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326 acute & chronic exam 3 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is Heart Failure?

A
  • 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.
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2
Q

Which side of the heart usually fails first?

A

Most heart failure begins with failure of the left side and can progress to the right side.

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3
Q

What causes the clinical manifestations of Right-Sided Heart Failure?

A

The clinical manifestations of right-sided heart failure are related to fluid accumulation of the peripheral tissues.

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4
Q

Right-Sided Heart Failure clinical manifestations?

A

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)
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5
Q

What is Edema?

A
  • Usually affects feet and ankles (can progress)
  • Swelling is decreased when feet are elevated.
  • Edema may be localized (abdomen, periorbital, sacral)
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6
Q

What is Pitting Edema?

A
  • 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.
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7
Q

What is Hemtagomegaly?

A
  • There is tenderness in the right upper quadrant secondary to venous engorgement of the liver.
  • May lead to hepatic dysfunction.
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8
Q

What can Ascites lead to?

A
  • Increased pressure on stomach and intestines can lead to GI distress.
  • Increased pressure on diaphragm leading to respiratory distress
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9
Q

What can cause Anorexia?

A

Secondary to venous engorgement and venous stasis within abdominal organs

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10
Q

What causes weakness?

A
  • Decreased cardiac output
  • Impaired circulation
  • Decreased removal of catabolic waste
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11
Q

What the two types of Left-Sided Heart Failure?

A
  • Systolic Failure / Heart Failure with Reduced Ejection Fraction
  • Diastolic Failure / Heart Failure with Preserved Ejection Fraction
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12
Q

What is Ejection Fraction?

A
  • 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%
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13
Q

Left-Sided Heart Failure clinical manifestations?

A

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)
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14
Q

Decreased cardiac output manifestations?

A
  • 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
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15
Q

Organ system manifestations of decreased cardiac output?

A
  • Decreased GI perfusion- altered digestion
  • Decreased brain perfusion- dizziness, confusion, restlessness, anxiety
  • Decreased kidney perfusion- oliguria
  • Decreased oxygen saturation levels
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16
Q

Pulmonary congestion manifestations?

A

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
17
Q

Elaborate on the manifestations of pulmonary congestion (cough, orthopnea, crackles).

A
  • 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)
18
Q

Other than manifestations, how else can you assess for heart failure?

A
  • 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.
19
Q

How is Heart Failure diagnosed?

A
  • 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
20
Q

Heart Failure interventions?

A
  • 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
21
Q

Why do HF patients need to be on sodium restriction?

A

To reduce circulating blood volume

22
Q

What should we educate HF patients about potassium?

A
  • 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)
23
Q

What are some pharmacologic therapy options used for Heart Failure?

A
  • Diuretics
  • Antihypertensives
  • Anticoagulants (check INR)
24
Q

What is INR?

A
  • 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.
25
Q

What does Digitalis (Digoxin) do?

A
  • 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.
26
Q

Describe digoxin toxicity.

A
  • 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)
27
Q

Describe Digitalis (Digoxin) in relation to Potassium.

A

Hypokalemia increases the risk of digoxin toxicity (low K+ causes cells to receive more Dig)

  • watch out for diuretics (loop & thiazide loses K+)
28
Q

S/S of Digoxin Toxicity?

A
  • Anorexia, nausea, vomiting
  • Visual disturbances (seeing green or yellow around lights)
  • Arrhythmias/dysrhythmias
    • Bradycardia
    • Heart block
29
Q

Describe Digoxin nursing considerations in relation to pulse.

A
  • 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.
30
Q

Describe Digoxin nursing considerations in relation to IV and electrolytes.

A
  • 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

326 acute & chronic exam 3 (8 decks)

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