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410 Patho Exam 2 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

These following flashcards are going to be a recap on what we had learn back last year on patho that we are expected to know for this upcoming exam that will include more heart failure things

A
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2
Q

what does heart failure mean ?

A

an abnormal clinical syndrome that involves

inadequate pumping and filling of the heart that results in the inability of the heart to provide enough blood to meet the oxygen needs of the tissues

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3
Q

Heart failure is characterized by decreased cardiac output, which results in what 4 things?

A

decreased tissue perfusion
impaired gas exchange
fluid volume imbalance
activity intolerance

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4
Q

the following terms below are terms we need to know in order to help our understanding of heart failure a little better, so describe/explain each

preload
afterload
contractility
heart rate

A

the amount of volume of blood that sits in your left ventricle ready to be pumped out

the force your heart is needing to pump blood out the body/against something
( like hypertension )

the ability of your muscles fibers in your heart to contract

how fast your heart is beating per minute

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5
Q

true or false
anything that affects your cardiac output can lead or cause heart failure and why?

A

true
because if you’re heart is trying to push more blood so your body can reach a normal level, it will eventually give out and go into heart failure, just like how hypertension causes hypertrophy, sooner or later your body will not be able to function too well with hypertrophy

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6
Q

What tool do we use to help measure the severity of heart failure in patients?

A

ejection fraction

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7
Q

what is ejection fraction ?

A

blood pumped out of ventricle
/
blood left in ventricle

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8
Q

what is normal ejection fraction ?

A

55-65%

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9
Q

what are some risk factors for heart failure ?

A

hypertension
diabetes
advancing age
tobacco use
obesity
high serum cholesterol
myocardial infarction

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10
Q

usually when it comes to heart failure we like to put the risk factors into two categories, what are the two causes of heart failure ?

A

primary causes
precipitating causes

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11
Q

what is a primary cause of heart failure ?
what is the criteria to be a primary cause?
explain to me why this example is a primary cause for heart failure ?

A

myocardial infarction ( heart attack )

conditions that directly damages the heart

the reason why heart attack are primary causes for heart failure is because of the direct tissue damage it causes on the heart before, during and after experiencing a heart attack. think of how before a heart attack your tissue slowly starts to die, then it does die and then it becomes scar tissue. it is a direct damage to the heart.

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12
Q

what is an example of precipitating causes for heart failure?

what is the criteria to be a precipitating cause for heart failure ?

explain to me why the example is a precipitating cause

A

hypertension

conditions that increase workload of the heart

the reason why hypertension is a precipitation cause for heart failure Is because hypertension in itself is causing the heart to pump more blood out because of the intensive vasoconstriction hypertension does. it slowly progresses if left untreated and is sadly one of the main causes of heart failure because patients do not end up knowing or getting well treated for it.

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13
Q

what are the 2 classifications we give to heart failure in order to diagnose, treat and expect from heart failure ?

A

left sided or right sided heart failure

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14
Q

what is the most common heart fault?

A

left sided

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15
Q

right sided heart failure is usually a cause from what ?

A

left sided, its a consequence

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16
Q

most of the time we like to identify heart failure with a systolic and diastolic issue.
explain to me what is systolic issue
explain to me what diastolic issue
for heart failure ?

A

inability for your left ventricle to
empty/pump enough blood during systolic
fill/relax enough blood during diastolic

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17
Q

can you explain to me the patho behind left sided heart failure ?
there are usually 5 steps to this

A
  1. left ventricle dysfunction
  2. blood will end up backing to the left atrium
  3. left atrium goes into the pulmonary veins
    4.pulmonary veins will cause increased pulmonary pressure and will leak into the lungs
    5.causing pulmonary congestion and edema
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18
Q

what do you normally heart in a patient who has pulmonary edema or congestion with left sided heart failure ?

A

crackles in the lungs
- remember the blood isn’t being able to go to the rest of the body so it’ll back up into the lungs and fill the lungs with fluids, sounding like crackles

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19
Q

how do you think we will treat pulmonary edema or congestion for patients with left sided heart failure ?

