Heart Failure

Question 1

Heart Failure

Answer 1

• Pump Failure: chronic inability of heart to work effectively as a pump
• Heat not able to maintain adequate cardiac output to meet metabolic needs of body
• Types:
  > left-sided HF
  > right-sided HF
  > high-output failure
• Most HF begins w/ failure of left ventricle & progresses to failure of both ventricles

Question 2

Causes of Right-Sided HF

Answer 2

• Left ventricle failure
• Right ventricle MI
• Pulmonary HTN
• Chronic lung disease

Question 3

Symptoms of Right-Sided HF

Answer 3

• Systemic Congestion
  > jugular vein distention
  > enlarged liver & spleen
  > anorexia & nausea
  > dependent edema (legs & sacrum)
  > distended abdomen
  > swollen hands & fingers
  > polyuria at night
  > weight gain
  > incrd BP (from excess fluid)
  > dcrd BP (from failure)

Question 4

Left-Sided HF

Answer 4

• Dcrd tissue perfusion from poor cardiac output & pulmonary congestion
• Systolic HR
  > heart can’t contract forcefully enough to eject adequate blood
• Dystolic HF
  > ventricle can not relax adequately during diastole preventing adequate filling of blood

Question 5

Causes of Left-Sided HF

Answer 5

• HTN
• Coronary Artery Disease
• Valvular disease

Question 6

Symptoms of Left-Sided HF

pulmonary congestion

Answer 6

• Hacking cough, worse at night
• Dyspnea
• Crackles/wheezes in lungs
• Pink, frothy sputum
• Tachypnea
• S3/S4 gallop

Question 7

Symptoms of Left-Sided HF

dcrd cardiac output

Answer 7

• Fatigue & weakness
• Oliguria during day
• Nocturia at night
• Angina
• Confusion & restlessness
• Dizziness
• Pallor & cool extremities
• Weak peripheral pulses
• Tachycardia

Question 8

Lab Assessments - HF

electrolytes
BUN & creatinine
H/H
urinalysis
ABGs

Answer 8

• Electrolytes
  > abns from comps of HF or side effects of drug therapy
• BUN & Creatinine
  > inadequate perfusion of kidneys can result in impairment & elevated lvls
• H/H
  > could be low secondary to hemodilution
• Urinalysis
  > possible proteinuria & high specific gravity
  > microalbuminuria: early indicator of dcrd compliance of heart & occurs b4 BNP rises
• ABGs
  > evaluates for hypoxemia
  > dcr in gas exchange secondary to fluid filled aveoli

Question 9

Diagnostic Assessment - HF

lab - BNP
imaging - cxr & echo

Answer 9

• BNP
  > elevated & used for diagnosing HF
  > BNP produced & released by vents when pt has fluid overload
  > natriuretic peptides are neurohormones tht promote vasodilations & diuresis through sodium loss in renal tubules
• Chest X-Ray
  > cardiomegaly (enlarged heart) may be present
• Echocardiography
  > ultrasound of heart
  > best tool in diagnosing HF
  > measures chamber size, ejection fraction, & flow

Question 10

Nursing Interventions for HF

pt 1

Answer 10

• Oxygen
  > above 90%
• Monitor resps & lung sounds
• If dyspnea present, high-Fowler’s position
  > maximize chest expansion & improve oxygenation
• Reposition, cough, & deep breathe q2
  > improve oxygenation & prevent atelectasis
• Drug therapy
  > improve stroke vol: will reduce afterload, reduce preload, & improve cardiac muscle contractility

Question 11

Nursing Interventions for HF

nutrition
fluid
weight
+ more

Answer 11

• Nutrition therapy
  > reduce sodium & water retention (sodium intake as low as 2g/day)
• Fluid Restriction
  > 2-3L/day
• Weigh daily
  > most reliable indicator of fluid gain or loss
  > 1kg of weight gain or loss equal 1L of retained or lost fluid
• Monitor & record I&Os
• Provide periods of uninterrupted rest
• Assess pt’s response to incrd activity