Heart Failure Flashcards

1
Q

What is Heart failure?

Inadequate ______ or _______ of heart

A

Inadequate pumping or filling of heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are four things that cause heart failure?

  1. _______-amount of blood sitting in the heart during diastole
  2. ________-amount of resistance that the left ventricle has to overcome in order to get blood out of heart (Ex: If afterword elevated it is hard for blood to get out ultimately causing heart failure).
  3. ____________-contractility of Myocardial regardless of fluid volume
  4. ___________-(too fast or too slow over time)
A
  1. Preload-amount of blood sitting in the heart during diastole
  2. Afterload-amount of resistance that the left ventricle has to overcome in order to get blood out of heart (Ex: If afterword elevated it is hard for blood to get out ultimately causing heart failure).
  3. Myocardial contractility-contractility of Myocardial regardless of fluid volume
  4. Heart rate-(too fast or too slow over time)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

_______ = Amount (in %) of blood ejected from the ventricle

_______ = Amount of blood in the ventricle prior to ejection

(Stroke volume) ÷ (End-diastolic volume) =

A

Amount (in %) of blood ejected from the ventricle (Stroke volume)
÷
Amount of blood in the ventricle prior to ejection (End-diastolic volume)
=
ejection fraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Types of Heart Failure

_____ sided-Blood backs up in ______atrium/Pulmonary veins.
Manifested by: Pulmonary congestion/edema

_______ sided heart failure-blood backs up into the _______ atrium/venous circulation.
Manifested by: JVD, Hepatomegaly, Ascites, Vascular congestion GI tract, Peripheral edema, scrotal edema

A

Left sided-Blood backs up in left atrium/Pulmonary veins.
Manifested by: Pulmonary congestion/edema

Right sided heart failure-blood backs up into the right atrium/venous circulation.
Manifested by: JVD, Hepatomegaly, Ascites, Vascular congestion GI tract, Peripheral edema, scrotal edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

______ sided heart ❤️ failure Signs/Symptoms

Paroxysmal Nocturnal Dyspnea
Pulmonary Congestion (Cough, Crackles, Wheeze, Blood-Tinged Sputum, Tachypnea)
Restlessness
Confusion
Orthopneic
Exertional Dyspnea
Fatigue
Cyanosis

A

Left

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Left or Right sided heart failure s/s

  1. Paroxysmal Nocturnal Dyspnea
  2. Fatigue
  3. Increase Peripheral Venous Pressure
  4. Pulmonary Congestion (Cough, Crackles, Wheeze, Blood-Tinged Sputum, Tachypnea)
  5. Ascites
  6. Restlessness
  7. Confusion
  8. Enlarged liver & spleen
  9. Distended Jugular Veins
  10. Orthopneic
  11. Anorexia & Compliants of GI distress
  12. Exertional Dyspnea
  13. Swelling in hands and fingers
  14. Fatigue
  15. Cyanosis
  16. Dependent edema (feet…also in hands)
A

L 1. Paroxysmal Nocturnal Dyspnea
Both 2. Fatigue
R 3. Increase Peripheral Venous Pressure
L 4. Pulmonary Congestion (Cough, Crackles, Wheeze, Blood-Tinged Sputum, Tachypnea)
R 5. Ascites
L 6. Restlessness
L 7. Confusion
R 8. Enlarged liver & spleen
R 9. Distended Jugular Veins
L 10. Orthopneic
R 11. Anorexia & Compliants of GI distress
L 12. Exertional Dyspnea
R 13. Swelling in hands and fingers
Both 14. Fatigue
L 15. Cyanosis
R 16. Dependent edema (feet…also in hands)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

_____ sided heart ❤️ failure Signs/Symptoms
~~~
Fatigue
Increase Peripheral Venous Pressure
Ascites
Enlarged liver & spleen
Distended Jugular Veins
Anorexia & Compliants of GI distress
Swelling in hands and fingers
Dependent edema (feet…also in hands)
~~~

A

Right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

____________ = Enlargement of the right side of the heart as a result of Pulmonary hypertension (as is the case sometimes with COPD patients)

Note: Right sided failure that results from left sided failure is NOT the same thing

A

“cor pulmonale”.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Typically diagnosed in OUTPATIENT setting
Marked by periods of ACUTELY &/OR SLOWLY worsening cardiac function.
Often the consequence of damage caused by other cardiac events or disease, regardless of whether manifested as an acute event.