A

diuretics
typically like furosemide or lasix

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20
Q

what are some typical left sided heart failure symptoms you will see ? (5)

A

pulmonary congestion !!!
- crackles
- blood tinged sputum
extertional dyspnea
fatigue
orthopnea !!!
( when laying down its hard to breathe)
tachycardia
restlessness !!!
paroxysmal nocturnal dyspnea !!!
( random at night its hard to breathe)
elevated pulmonary capillary wedge pressure !!!

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21
Q

what is the patho behind right sided heart failure ?
4 steps

A

1.right ventricular dysfunction
2. blood backs from the right atrium
3. right atrium into the venous circulation
4. resulting in pitting edema or edema elsewhere in the body

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22
Q

what are some common clinical manifestions that are for right sided heart failure?(5)

A

increases peripheral venous pressure
ascites
enlarged liver and spleen !!!
( hepatomegaly and splenomegaly )
distended julgar veins !!!
weight gain !!!
dependent edema !!
anorexia/gi distress !!

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23
Q

what is biventricular failure ?

A

both right and left sided ventricular dysfunction

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24
Q

when you have heart failure, there are a couple of things your body will try to do to help compensate.
we are going to talk about kidneys.
explain to me what the body will do and the name of this mechanism?

A

renin-angiotensin-adolertsone-system
(RAAS)

to understand this we must understand when we aren’t perfusing well, the first organ to go out is the kidneys.
- so in heart failure we aren’t going to be perfusing well so our kidneys will stop working

our kidneys doesn’t know that our heart is the issue, but instead this of it as a low blood pressure issue, so it will try to increase our blood pressure by releasing angiotensin and adolersone

this will help increase our blood pressure by retaining that sodium and water that we can’t/won’t excrete our because of bad perfusion

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25
Q

I dont think we need to know this for the test but something important to note
another compensatory mechanism is the sympathetic nervous system
- baroreceptors sense low arterial pressure
- catecholamines are release
- stimulation of b-adrenergic receptors increase heart rate and ventricular contractility

heart is working harder to try to increase cardiac output

A
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26
Q

Overtime your body will do another compensatory mechanism which is the dilation of the heart
- this will enlarge the heart chambers in order to help push out more blood but also will slowly be caused by the amount of pressure the body is demanding for more blood

this results in the famous what term ____

eventually this mechanism becomes inadequate and actually worsens the cardiac output

A

hypertrophy

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27
Q

another beneficial compensatory mechanism the body will do will help release _____

A

brain natriuretic peptide !

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28
Q

what are the 2 reasons why bnp is being released ?
like what are the 2 causes

A

increased in blood volume
ventricular wall stretching

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29
Q

how does bnp help the body?
helps in 2 ways

A

excretion of water and sodium
vasodilation ( hypotension )

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30
Q

what is a great diagnostic tool we use to help detect heart failure in patients ?

A

bnp

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31
Q

additional important information
the higher the bnp the more likely that the patient has ?

A

severe heart failure

( fluid retention as well )

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32
Q

notes
additional compensatory methods
nitric oxide and prostaglandin
- released from vascular endothelium in response to compensatory mechanism
- causes relaxation of arterial smooth muscle, resulting in vasodilation and decreased after load

A
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33
Q

something in the heart failure key points pdf that dr.brooks put up that I found to be important to help understand the information better is that the body will have compensated heart failure and decompenstated heart failure

what is the difference?

A

compensatory mechanisms support an adequate cardiac output needed for tissue perfusion

decompensated mechanisms are when the mechanism can no longer maintain adequate cardiac output and inadequate tissue perfusion results

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34
Q

at first these compensatory mechanisms work well to maintain cardiac output but over time, chronic stimulation of the RAAS and SNS leads to ?
dont over think it

A

sodium and water retention
inflammatory mediator activity
ventricular remodeling
dysrhythmias

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35
Q

the following flashcards are still going to be about heart failure, the only difference is that now its onto the actual powerpoint that she assigned us for this actual test

A
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36
Q

what is acute decompensated heart failure?

