Heart Failure Flashcards
Most common type of heart failure
Left sided
HF in which the heart does not have a forceful enough contraction to eject blood
Systolic HF
Measurement of blood leaving the left ventricle and going into circulation
Ejection Fraction (EF)
EF normal range
50-70%
Effects of decreasing EF
Decreased tissue perfusion, accumulation of blood initially in pulmonary vessels, fluid backs-up into pulmonary system causing crackles, dyspnea, etc.
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
Diastolic
Mixed/both systolic and diastolic HF with dilated ventricular wall
Combination HF
Types of left side HF
Systolic, diastolic, combination
Common causes of right-sided HF
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)
___ is the most common reason for hospital admission for people >65
HF
What race is HF more common in?
African Americans under 50
HF etiology
Systemic HTN (increased SVR causes growth of LV —> HF), CAD (plaque —> arterial narrowing —> cardiac ischemia), MI, structural changes such as ventricular remodeling
Right-side HF in the absence of left-side HF is associated with
Pulmonary problems such as COPD, ARDS, sleep apnea, etc.
S/S of L-sided HF
Dyspnea (exertional, paroxysmal nocturnal), fatigue (d/t inadequate perfusion), weakness, arm heaviness, chest pain/palpitations/skipped beats/fast rate, decreased UO, weak pulses
S/S of R-sided HF
JVD, increased abdominal girth (ascites), dependent edema, hepatomegaly, hepatojugular reflux
What kind of HF is associated with increased systemic venous pressures and congestion?
R-sided
Where would dependent edema be assessed in a bedridden patient?
Around the sacrum
What is the most reliable indicator of fluid gain/loss?
Weight
Weight gain to report
> 2 lbs in 24 hr period OR 5 lbs in a week
Inability of both the R and L ventricles to pump effectively
Biventricular HF
Effects of biventricular HF
Fluid build-up and venous engorgement, decreased perfusion to vital organs
Increase in pulmonary venous pressures and engorgement of pulmonary vascular system (lungs lose compliance) caused by LV failure
Acute Decompensated Heart Failure (ADHF)
ADHF patho
Alveoli lining cells are disrupted, fluid with RBCs moves into alveoli causing pulmonary edema
S/S of pulmonary edema
Cyanosis, anxiety (impending doom), pallor, RR>30 w/ use of accessory muscles, wheezing, coughing, orthopnea, frothy pink sputum, tachycardia
ADHF ABGs
low PaO2 + high PaCO2 = respiratory acidosis
Causes of ADHF
Transfusing fluids too quickly, HF with renal insufficiency
CO is insufficient to meet body’s demands
Heart Failure
HF compensatory mechanisms
SNS stimulation (initial mechanism), RAS system activation, chemical responses such as: ventricular remodeling, inflammatory response, production of BNP
Stimulation of SNS patho
Triggered by low CO —> release of epi and norepi. To increase HR, contractility, and systemic vasoconstriction
Effects of SNS compensatory mechanism on HF
Increased cardiac workload and oxygen demand; long-term SNS can worsen HF
Activation of RAAS patho
Low CO causes decreased blood flow to kidneys, activating RAAS —> angiotensin II and aldosterone retain sodium and water increasing preload and afterload
RAAS compensatory mechanism effects on HF
Long term activation can cause edema; angiotensin II contributes to ventricular remodeling
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
Ventricular remodeling
Ventricular remodeling complication
Increased risk for sudden cardiac death
Hormone released by the ventricles in response to fluid overload and HF
B-type natriuretic peptide (BNP)
BNP promotes
Vasodilation and diuresis
Compensatory mechanism characterized by thicken heart muscles
Myocardial hypertrophy
Myocardial Hypertrophy complications
Higher oxygen needs; higher risk for dysrhythmias d/t inadequate coronary circulation
Patients at risk for HF
Family hx, hx of MI, chronic HTN, diabetes, smoking, African Americans, obesity, hyperlipidemia
HF classification resources
NYHA, AHA
NYHA HF classification for patients at high risk for developing HF
Class I
NYHA HF classification for patients w/ cardiac structural abnormalities or remodeling who have NOT developed HF symptoms