A

chronic heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Typically diagnosed in INPATIENT setting
Worsening CHRONIC health failure s/s requiring URGENT therapy
A LIFE-THREATENING condition requiring acute interventions
Typically present with SOA due to excess fluid caused by CARDIAC OVERLOAD.

A

acute decompensated heart failure (ADHF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do we diagnose heart failure? (6)

A

History & Physical exam
EKG
BNP & ProBNP (helps distinguish HF from other sources of Dyspnea). Most dyspneic patients w/HF have BNP >400
CxR (may see cardiomegaly & pleural effusion if HF)
Echo (including EF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the correlation with symptoms of heart failure & BNP levels

A

The higher the BNP levels the more symptomatic the patient.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Collaborative care for CHRONIC heart failure

A

Treat underlying cause (Ex: HTN, give antihypertensives)
Oxygen therapy (2-6 L/min per NC). Helps relieve dyspnea/fatigue.
Rest-activity periods
Daily weights
Sodium restricted diets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Collaborative care for CHRONIC heart failure (cont)

A
Drug Therapy 
ACE 
ARBS
Beta Blockers 
Diuretics 
Nitrates
Cardiac glycosides (Digoxin)-A positive inotrope thar increases contractility. A negative chronotrope that slows the heart rate. Therefore enhancing cardiac output.
Left Ventricular assist device (LVAD)
Heart transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why is Spironolactone specific to heart failure?

Used for suppression of ___________ to help with offloading of Left ventricle

Associated with __creased hospitalizations & cardiac _____

Teach patients this is a _________ sparing diuretic.

Watch carefully for _______kalemia and worsening _________

A

Used for suppression of sodium/water retention to help with offloading of Left ventricle

Associated with decreased hospitalizations & cardiac death

Teach patients this is a potassium sparing diuretic.

Watch carefully for HYPERkalemia and worsening renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Nursing Implications when giving Digoxin?

Monitor serum ___________ levels

Digitalis + ______kalemia (dig toxicity, cardiac dysfunction, serios dysrhythmias)

S/S of digitalis toxicity-Bradycardia, H/A, dizziness,confusion, nausea, visual disturbances (blurry/Yellow vision)

Take ________ for FULL minute prior to administration digoxin
HOlD if ______ below ________

ANTIDOTE for digitalis toxicity-Digoxin immune Fab (_________) given IV

Patient education very important taking own ______

A

Monitor serum potassium levels-

Digitalis + hypokalemia (dig toxicity, cardiac dysfunction, serios dysrhythmias)

S/S of digitalis toxicity-Bradycardia, H/A, dizziness,confusion, nausea, visual disturbances (blurry/Yellow vision)

Take apical pulse for FULL minute prior to administration digoxin
HOlD if pulse below 60bpm

ANTIDOTE for digitalis toxicity-Digoxin immune Fab (Digiband) given IV

Patient education very important taking own pulse

17
Q

Collaborative care for ADHF (Acute decompensated heart failure) or chronic HF?

Treat underlying cause

VS/urine output hourly

Continuous EKG & pulse ox

Monitor ABG results

High fowler position w/feet horizontal or dangling @ Bedside (decreases venous return/preload). Eases workload on heart.

02 by mask (non-rebreather) or BiPap

Daily weights

Drug therapy -decreases intravascular volume, decreases afterload (Systemic vascular resistance SVR), increases Ventricular function and decrease anxiety.
Diuretics 
Vasodilators
Morphine 
Positive inotropes

Hemodynamic monitoring (ICU stuff)

A

ADHF

Treat underlying cause

VS/urine output hourly

Continuous EKG & pulse ox

Monitor ABG results

High fowler position w/feet horizontal or dangling @ Bedside (decreases venous return/preload). Eases workload on heart.

02 by mask (non-rebreather) or BiPap

Daily weights

Drug therapy -decreases intravascular volume, decreases afterload (Systemic vascular resistance SVR), increases Ventricular function and decrease anxiety.
Diuretics 
Vasodilators
Morphine 
Positive inotropes

Hemodynamic monitoring (ICU stuff)