Heart Failure

Question 1

Heart Failure Epidemiology

Answer 1

6.5 million people over age 20

1 million new cases each year

Question 2

Heart failure is based on what?

Answer 2

Based on the ejection fraction

Question 3

What is the normal ejection fraction of a normal healthy adult?

Answer 3

Anywhere between 55-70%

Question 4

What would the ejection fraction be of someone who is in heart failure?

Answer 4

As low as 20%

Question 5

What is it called when we have heart failure on both sides of the heart?

Answer 5

Biventricular Heart Failure

Question 6

What is right sided heart failure?

Answer 6

The inability of the right side of the heart to effectively piump blood to the lungs.

Question 7

What left sided heart failure?

Answer 7

The inability of the left side of the heart to effectively pump blood to the rest of the body

Question 8

Acute heart failure

Answer 8

Something that is sudden; needs to be treated right away.

Question 9

Chronic Heart Failure

Answer 9

Patient had heart failure for a while

The body has the ability to kind of compensate for that.

Question 10

What is a tell tale sign of heart failure?

Answer 10

Weight gaining is a tell tale sign of an exacerbation.

Question 11

What is an important thing to monitor is heart failure patients?

Answer 11

Weight

Check weight daily

Question 12

Heart Failure Risk Factors

Answer 12

C A D,

hypertension,

D M,

metabolic syndrome,

obesity,

smoking,

high sodium intake

African descent

Age- greater than 65

Men greater risk than women

Question 13

Heart Failure: Pathophysiology

Answer 13

Myocardial cell dysfunction

Inability of heart to meet needs of body

Question 14

Heart Failure: Clinical Manifestations

Answer 14

Fatigue
Weight gain
Tachycardia
Hypo or hypertension
Murmurs

Question 15

Heart Failure: Medical Management - Diagnosis

Answer 15

Physical assessment
Chest x-ray
Echocardiogram
ECG
Multigated acquisition scans
Laboratory testing

Question 16

Heart Failure: Medical Management

Treatment

Answer 16

Reduction of risk factors
Manipulation of cardiac output

Question 17

Heart Failure- Medical Management- Medications

Answer 17

Beta blockers
Aldosterone antagonist diuretics
A C E inhibitors
Calcium channel blockers
Digoxin

Question 18

If patient is given digoxin, what needs to be checked?

Answer 18

HR

Question 19

Heart Failure: Surgical Management

Answer 19

Internal cardiac defibrillator

Ventricular assist device

Question 20

What may patients be given to treat heart failure? Why?

Answer 20

Nitroglycerin or vasodilators

Open up the blood vessels

Question 21

Heart Failure- Self-Management

Answer 21

Symptom monitoring
Medication adherence
Lifestyle changes

Question 22

Heart Failure- Complications

Answer 22

Pulmonary edema
Renal failure

Question 23

Heart Failure: Nursing Management- Assessment and Analysis

Answer 23

Signs and symptoms related to weakened cardiac contraction, decreased cardiac output, back up of blood, poor peripheral perfusion

Question 24

Heart Failure: Nursing Diagnoses

Answer 24

Impaired oxygenation
Decreased cardiac output
Ineffective peripheral perfusion

Question 25

Heart Failure: Nursing Interventions – Assessments

Answer 25

Vital signs Breath sounds Monitor rate and rhythm Skin color, temperature, peripheral pulses Dry, persistent cough Activity intolerance Urine output Daily weight Laboratory data Depression screening Social support

Question 26

Heart Failure: Nursing Interventions- Actions

Answer 26

Oxygen therapy Elevate head of bed Administer medication as ordered Fluid and sodium restriction

Question 27

Heart Failure: Teaching

Answer 27

Medication management Maintain activity as tolerated Low-salt diet Daily weight Cardiac rehabilitation Signs and symptoms of worsening heart failure

Question 28

Heart Failure: Evaluating Care Outcomes

Answer 28

Reduced dyspnea Absence of fatigue Participates in activities of daily living Reduced hospitalizations

