HEART FAILURE

Question 1

What is heart failure?

Answer 1

Heart failure is the inability of the heart to pump sufficient blood to meet the body’s metabolic needs.

Question 2

What is ejection fraction?

Answer 2

Ejection fraction is the percentage of blood the left ventricle ejects when it contracts.

Question 3

What is the normal ejection fraction for a healthy heart?

Answer 3

A healthy heart ejects 55% or more of the blood that fills the left ventricle during diastole.

Question 4

How is ejection fraction measured?

Answer 4

The heart’s ejection fraction is measured using an echocardiogram or multigated acquisition scan (MUGA).

Question 5

What does congestive heart failure (CHF) describe?

Answer 5

CHF describes the accumulation of blood and fluid in organs and tissues from impaired circulation.

Question 6

How can heart failure be classified?

Answer 6

Heart failure can be classified as acute or chronic, and by location: right-sided or left-sided.

Question 7

What is the New York Heart Association classification for heart failure?

Answer 7

The classification includes four classes based on activity limitations: Class I (no symptoms), Class II (mild symptoms), Class III (marked limitation), Class IV (severe limitations).

Question 8

What is acute heart failure?

Answer 8

Acute heart failure is a sudden change in the heart’s ability to contract, potentially causing life-threatening symptoms.

Question 9

What is chronic heart failure?

Answer 9

Chronic heart failure occurs when the heart’s ability to pump effectively is gradually compromised.

Question 10

What is left-sided heart failure?

Answer 10

Left-sided heart failure results from conditions that impair the left ventricle’s ability to eject blood into the aorta.

Question 11

What is right-sided heart failure?

Answer 11

Right-sided heart failure occurs when the right ventricle fails to eject blood into the pulmonary artery, causing congestion in the venous vascular system.

Question 12

What are the primary causes of heart failure?

Answer 12

Primary causes include myocardial infarction (MI) and conditions that impair the heart muscle’s ability to contract.

Question 13

What happens during left-sided heart failure?

Answer 13

Blood becomes congested in the left ventricle, left atrium, and pulmonary vasculature, leading to impaired gas exchange and hypoxia.

Question 14

What are common causes of chronic heart failure?

Answer 14

Common causes include hypertension, tachydysrhythmias, valvular disease, cardiomyopathy, and renal failure.

Question 15

What is cor pulmonale?

Answer 15

Cor pulmonale is a condition where the heart is affected secondarily by lung damage, leading to right-sided heart failure.

Question 16

What are compensatory mechanisms in heart failure?

Answer 16

Compensatory mechanisms include increased heart rate, vasoconstriction, and fluid retention to maintain blood pressure and cardiac output.

Question 17

What are the signs and symptoms of left-sided heart failure?

Answer 17

Signs include fatigue, dyspnea, orthopnea, cough with pink frothy sputum, and hypoxia.

Question 18

What are the signs and symptoms of right-sided heart failure?

Answer 18

Signs include weight gain, dependent edema, ascites, and jugular vein distention.

Question 19

What diagnostic findings are associated with left-sided heart failure?

Answer 19

Findings include cardiac enlargement and fluid accumulation in the lungs seen on chest radiography.

Question 20

What diagnostic findings are associated with right-sided heart failure?

Answer 20

Findings include right ventricular enlargement on chest radiograph and ECG.

Question 21

What is the medical management for heart failure?

Answer 21

Management includes dietary modifications, drug therapy, and lifestyle changes to reduce the heart’s workload.

Question 22

What is the mechanism of action of cardiac glycosides?

Answer 22

They increase cardiac output by slowing heart rate and increasing the force of contraction.

Question 23

What are common side effects of diuretics?

Answer 23

Common side effects include dizziness, dehydration, and orthostatic hypotension.

Question 24

What nursing considerations are important for ACE inhibitors?

Answer 24

Monitor for hypotension and administer 1 hour before or 2 hours after meals.

Question 25

What should be assessed in a client with congestive heart failure?

Answer 25

Assess for dyspnea, heart rate, blood pressure, distended neck veins, and signs of peripheral edema.

Question 26

What should the nurse monitor in a client on diuretics?

Answer 26

The nurse should note laboratory test results of serum electrolytes, particularly potassium levels, as certain diuretics can deplete potassium. ## Footnote Monitor intake and output measurements and evaluate fluid volumes at least every 8 hours.

Question 27

What is the expected outcome for a client with decreased cardiac output?

Answer 27

The client will have increased cardiac output as evidenced by a heart rate between 60 to 100 beats/minute, urinary output between 1500 to 3000 mL/day, systolic BP below 140 mm Hg, diastolic BP below 90 mm Hg, and no mental confusion.

Question 28

What should be done before administering a cardiac glycoside?

Answer 28

Assess the apical heart rate before administering a cardiac glycoside or other drug that slows heart rate. Withhold the medication if the heart rate is less than 60 or more than 120 beats/minute until the physician is consulted.

Question 29

What medications may be administered for decreased cardiac output?

Answer 29

Administer prescribed medications such as cardiac glycosides, diuretics, and antihypertensives. ## Footnote Cardiac glycosides slow heart rate and increase force of contraction; diuretics decrease afterload; antihypertensives promote vasodilation.

Question 30

What is the expected outcome for excess fluid volume?

Answer 30

Fluid volume will be reduced as evidenced by reduced weight and peripheral edema, normal BP measurements, increased urine output, and no adventitious lung sounds.

Question 31

What dietary recommendation is made for managing excess fluid volume?

Answer 31

Provide a sodium-restricted diet as prescribed, since sodium attracts water and reducing sodium decreases water retention.

Question 32

What is the expected outcome for risk of impaired gas exchange?

Answer 32

The client will maintain adequate gas exchange as evidenced by clear lung sounds, decreased work of breathing, SpO2 above 90%, PaO2 between 80 and 100 mm Hg, PaCO2 between 35 and 45 mm Hg, and blood pH between 7.35 and 7.45.

Question 33

What position should the client be maintained in to aid gas exchange?

Answer 33

Maintain the client in a high Fowler's, semi-Fowler's, or orthopneic position to maximize lung expansion.

Question 34

What should be avoided to prevent impaired gas exchange?

Answer 34

Avoid gas-forming foods and offer small, frequent feedings to prevent stomach distention and increase thoracic cavity space for lung expansion.

Question 35

What is the expected outcome for activity intolerance?

Answer 35

The client will tolerate activities of daily living without becoming breathless, hypertensive, or tachycardic.

Question 36

What should be monitored for hypokalemia in clients on diuretics?

Answer 36

Monitor for clinical signs of hypokalemia such as fatigue, muscle weakness, and abnormal sensations. ## Footnote Observe the ECG for a U wave or dysrhythmia.

Question 37

What foods are good sources of potassium?

Answer 37

Foods rich in potassium include potatoes, bananas, orange juice, and yogurt. ## Footnote These foods can help manage serum potassium levels.

Question 38

What should the nurse instruct the client and family about heart failure?

Answer 38

The nurse should instruct about the disease process, signs of impending CHF, and the importance of taking medications regularly. ## Footnote This includes monitoring weight and pulse daily, scheduling rest periods, and avoiding extreme temperatures.

Question 39

What should be reported to the physician in heart failure management?

Answer 39

Report a heart rate less than 60 or more than 120 beats/minute before taking digitalis, and contact the physician if symptoms return or swelling in the legs, ankles, or feet suddenly increases.