Heart Failure Flashcards
What is Heart Failure?
- Inability of the heart to pump a sufficient amount of blood to meet the demands of the body.
- When the heart fails, cardiac output decreases and peripheral tissue is not adequately perfused with oxygen and nutrients.
Which side of the heart usually fails first?
Most heart failure begins with failure of the left side and can progress to the right side.
What causes the clinical manifestations of Right-Sided Heart Failure?
The clinical manifestations of right-sided heart failure are related to fluid accumulation of the peripheral tissues.
Right-Sided Heart Failure clinical manifestations?
Blood is backing up through superior/inferior vena cava, so there is too much blood volume in the brain, spleen, kidneys, lower extremities, etc.
Just remember Right HF is fluid accumulation; don’t have to memorize this list
-megaly = irregular enlargement
- Jugular neck vein distention
- Hepatomegaly
- Splenomegaly
- Anorexia/nausea
- Dependent edema (lower extremities)
- Weakness
- Ascites (assess using measuring tape)
- Accumulation of fluid in the peritoneal cavity
- Swollen hands and fingers
- Nocturia
- Weight gain from fluid retention (assess through daily weights, not I&O’s)
- Elevated BP from excess volume (hypervolemia)
What is Edema?
- Usually affects feet and ankles (can progress)
- Swelling is decreased when feet are elevated.
- Edema may be localized (abdomen, periorbital, sacral)
What is Pitting Edema?
- This occurs when indentations are left after pressing of fingertips on the affected skin.
- It is seen after there is at least 10 pounds of fluid gain.
What is Hemtagomegaly?
- There is tenderness in the right upper quadrant secondary to venous engorgement of the liver.
- May lead to hepatic dysfunction.
What can Ascites lead to?
- Increased pressure on stomach and intestines can lead to GI distress.
- Increased pressure on diaphragm leading to respiratory distress
What can cause Anorexia?
Secondary to venous engorgement and venous stasis within abdominal organs
What causes weakness?
- Decreased cardiac output
- Impaired circulation
- Decreased removal of catabolic waste
What the two types of Left-Sided Heart Failure?
- Systolic Failure / Heart Failure with Reduced Ejection Fraction
- Diastolic Failure / Heart Failure with Preserved Ejection Fraction
What is Ejection Fraction?
- Major distinction between both HFs is a decrease in the ejection fraction (less than 45%)
- Normal EF is 55-60%
- Ejection fraction is the amount of the blood that the left ventricle is able to eject from the ventricle.
- The left ventricle is never completely empty after each contraction.
- Ejection fraction can get as low as 5%-10%
Left-Sided Heart Failure clinical manifestations?
The clinical manifestations of left-sided heart failure are related to two distinct dysfunctions:
- Decreased cardiac output
- Pulmonary congestion (blood is backing up into the left ventricle → left atrium → lungs)
Decreased cardiac output manifestations?
- not enough O2 to the tissues! look for neuro manifestations!
- Fatigue
- Weakness (↓ O2 to muscles)
- Confusion (↓ O2 to brain)
- Restlessness
- Dizziness
- Tachycardia (body tries to compensate for ↓ CO)
- Pallor (↓ O2 to tissues)
- Weak peripheral pulses
- Cool extremities
Organ system manifestations of decreased cardiac output?
- Decreased GI perfusion- altered digestion
- Decreased brain perfusion- dizziness, confusion, restlessness, anxiety
- Decreased kidney perfusion- oliguria
- Decreased oxygen saturation levels
Pulmonary congestion manifestations?
fluid is interfering with gas exchange, which leads to compensatory mechanisms
-pnea = breath, respiration
- Hacking cough, worse at night
- Dyspnea on exertion
- Orthopnea
- Crackles
- Wheezes
- Frothy sputum
- Tachypnea
Elaborate on the manifestations of pulmonary congestion (cough, orthopnea, crackles).
- Cough starts as dry and hacking and then can progress to moist (frothy, sputum)
- Orthopnea - can’t lie flat, need pillow to prop and sleep sitting up
- Crackles starts in lower lungs and then moves upward (unrelieved by coughing)
Other than manifestations, how else can you assess for heart failure?
- Family and medical history
- Medication review
- NSAIDS can cause sodium retention → increased blood volume (heart has to work harder to pump extra blood)
- CHF may go undetected until the patient presents with signs and symptoms of pulmonary/peripheral edema.
How is Heart Failure diagnosed?
- Chest x-ray
- Echocardiogram (uses sound to look at the heart)
- Usually performed to confirm diagnosis
- EKG/ECG
- Cardiac catheterization
- Lab studies
- B-type natriuretic peptide (BNP)
- BUN
- Creatinine
- Urinalysis
Heart Failure interventions?
- Provide oxygen as needed
- Monitor weight – report immediately weight gain of 3 lbs. in 2 days or 3-5 lbs. in a week
- Daily weights is the best indicator of fluid loss/gain
- Same scale, same time of day, same amount of clothing
- Small frequent meals
- Activity as tolerated
- Avoid emotional upsets
Why do HF patients need to be on sodium restriction?
To reduce circulating blood volume
What should we educate HF patients about potassium?
- May develop hypokalemia from diuresis so teach regarding food supplements that have a high potassium content.
- Patients may be prescribed a potassium supplement.
- Foods with K+: toes & does (tomatoes, potatoes, avocados, apricots, citrus fruits, raisins)
What are some pharmacologic therapy options used for Heart Failure?
- Diuretics
- Antihypertensives
- Anticoagulants (check INR)
What is INR?
- International Normalization Ratio – measures blood clotting ability – basically how much time it takes for blood to clot.
- Normal INR- 0.8-1.1
- If a person is on anticoagulant therapy like warfarin/Coumadin, an INR will always be obtained.
What does Digitalis (Digoxin) do?
- Indicated for heart failure
- Increases the force of the contraction
- Decreases heart rate (we want them to have a more effective contraction rather than just beating really fast)
- Results in increased cardiac output-positive inotropic.
Describe digoxin toxicity.
- Digoxin has a narrow therapeutic range (very easy to have digoxin toxicity)
- Therapeutic (Normal) digoxin levels are 0.5ng/ml – 2.0 ng/ml.
- Older adults are at a greater risk for toxicity due to normal age-related renal changes.
- Renal and hepatic dysfunction can increase the risk of digoxin toxicity (Dig is excreted by kidneys and metabolized in liver)
Describe Digitalis (Digoxin) in relation to Potassium.
Hypokalemia increases the risk of digoxin toxicity (low K+ causes cells to receive more Dig)
- watch out for diuretics (loop & thiazide loses K+)
S/S of Digoxin Toxicity?
- Anorexia, nausea, vomiting
- Visual disturbances (seeing green or yellow around lights)
- Arrhythmias/dysrhythmias
- Bradycardia
- Heart block
Describe Digoxin nursing considerations in relation to pulse.
- Monitor apical pulse for one full minute before administration.
- Withhold dose and notify healthcare professional if pulse is less the 60 in an adult.
- Also notify if there are any significant changes in rate, rhythm, quality of pulse.
- Instruct patient to take Dig the same time everyday.
Describe Digoxin nursing considerations in relation to IV and electrolytes.
- Observe IV site for redness and irritation. Digoxin can cause extravasation.
- If administered IV, monitor EKG/ECG
- Monitor intake and output daily.
- Assess for fall risks in older adults – dig causes vasodilation
- Evaluate lab values – dig level, potassium
