation needs of the body as a result of decreased pumping ability or decreased filling ability or both (biventricular failure)

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2
Q

Precipitating factors of heart failure

A

Anything that decreases supply or increases demand of oxygen

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3
Q

Two types of cardiomyopathy

A

Dilated/congestive (can’t squeeze, associated with fluid volume overload) = systolic failure
Hypertrophic (thickening of ventricular walls and septum, chambers get smaller) = diastolic failure

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4
Q

Normal stroke volume amount

A

About 70 mL

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5
Q

APE TM

A

Aortic valve - 2nd right ICS
Pulmonic valve - 2nd left ICS
Erb’s point - 3rd left ICS
Tricuspid valve - left lower sternal border, 4-5th ICS
Mitral valve (apex) - 5th ICS, left mid clavicular line

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6
Q

List of causes of left ventricular failure:

A

MI
CAD
HTN
Aortic stenosis
Aortic regurgitation
Mitral stenosis
Mitral regurgitation
Cardiomyopathy

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7
Q

List of causes of right ventricular failure

A

Left ventricular failure
Pulmonary HTN
Right ventricular infarct

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8
Q

Characteristics of left ventricular failure

A
  • Decreased cardiac output
  • Increased LVEDV/P (left ventricular end diastolic volume/pressure)
  • Increased left atrial pressure
  • Increased pulmonary venous pressure
  • *Pulmonary interstitial edema
  • Intra-alveolar edema
  • **Cardiogenic pulmonary edema
  • Eventual increased pulmonary artery pressure
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9
Q

Major complication to be on lookout for with left ventricular failure

A

Pulmonary interstitial edema

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10
Q

Major problem with cardiogenic pulmonary edema

A

Can’t suction out because more keeps coming, *pt needs diuretics

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11
Q

Characteristics of right ventricular failure

A

Pulmonary HTN
Increased RVEDV/P
Increased right atrial pressure
Increased systemic venous pressure
Systemic edema

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12
Q

Compensatory mechanisms for heart failure

A
  • SNS - detects drop in CO & makes heart work harder
  • Renin-angiotensin mechanism - makes body hold onto water
  • Atrial/B-type natriuretic hormones - encourage diuresis measured through BNP
  • Tissue necrosis factor
  • Myocardial hypertrophy
  • Ventricular dilation
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13
Q

*Assessment cues for left ventricular heart failure

A

Dyspnea
Orthopnea
Fatigue
Crackles
Cough
Hemoptysis
Cyanosis
Palpitations
Dysrhythmias
Pulsus alternans
S3 heart sounds
Increased PCWP
*Pulmonary edema

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14
Q

Most common dysrhythmia with left ventricular failure

A

Afib

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15
Q

How to treat PCWP

A

Diuretics

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16
Q

Symptom of very severe LVF

A

Hemoptysis (pink frothy sputum)

17
Q

Most life threatening complication of LVF

A

*pulmonary edema

18
Q

Manifestations of pulmonary edema

A

SOB
Dyspnea at rest
Disorientation
Anxiety
Tachycardia
Crackles
Frothy, blood-tinged sputum
Cold, clammy skin
Cyanosis

19
Q

*Signs and symptoms or RVF

A

Increased CVP/RAP
JVD
Hepatojugular reflux
Splenomegaly
Ascites
N/V
Anorexia
Peripheral edema
Weight gain
Nocturia

20
Q

What should you teach pt about weight gain with RVF

A

*weigh themselves every day at same time and report weight gain > 2 lbs in 24 hrs
- to prevent this, take diuretics *as prescribed every time

21
Q

Assessment diagnostics for heart failure

A

CXR
EKG
Echocardiogram
Lab: BNP (used to confirm, higher = worse HF)

22
Q

Non-surgical interventions for acute HF

A

Balance oxygenation and activity:
- intra-aortic balloon pump (IABP)
- left/right ventricular assist device (LVAD)
- fluid and electrolyte balance
- pharmacologic therapy

23
Q

What is involved in fluid and electrolyte balance?

A

Sodium restriction
Fluid restriction
Daily weight
Monitoring potassium levels
Strict intake and output

24
Q

*List of options to treat heart failure

A

Balloon pump
Behavior modification
Batista procedure
Biventricular pacing
Cardiac rehab
Fluid and electrolyte balance
Heart jacket
Implanted cardoiverter defibrillation
Left/right ventricular assist device

25
Q

What does self-management education include for a pt with valvular heart disease

A
  • Disease process and possibility of HF
  • Drug therapy including: diuretics, vasodilators, beta blockers, calcium channel blockers, antibiotics, and anticoagulants
  • The prophylactic use of antibiotics
  • A plan of activity to rest and conserve energy
26
Q

Precautions patients need to adhere to regarding infective endocarditis

A

Pts with defective or repaired valves are at risk so they need to inform all health care providers or valvular heart disease history
- will require antibiotic administration before all invasive dental procedures

27
Q

What will patients who have had valve replacements with prosthetic valves require?

A

Lifetime prophylactic anticoagulation therapy to prevent thrombus formation

28
Q

What should we teach pts taking anticoagulants?

A

Nutritional considerations (if taking warfarin) and prevention of bleeding
*Avoid foods high in vitamin K, especially dark leafy veggies
*Use electric razor to avoid skin cuts
*Report any bruising or excessive bleeding to PCP

29
Q

What should pts who have had valvular surgery avoid?

A

Avoid invasive dental procedures for 6 months because of potential for endocarditis

30
Q

What should pts with prosthetic valves avoid?

A

Any procedure using magnetic resonance unless the newest technology is available

Critical Care (35 decks)

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