heart failure

Question 1

dx of heart failure

Answer 1

-elevated BNP&ProBNP
-H&P
-EKG (possible reduced EF)
-CRX (possible cardiomedaly & pleural effusion)
-echo

Question 2

chronic heart failure treatment

Answer 2

-treat cause
-Oxygen 2-6L NC
-rest & activity periods
-daily wts
-reduced Na diet
-meds

Question 3

meds for chronic heart failure treatment

Answer 3

-ACE & ARBs
-beta blockers
-diuretics
-nitrates
-digoxin

Question 4

advanced treatment for chronic heart failure

Answer 4

-LVAD
-heart transplant

Question 5

digoxin

Answer 5

-2nd line d/t risk of dysrhythmias
-negative chronotrope (will slow HR)
-positive inotrope (will increase contractility)
-hypoK worsens toxicity

Question 6

digoxin nursing considerations

Answer 6

-monitor serum K+ & cardiac rhythm
-take apical pulse for full minute, hold if below 60
-antidote: digoxin immune fab (digibind)
-toxicity: brady, headache, dizziness, confusion, nausea, blurred vision

Question 7

w/ an LVAD

Answer 7

-blood pressure cannot be so need to take w/ manual doppler
-S1S2 cannot be heard
-do not start CPR until pump is turned off

Question 8

ADHF care

Answer 8

-treat cause
-VS & hourly urine output & daily wts
-continuous EKG & pulse ox
-monitor ABGs
-high fowlers w/ feet horizontal or dangling at bedside (to decrease venous return/prelaod)
-O2 w/ bipap or nonrebreather

Question 9

ADHF drug therapy

Answer 9

-diuretics
-vasodilators
-morphine
-postive inotropes
goal: dec intravascular volume, dec afterload, inc left ventricular function, dec anxiety