A

sudden increase in symptoms of heart failure with decrease in functional status

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37
Q

can you provide an example on what it means to say a sudden increase in symptoms of heart failure with decrease in functional status for the definition of acute decompensated heart failure?

A

patient will have shortness of breathe
normally but then it will increases so much more to the point that it affects their daily living

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38
Q

acute decompensated heart failure requires what ?

A

escalation of therapy and hospitalization

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39
Q

what is the main cause for patients with heart failure to develop acute decompensated heart failure ?

A

pulmonary congestion and volume overload due to sodium and fluid accumulation

  • bolus of fluids really
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40
Q

what do you see in early acute decompenstated heart failure ? (4)

A

increased pulmonary venous pressure
- patient has pulmonary hypertension
- increase in respiratory rate
- decrease in oxygenation

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41
Q

what do you see later on in acute decompensated heart failure ? (3)

A

insteritial edema
- tachypnea
- shortness of breath

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42
Q

what happens as it progress with the worsen interstitial edema in acute deompenstated heart failure ?(2)

A

alveolar edema - so now in the small alveoli ( lungs )

respiratory acidosis

43
Q

what is one of the first things you will see in a patient who is having acute decompensated heart failure ?

A

pulmonary edema

44
Q

what are some clinical manifestations the patients will present or do when they have pulmonary edema?(4)

A

anxious, paleness
orthopnea
( laying down is very hard cause all the fluid )

paroxysmal nocturnal
( random in the middle of night sob )

crackles

use of accessory muscles

45
Q

pulmonary edema has a very specific cough, what is it ?

A

pink frothy, blood tinged sputum

46
Q

dr.brooks has this slide that shows the most common clinical manifestations patients who have chronic heart failure end up having.
what is the anagram to help remember these very common manifestions you have when you have chronic heart failure ? (5)

A

faces !

fatigue
limitation of actives
cough/chest congestion
edema
shortness of breath

47
Q

I want to mention something so I dont get confused, where do we normally see pulmonary edema ?
pitting edema ?

left or right sided ?

A

left sided - pulmonary
right sided - pitting

48
Q

on the topic of edema, what is the biggest assessment we have to do in order to tell if the diuretic or edema is getting worse ?

and how do we do it ?

A

weight checks

same time and same clothing every day

49
Q

if a patient has a sudden weight gain of ____ in the span of ___it may indicate ___

A

3 pounds (1.4kg)
2 days
acute decompensated heart failure/ an exacerbation of chronic heart failure

50
Q

dr.brooks brings up a good issue on edema.
we understand that edema Is an issue with sodium and water retention because our kidneys are not getting perfused.

however during the night, we know patients end up having noctuira, even though they have edema, how does this make sense?

A

because during the day and being active, patients are normally walking around and the fluid is fighting gravity, usually it goes down to the feet and legs

however when its night time, resting time, the patients are laying down, they aren’t fighting that gravity, so it will even out and reach the kidneys to be excreted

51
Q

this flashcards you are going to have to identify the respected symptom that is associated with the system, so what do we expect to see with a patient who has chronic heart failure ?

skin related
neurological
mental status
sleeping
cardiac
renal

A

dusky color, mottling, shiny, swollen,decreased hair growth, brown areas on lower legs

dizziness, syncope (fainting)

confusion
altered sleep because they can’t sleep
chest pain

nocturia and edema

52
Q

what are the 5 main complications of heart failure ?

and explain how each one is affected by heart failure
Think of your compensatory mechanism failing !
Pe,D, h, RF, A

A

pleural effusion
- fluid going into the pleural cavity because of the back of blood

dysrhythmias
- heart is working overtime to try to get blood through and can strain it

hepatomegaly
- edema and enlargement of liver

renal failure
(cardioreneal syndrome )
- not that your kidneys dont work, its because perfusion is being focused on the heart and taken away from the kidneys

anemia
- from the kidneys not working, it won’t create rbcs

53
Q

what are some diagnostic studies we can do for patients to help diagnose heart failure?

best one ?

