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54/64 Unit 1 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Most common type of heart failure

A

Left sided

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2
Q

HF in which the heart does not have a forceful enough contraction to eject blood

A

Systolic HF

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3
Q

Measurement of blood leaving the left ventricle and going into circulation

A

Ejection Fraction (EF)

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4
Q

EF normal range

A

50-70%

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5
Q

Effects of decreasing EF

A

Decreased tissue perfusion, accumulation of blood initially in pulmonary vessels, fluid backs-up into pulmonary system causing crackles, dyspnea, etc.

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6
Q

HF in which the left ventricular ejection fraction may still be preserved, but left ventricle stiffens and loses compliance over time causing inadequate ventricular filling

A

Diastolic

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7
Q

Mixed/both systolic and diastolic HF with dilated ventricular wall

A

Combination HF

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8
Q

Types of left side HF

A

Systolic, diastolic, combination

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9
Q

Common causes of right-sided HF

A

Clients with L-sided HF that progresses to biventricular HF, MI in coronary arteries on R side of heart, inability of R ventricular to empty completely (causing systemic congestions and pulmonary edema)

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10
Q

___ is the most common reason for hospital admission for people >65

A

HF

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11
Q

What race is HF more common in?

A

African Americans under 50

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12
Q

HF etiology

A

Systemic HTN (increased SVR causes growth of LV —> HF), CAD (plaque —> arterial narrowing —> cardiac ischemia), MI, structural changes such as ventricular remodeling

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13
Q

Right-side HF in the absence of left-side HF is associated with

A

Pulmonary problems such as COPD, ARDS, sleep apnea, etc.

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14
Q

S/S of L-sided HF

A

Dyspnea (exertional, paroxysmal nocturnal), fatigue (d/t inadequate perfusion), weakness, arm heaviness, chest pain/palpitations/skipped beats/fast rate, decreased UO, weak pulses

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15
Q

S/S of R-sided HF

A

JVD, increased abdominal girth (ascites), dependent edema, hepatomegaly, hepatojugular reflux

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16
Q

What kind of HF is associated with increased systemic venous pressures and congestion?

A

R-sided

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17
Q

Where would dependent edema be assessed in a bedridden patient?

A

Around the sacrum

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18
Q

What is the most reliable indicator of fluid gain/loss?

A

Weight

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19
Q

Weight gain to report

A

> 2 lbs in 24 hr period OR 5 lbs in a week

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20
Q

Inability of both the R and L ventricles to pump effectively

A

Biventricular HF

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21
Q

Effects of biventricular HF

A

Fluid build-up and venous engorgement, decreased perfusion to vital organs

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22
Q

Increase in pulmonary venous pressures and engorgement of pulmonary vascular system (lungs lose compliance) caused by LV failure

A

Acute Decompensated Heart Failure (ADHF)

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23
Q

ADHF patho

A

Alveoli lining cells are disrupted, fluid with RBCs moves into alveoli causing pulmonary edema

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24
Q

S/S of pulmonary edema

A

Cyanosis, anxiety (impending doom), pallor, RR>30 w/ use of accessory muscles, wheezing, coughing, orthopnea, frothy pink sputum, tachycardia

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25
Q

ADHF ABGs

A

low PaO2 + high PaCO2 = respiratory acidosis

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26
Q

Causes of ADHF

A

Transfusing fluids too quickly, HF with renal insufficiency

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27
Q

CO is insufficient to meet body’s demands

A

Heart Failure

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28
Q

HF compensatory mechanisms

A

SNS stimulation (initial mechanism), RAS system activation, chemical responses such as: ventricular remodeling, inflammatory response, production of BNP

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29
Q

Stimulation of SNS patho

A

Triggered by low CO —> release of epi and norepi. To increase HR, contractility, and systemic vasoconstriction

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30
Q

Effects of SNS compensatory mechanism on HF

A

Increased cardiac workload and oxygen demand; long-term SNS can worsen HF

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31
Q

Activation of RAAS patho

A

Low CO causes decreased blood flow to kidneys, activating RAAS —> angiotensin II and aldosterone retain sodium and water increasing preload and afterload

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32
Q

RAAS compensatory mechanism effects on HF

A

Long term activation can cause edema; angiotensin II contributes to ventricular remodeling

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33
Q

Chemical response that occurs in HF and MIs in which myocytes become hypertrophied (large, misshapen) and do not contract as well causing more problems within the heart

A

Ventricular remodeling

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34
Q

Ventricular remodeling complication

A

Increased risk for sudden cardiac death

35
Q

Hormone released by the ventricles in response to fluid overload and HF

A

B-type natriuretic peptide (BNP)

36
Q

BNP promotes

A

Vasodilation and diuresis

37
Q

Compensatory mechanism characterized by thicken heart muscles

A

Myocardial hypertrophy

38
Q

Myocardial Hypertrophy complications

A

Higher oxygen needs; higher risk for dysrhythmias d/t inadequate coronary circulation

39
Q

Patients at risk for HF

A

Family hx, hx of MI, chronic HTN, diabetes, smoking, African Americans, obesity, hyperlipidemia

40
Q

HF classification resources

A

NYHA, AHA

41
Q

NYHA HF classification for patients at high risk for developing HF

A

Class I

42
Q

NYHA HF classification for patients w/ cardiac structural abnormalities or remodeling who have NOT developed HF symptoms

