Heart Failure Flashcards
1
Q
Pathophysiology of Heart Failure
A
Alterations in preload, after load, myocardial contractility and heart rate reducing cardiac output
2
Q
Risk Factors
A
- Congenital Heart Defects
- Hypertension
- Kawasaki Disease
- Infections
- Sepsis
- Drug Use
- Emotional Stress
- Nutritional Deficiencies
3
Q
Signs and Symptoms
A
- Rapid weight gain
- Failure to thrive
- Difficulty feeding
- Dizziness, irritability
- Exercise intolerance
- Shortness of breath
- Sucking then tiring easily
- Syncope
- Decreased number of wet diapers
4
Q
Nursing Assessment: Health History
A
- Be on alert for statements such as:
> The baby drinks a small amount of breast milk (formula) and stops but then wants to eat again
> The baby seems to perspire a lot during feedings
> The baby seems more comfortable when he’s sitting up or on my shoulder than when he’s laying flat - Note any episodes of rapid breathing or grunting
- Ask about history of congenital heart defects and treatments to repair the defect
- Determine current medication regimen
- Ask about any recent or past infections
5
Q
Nursing Assessment: Physical Examination
A
- WEIGH THE CHILD and note rapid weight gain or lack of weight
- Note tachypnea or tachycardia
- Measure BP on upper and lower extremities, comparing the finding for differences
- Note pallor or cyanosis or diaphoresis
- Inspect for edema in face, hands, and lower extremities
- Note increase work of breathing (nasal flaring or retractions)
- Note presence of cough which may be productive with bloody sputum
- Listen to heart sounds noting murmur, gallop, or accentuated third heart sound
- Listen to lungs for crackles or wheezes indicating pulmonary congestion
- Palpate peripheral pulse (weak or thready)
- Note temperature of the extremities (cool, clammy and pale)
- Assess abdomen distention (indicative of ascites)
- Palpate the abdomen to identify hepatomegaly or splenomegaly
6
Q
Nursing Assessment: Laboratory and Diagnostics
A
Labs:
1. CBC (show signs of anemia or infection)
2. Electrolyte levels
3. Arterial Blood Gases
4. Increased lactic acid and decreased bicarbonate level (tissue hypoxia)
Diagnostics
1. Chest Radiograph
2. Electrocardiogram
3. Echocardiogram
7
Q
Nursing Interventions: Promoting Oxygenation
A
- Position the infant/child in a semi-upright position
- Suction as needed
- Chest physiotherapy
- Administer oxygen as needed and monitor oxygen via pulse oximeter
- May require intubation and positive-pressure ventilation to normalize blood gas tension
8
Q
Nursing Intervention: Supporting Cardiac Function
A
- Administer diuretics, ACE inhibitors as prescribed
- Digoxin Therapy
> monitor for prolong PR interval and decreased ventricular rate
> monitor for signs of digoxin toxicity - Measure BP before and after administration of ACE inhibitor
> Notify physician if BP falls more than 15 mm Hg - Observe for signs of hypotension
> lightheadness
> dizziness
> fainting - WEIGH THE CHILD DAILY
- Measure I&Os
- Monitor potassium levels
9
Q
Nursing Intervention: Adequate Nutrition
A
- Infant have an increased metabolic rate associated with heart failure and require more calorie intake*
- Higher calorie intake
- Offer small, frequent feeding if the child can tolerate them
- In acute phase, infants may require continuous or intermittent gavage feedings to maintain or gain weight
10
Q
Nursing Intervention: Promoting Rest
A
- Minimize metabolic needs to decrease cardiac demand
- Ensure adequate time for sleep and attempt to limit disturbing interventions
- Provide age-appropriate activities that can be performed quietly in bed (books, coloring or drawing, video games, board games)
11
Q
Complications
A
- Pulmonary edema
- Organ failure, especially the brain and kidneys
- Myocardial infarction
- Arrhythmias
- Valvular insufficiency
- Sudden cardiac death