A

echocardiogram
( shows the picture of the heart )

ekg, 6-mintue walk,

BNP levels !!!

54
Q

what does the elevated bnp tell us about your heart failure ?

A

the severity of the stretching your heart fibers have done in order to try to compensate

55
Q

additional information
TROPONION LEVELS DONT TELL HEART FAILURE THEY TELL WHAT?

A

heart attacks!

56
Q

what some basic goals therapy to help patients with acute decompensated heart failure ?

A

symptom relief
optimizing volume status
support oxygenation
avoid complications

57
Q

the following are going to be interventions we are going to do for these patients of acute decompenstated heart failure
what are we going to monitoring ?
- basic things dont over think it

A

vital signs
oxgenation
weight
urinary output

58
Q

why are we going to place the patient in a high fowlers position instead of a semi fowlers?

A

to help with breathing because more than likely semi fowlers, if they have pulmonary edema will be very hard to breathe

59
Q

if the patient with ADHF has extreme trouble trying to breathe on their own, sometimes we can place these patients on what?

A

BIPAP or mechanical ventilation

60
Q

If a heart failure patient is receiving diuretics to aid with their edema, and the patient is not responding will the the diuretics, what is another method of treatment we can use to help try to get rid of fluid ?

A

ultrafiltration (aquapheresis)

61
Q

what does ultrafiltration (aquaphereis) do?

A

think of it as a dialysis machine
- it takes your blood and removes the additional fluid and goes back in

helps with edema

62
Q

sometimes patients who have heart failure may have a lot of damage and it takes a lot for them to pump blood in their heart, we can use 2 mechanical cardiac assisted devices, what are they ?

A

intra aortic ballon pump (IABP)
ventricular assisted devices (VADs)

63
Q

what does an intra aortic ballon pump do?

what does a ventricular assisted device do ?

A

balloon that is inserted into the aorta and is blown up to match the timing of when the heart is pumping blood in order to restore and aid with cardiac function

its an implanted motor machine that pretty much is pumping the heart adequately for the patient
- its continuous

64
Q

what are the medications/drug therapy we are going to be doing for patients who have acute decompensated heart failure ? (7)

A

ace inhibitors/arbs
beta blockers
vasodilators
positive inotropic agents
morphine
diuretics
inhibitor of cardiac sinus node

65
Q

how is diuretics going to help patients who have acute decompensated heart failure ?

give an example of the medication name ?

what 2 things we are monitoring ?

A

decrease volume overload (preload)
- reducing edema

furosemide

hypokalemia & ringing in hearing

66
Q

how are vasodilators going to help patients who have acute decompensated heart failure ?

give medication name ?

side effects?

A

reduce circulating blood volume and improve coronary artery circulation
- hypotensive effects, relaxing

nitroglycerin

hypotension

67
Q

how is morphine going to help a patient who has acute decompensated heart failure ?

monitor for what?

A

reduce the amount of blood that is needed to fill the left ventricle

reduce the amount of force for blood to leave the left ventricle

pain

respiratory depression

68
Q

how does positive inotropes help patients with acute decompenstatred heart failure ?

what is the down side ?

example of medications ?

A

increase contractility

can cause dysrhythmias and increase cardiac oxygen demand

dopamine, digoxin

69
Q

how does beta blockers help patients with acute decompenstated heart failure ?

watch out for ?

A

decreased after load and preventing ventricular remodeling

hypotension

70
Q

what do you need to watch out for when giving a patient an ace/arb and aldosterone antagonist ?

A

hyperkalemia

71
Q

why do you think we give patients oxygen therapy when they have chronic heart failure ?

A

because it helps relieve the fatigue of their shortness of breathe and overall relieve the dyspnea that comes with heart failure

72
Q

why do we tell patients they need to monitor their physical and exercise ?

A

because moving can take a lot of energy and oxygen

so we tell them to rest

73
Q

we tell patients after any conditions or leaving the hospital with heart failure to go to a cardio rehab, why ?