A

Class I

43
Q

NYHA HF classification for patients with current or prior symptoms of HF

A

Class II or III

44
Q

NYHA HF classification for patients with refractory end-stage HF

A

Class IV

45
Q

Complications of chronic HF

A

Pleural effusion, dysrhythmias and dyssychronous contractions, hepatomegaly, cardiorenal syndrome, anemia

46
Q

Laboratory assessment of chronic HF

A

Serum electrolytes (potassium), low H&H (diluted d/t fluid retention), elevated BNP, urine dilute if diuresing but concentration if HF with renal insufficiency, respiratory acidosis (trapping of CO2). Other assessments: BUN/creatinine, magnesium

47
Q

Imaging assessment for HF

A

CXR, echocardiography, radionuclide studies, multigated angiography study (MUGA)

48
Q

Gold standard imaging assessment for HF

A

Echocardiography

49
Q

__________ allows for direct assessment of cardiac function and volume status

A

Hemodynamic monitoring

50
Q

Short-term mechanical circulatory support devices for HF

A

Intra-aortic balloon pump (IABP), Extracorporeal membrane oxygenation (ECMO)

51
Q

Long-term mechanical circulatory support device for HF, often used in clients w/end-stage HF who may not be good candidates for transplant

A

Ventricular Assist Device (VAD)

52
Q

Gold standard therapy suitable for patient in end-stage HF

A

Heart transplant

53
Q

Heart transplant process

A

Candidates must undergo a comprehensive physical, diagnostic, and psychological evaluation

54
Q

Antihypertensives that inhibit the RAAS system

A

ACE inhibitors (-pril)

55
Q

Medications administered in HF to block the negative effects of SNS such as tachycardia

A

Beta Blockers (-olol, metoprolol, etc.)

56
Q

Nursing consideration for beta blockers

A

Do not administer if HR<60

57
Q

First line drugs for HF

A

ACE inhibitors, BB, ARBs

58
Q

Medications that help with myocardial ischemia, commonly given if patient is intolerant to ACE inhibitors

A

Nitrates such as hydralazine

59
Q

__________ increase cardiac contractility

A

Positive inotropic agents such as digoxin

60
Q

Positive inotropic agents are often used in conjunction with

A

ACE and BB

61
Q

HCN channel blocker that slows HR to effectively pump more blood; used in severe HF

A

Ivabradine

62
Q

Examples of diuretics used in HF

A

Furosemide (IVP), HCTZ, spironolactone

63
Q

Option for volume overload or fluid retention used in patients who do not response well to diuretics or who have major pulmonary or systemic overload; removes salt and water from patient’s blood

A

Ultrafiltration or aquaphoresis

64
Q

Ultrafiltration or aquaphoresis consideration

A

Patient must be hemodynamically stable

65
Q

Practice Questions: A nurse is assessing a client with L-side HF. For which clinical manifestations would the nurse assess?

A

Pulmonary crackles, cough that worsens at night

66
Q

What kind of HF occurs with a decrease in contractility of the heart or an increase in afterload?

A

L-sided HF

67
Q

Most of the signs associated with L-side HF will be noted in the

A

Respiratory system; S/S include crackles, confusion (d/t decreased oxygenation), and cough

68
Q

Right ventricular HF is associated with

A

Pulmonary HTN, edema, and JVD

69
Q

Example hypotheses for HF

A

Decreased gas exchange d/t ventilation/perfusion imbalance, potential for decreased perfusion d/t inadequate CO, potential for pulmonary edema d/t L-sided HF

70
Q

Interventions for increasing gas exchange

A

Elevate HOB, supplemental O2 (starting w/ 2 L and titrate up), treat underlying problem (such as administering diuretics to decrease fluid overload)

71
Q

Pharmacological interventions for increasing perfusion

A

Medications such as BB (carvedilol), digoxin

72
Q

Intervention for preventing and managing pulmonary edema

A

Limit fluid intake < 2 L/day (or 2000 mL/day)

73
Q

Standard of care expected of nurses for patients with HF

A

MAWDS

74
Q

MAWDS

A

Medication, Activity, Weight, Diet, Symptoms

75
Q

HF diet

A

Sodium restriction (2-3 g/day)

76
Q

Level of acute care in the home setting

A

Hospital at Home

77
Q

Hospital at Home requirements

A

1 provider visit per day, 2 RN visits per day, one can be in-person and the other can be telehealth

78
Q

Benefits of Hospital at Home

A

Reduced risk for falls, pressure ulcers, HAIs; patient’s report better experience; hospitals save on PPE

79
Q

Gold standard for HF resources

A

American Heart Association (HF helper app, self-check plan for HF management)

80
Q

Practice Question: A nurse cares for a client with R-sided HF. The client asks “why do I need to weigh myself everyday?” How would the nurse respond?

A

“Weight in the best indication that you are gaining or losing fluid”

81
Q

1 L of fluid = ? Lbs

A

2.2 lbs (1 kg)

82
Q

Assessing tissue perfusion

A

Capillary refill, pedal and peripheral pulses

83
Q

Evaluation of effectiveness of HF interventions

A

Adequate tissue perfusion, increased cardiac pump effectiveness, free of pulmonary edema (clear upon auscultation)

84
Q

Severe attack of difficulty breathing that awakens an individual, typically within 1-2 hours of falling asleep

A

Paroxysmal nocturnal dyspnea

54/64 Unit 1 (9 decks)

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