Class I
NYHA HF classification for patients with current or prior symptoms of HF
Class II or III
NYHA HF classification for patients with refractory end-stage HF
Class IV
Complications of chronic HF
Pleural effusion, dysrhythmias and dyssychronous contractions, hepatomegaly, cardiorenal syndrome, anemia
Laboratory assessment of chronic HF
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
Imaging assessment for HF
CXR, echocardiography, radionuclide studies, multigated angiography study (MUGA)
Gold standard imaging assessment for HF
Echocardiography
__________ allows for direct assessment of cardiac function and volume status
Hemodynamic monitoring
Short-term mechanical circulatory support devices for HF
Intra-aortic balloon pump (IABP), Extracorporeal membrane oxygenation (ECMO)
Long-term mechanical circulatory support device for HF, often used in clients w/end-stage HF who may not be good candidates for transplant
Ventricular Assist Device (VAD)
Gold standard therapy suitable for patient in end-stage HF
Heart transplant
Heart transplant process
Candidates must undergo a comprehensive physical, diagnostic, and psychological evaluation
Antihypertensives that inhibit the RAAS system
ACE inhibitors (-pril)
Medications administered in HF to block the negative effects of SNS such as tachycardia
Beta Blockers (-olol, metoprolol, etc.)
Nursing consideration for beta blockers
Do not administer if HR<60
First line drugs for HF
ACE inhibitors, BB, ARBs
Medications that help with myocardial ischemia, commonly given if patient is intolerant to ACE inhibitors
Nitrates such as hydralazine
__________ increase cardiac contractility
Positive inotropic agents such as digoxin
Positive inotropic agents are often used in conjunction with
ACE and BB
HCN channel blocker that slows HR to effectively pump more blood; used in severe HF
Ivabradine
Examples of diuretics used in HF
Furosemide (IVP), HCTZ, spironolactone
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
Ultrafiltration or aquaphoresis
Ultrafiltration or aquaphoresis consideration
Patient must be hemodynamically stable
Practice Questions: A nurse is assessing a client with L-side HF. For which clinical manifestations would the nurse assess?
Pulmonary crackles, cough that worsens at night
What kind of HF occurs with a decrease in contractility of the heart or an increase in afterload?
L-sided HF
Most of the signs associated with L-side HF will be noted in the
Respiratory system; S/S include crackles, confusion (d/t decreased oxygenation), and cough
Right ventricular HF is associated with
Pulmonary HTN, edema, and JVD
Example hypotheses for HF
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
Interventions for increasing gas exchange
Elevate HOB, supplemental O2 (starting w/ 2 L and titrate up), treat underlying problem (such as administering diuretics to decrease fluid overload)
Pharmacological interventions for increasing perfusion
Medications such as BB (carvedilol), digoxin
Intervention for preventing and managing pulmonary edema
Limit fluid intake < 2 L/day (or 2000 mL/day)
Standard of care expected of nurses for patients with HF
MAWDS
MAWDS
Medication, Activity, Weight, Diet, Symptoms
HF diet
Sodium restriction (2-3 g/day)
Level of acute care in the home setting
Hospital at Home
Hospital at Home requirements
1 provider visit per day, 2 RN visits per day, one can be in-person and the other can be telehealth
Benefits of Hospital at Home
Reduced risk for falls, pressure ulcers, HAIs; patient’s report better experience; hospitals save on PPE
Gold standard for HF resources
American Heart Association (HF helper app, self-check plan for HF management)
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?
“Weight in the best indication that you are gaining or losing fluid”
1 L of fluid = ? Lbs
2.2 lbs (1 kg)
Assessing tissue perfusion
Capillary refill, pedal and peripheral pulses
Evaluation of effectiveness of HF interventions
Adequate tissue perfusion, increased cardiac pump effectiveness, free of pulmonary edema (clear upon auscultation)
Severe attack of difficulty breathing that awakens an individual, typically within 1-2 hours of falling asleep
Paroxysmal nocturnal dyspnea