A

it helps build structure in their lives and aid with any issues with breathing and condition

74
Q

what is an inhibitor of cardiac sinus node medication and what does it do?

A

ivabradine (corlanor)
lowers your heart beat and decrease your oxygen demand

75
Q

it is fairly common for patients who have heart failure to experience dysrthymias, however we like to avoid that by giving them what 2 things ?

A

ICD
implantable cardioverter-defib
bioventricular pacing resynchronization therapy
( CRT )

76
Q

what type of diet are patients with heart failure going to be on?

A

low sodium diet

dash diet is always a good method too
- fresh fruits and vegs
- cutting down on salt intake

77
Q

another nutritional thing that Is not too common in patients in that we may need to do a fluid restriction for end stage heart failure

what is the restriction number ?

what are a common symptom ?

how do we aid?

when do we normally give most of their fluids and are tryin to prevent ?

A

less than 2L of fluids

dry mouth

ice chips, gum, hard candy, ice pops

2/3s during the morning and afternoon
1/3 during dinner time
- prevent them from moving so much and needing to pee during the night

78
Q

the following flashcards are on the next video of heart failure, I believe this is more so what we do for the patient and tell the patient.

A
79
Q

the first thing we are going to ask a patient is what for heart failure ?
dont over think it
nursing assessment based

A

past health history
- any cardiac history
- any medications they are on ?

any of the following symptoms of changes that have recently occurred
baseline, any symptoms, change of diet, ankle swelling, nausea/vomiting
weight gain, increase urintating at night, constipation, dyspnea, palpitations
change in the number of pillows, insomnia, waking up difficulty breathing, chest pain, abdominal discomfort

objective
- edema, palpitations, crackles, pink frothy sputum

80
Q

what type of electrolytes/labs are we mainly looking at for heart failure ? (2)

A

potassium - heart/cardiac function
sodium - retention/fluid volume

81
Q

the best way to test renal function ?

A

urinary output!

82
Q

chronic heart failure
overall goals
- decrease In symptoms
- decrease in peripheral edema
- increase in exercise toleranance
- adherence of the treatment plan
- no complications related to heart failure

A
83
Q

why do we want to promote health for patents who have heart failure ?

A

communication with patients and family to educate on how to prevent worsening of heart failure and those who dont have it, how to prevent it

84
Q

it is recommended that any patient who has heart failure to get what 2 vaccinations?

A

flu and pneumonia vaccines yearly

85
Q

its important to understand the heart failure is a ______, so we must educate to patients and family

A

progressive disease

86
Q

since heart failure is a progressive disease, the patient must understand that overall time, its only going to get worse, however, the nurse must educate to the patient on how to ?

A

slow down the progression and importance on the adherence to treatment regime

87
Q

chronic heart failure NOTES
most of this is re-emphaizing
nursing intervention
- monitor respiratory status
- administers oxygen therapy
-semi fowlers position
- monitor hemodynamic status
- daily weights
-intput and oxygen
-administer prescribed drugs
- monitor edema
- alternate rest with activity
- provide diversionary activities
- monitor response to activity
- collaborate with OT/PT to help with energy
- reduce anxiety
- evaluate support system
- patient teaching

A
88
Q

dr.brooks mentioned how patients with heart failure tend to be readmitted again because it is progression, so its important to ?

dont over think it

A

teach the patient how to avoid readmission and slow down the disease

89
Q

when should the patient call the doctor ?
(6)

A

edema gets worse
dyspnea gets worse
weight gains
shortness of breathe worse
chest pain
activity intolerance

90
Q

digoxin is the most important medication to tell the patients about drug toxicity levels. it does not take a lot for it to go from therautpic to toxic.
so what signs of toxicity will we tell patients to watch out for ?

A

nausea/vomitting
halo lights ( vision disturbances )

91
Q

digoxin is also one of those medications that must be taken at a certain what ?

and why is that?

and if patients are going to be prescribed this medication, what do we tell them to do before hand ?