Question 29

Hypertension: Epidemiology

Answer 29

78 million people in the U S

Question 30

Hypertension: Risk Factors

Answer 30

Race Gender Socioeconomic status

Question 31

Hypertension: Clinical Manifestations

Answer 31

Headaches Chest pain Vision changes Shortness of breath Renal dysfunction Dizziness Fatigue Nosebleeds

Question 32

Hypertension: Medical Management- Diagnosis

Answer 32

Two or more bp readings on >2 office visits

Question 33

Hypertension: Treatment

Answer 33

Lifestyle changes Medications

Question 34

Hypertension: Medications

Answer 34

Diuretics Antihypertensives

Question 35

Hypertension: Lifestyle Management

Answer 35

Weight Diet Alcohol consumption Exercise Stress

Question 36

Hypertension: Complications

Answer 36

Dilated cardiomyopathy Systolic dysfunction Renal failure Stroke Hypertensive crisis

Question 37

Hypertension: Nursing Management- Assessment and analysis

Answer 37

Typically no symptoms until disease is advanced

Question 38

Hypertension: Nursing diagnoses

Answer 38

Risk for ineffective therapeutic regimen management Risk for decreased cardiac output

Question 39

Hypertension: Nursing Interventions – Assessments

Answer 39

Neurological assessment Blood pressure Examination of optic fundi Auscultation for bruits Palpation for edema and pulses Labs B M I and waist circumference

Question 40

Hypertension: Nursing Interventions – Actions

Answer 40

Administer medications as ordered Provide DASH diet

Question 41

DASH diet

Answer 41

1,600 mg sodium restriction

Question 42

Hypertension: Teaching

Answer 42

Adherence to medication regimen Adherence to lifestyle changes Monitor blood pressure at home Signs and symptoms of complications

Question 43

Hypertension: Nursing Management – Evaluating care outcomes

Answer 43

Increased energy Absence of energy, headache, dizziness, vision changes

Question 44

Myocardial Infarction Epidemiology

Answer 44

630,000 deaths per year One in four deaths

Question 45

Myocardial Infarction: Risk Factors

Answer 45

Smoking High L D L Type 2 diabetes Elevated adrenaline Obesity Inactivity Hypertension

Question 46

Myocardial Infarction: Non-modifiable Risk Factors

Answer 46

Male sex Post menopausal women Family History

Question 47

Myocardial Infarction: Clinical Manifestations

Answer 47

Chest pain Shoulder and arm pain `

Question 48

Myocardial Infarction: Medical Management-Diagnosis

Answer 48

Laboratory tests (troponin, etc) Diagnostic testing

Question 49

Myocardial Infarction: Medical Management- Treatment

Answer 49

Maximize oxygenation Control pain Dilate coronary arteries Prevent clots Decrease myocardial workload

Question 50

Myocardial Infarction: Medical Management- Medications

Answer 50

Oxygen Nitroglycerin Aspirin Pain medication

Question 51

Myocardial Infarction: Surgical Management

Answer 51

Coronary artery bypass graft

Question 52

Myocardial Infarction: Complications

Answer 52

Heart failure Arrhythmias

Question 53

Myocardial Infarction: Nursing Management- Assessment and analysis

Answer 53

Signs/symptoms related to lack of oxygen delivery

Question 54

Myocardial Infarction- Nursing Management – Nursing diagnoses

Answer 54

Decreased cardiac output Pain

Question 55

Myocardial Infarction: Nursing Interventions – Assessments

Answer 55

Vital signs and pulse oximetry Characteristics of pain E C G Restlessness Skin color and temperature, peripheral pulses, diaphoresis Urine output Labs

Question 56

Myocardial Infarction: Nursing Interventions – Assessments Post-CABG

Answer 56

HR and BP Hemodynamic monitoring Continuous cardiac monitoring Heart tones Breath sounds and continuous oxygen saturation Core temperature

Question 57

Myocardial Infarction: Nursing Interventions – Actions

Answer 57

Administer oxygen Insert two large-bore IVs Administer medications as ordered Continuous E C G monitoring Bed rest