A

heart rate above 60

because it will lower your heart rate

how to take pules for a full minute

92
Q

its very important to tell patients when they are on medications like diuretics and ace/arbs/aldosteronie medications to watch for potassium levels.
which one hypokalemia
which one hyperkalmiea

A

diuretics is hypokalemia
ace/arbs/aldosterone hyperkalemia

93
Q

on the topic of hypokalemia for diuretics and hyperkalemia for ace and arbs and aldosterone, we want to encourage a good diet that follows which ever they are losing

so lets say they are on a diuretic, what type of foods should we encourage?

lets say they are on an ace/arbs and aldosterone, what foods should we discourage ?

A

bananas, orange juice,cantalope, sweet potatoes

no potassium food/ limit

94
Q

Dr.brooks doesn’t want us to worry too much on like stages of heart failure
STAGE 1 - no symptoms
STAGE 4 - severe symptoms
STAGE A - alright functioning
STAGE D - bad functioning

the more you progress in the stages the more likely they need what?

A

more treatment they need to be back on track or have a somewhat normal life

95
Q

patients who have heart failure usually end up having how long ___year survival rate?

its very sad, but sometimes we have to talk about advanced directives, hf therapies, palliative care and hospice

A

5

96
Q

notes
chronic heart failure
evaluation
expected outcomes
- maintain adequate gas exchange
- maintain adequate blood pumped
- reduction of edema
- realistic program of activities

A
97
Q

heart transplant is the ___standard for suitable for some patients in end stage heart failure

A

gold

98
Q

heart transplant
stable patients go home
unstable patients stay in the hospital

A
99
Q

posttransplantation monitoring
- rejection
- infection
- immunosuppressive therapy
- risk for cancer

A
100
Q

why do we do endomycocardial biopsy ?
how often do we do it?

A

to help tell if the patient new heart is doing well and signs of rejection

weekly first month
monthly for the next 6 months
every year after that

101
Q

notes
nursing care focuses on
- promoting patient adaptation to the transplant process
- monitoring cardiac function
- detecting subtle signs of symptoms of complications
- managing lifestyles
- providing ongoing teaching

A
102
Q

A patient with a history of chronic heart failure is hospitalized with severe dyspnea and a dry, hacking cough. Assessment findings include pitting edema in both ankles, BP 170/100 mm Hg, pulse 92 beats/min, and respirations 28 breaths/min. Which explanation, if made by the nurse, is most accurate?

A. “The assessment indicates that venous return to the heart is impaired, causing a decrease in cardiac output.”

B. “The manifestations indicate impaired emptying of both the right and left ventricles, with decreased forward blood flow.”

C. “The myocardium is not receiving enough blood supply through the coronary arteries to meet its oxygen demand.”

D. “The patient’s right side of the heart is failing to pump enough blood to the lungs to provide systemic oxygenation.”

A

B. “The manifestations indicate impaired emptying of both the right and left ventricles, with decreased forward blood flow.”

Reason
It talks about both side on edema so both sides of the ventricles are failing

103
Q

A patient with left-sided heart failure is prescribed oxygen at 4 L/min per nasal cannula, furosemide (Lasix), spironolactone (Aldactone), and enalapril (Vasotec). Which assessment should the nurse complete to best evaluate the patient’s response to these drugs?

A. Observe skin turgor.
B. Auscultate lung sounds.
C. Measure blood pressure.
D. Review intake and output.

A

B. Auscultate lung sounds.

Reason because we are thing to get rid of the pulmonary edema

104
Q

The home care nurse visits a patient with chronic heart failure who is taking digoxin (Lanoxin) and furosemide (Lasix). The patient reports nausea and vomiting. Which action is most appropriate for the nurse to take?

A. Perform a dipstick urine test for protein.

B. Notify the health care provider immediately.

C. Have the patient eat foods high in potassium.

D. Ask the patient to record a weight every morning.

A

B. Notify the health care provider immediately.

Reason toxicity

410 Patho Exam 2 (7 decks)

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