HEART FAILURE Flashcards
What is heart failure?
Heart failure is the inability of the heart to pump sufficient blood to meet the body’s metabolic needs.
What is ejection fraction?
Ejection fraction is the percentage of blood the left ventricle ejects when it contracts.
What is the normal ejection fraction for a healthy heart?
A healthy heart ejects 55% or more of the blood that fills the left ventricle during diastole.
How is ejection fraction measured?
The heart’s ejection fraction is measured using an echocardiogram or multigated acquisition scan (MUGA).
What does congestive heart failure (CHF) describe?
CHF describes the accumulation of blood and fluid in organs and tissues from impaired circulation.
How can heart failure be classified?
Heart failure can be classified as acute or chronic, and by location: right-sided or left-sided.
What is the New York Heart Association classification for heart failure?
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).
What is acute heart failure?
Acute heart failure is a sudden change in the heart’s ability to contract, potentially causing life-threatening symptoms.
What is chronic heart failure?
Chronic heart failure occurs when the heart’s ability to pump effectively is gradually compromised.
What is left-sided heart failure?
Left-sided heart failure results from conditions that impair the left ventricle’s ability to eject blood into the aorta.
What is right-sided heart failure?
Right-sided heart failure occurs when the right ventricle fails to eject blood into the pulmonary artery, causing congestion in the venous vascular system.
What are the primary causes of heart failure?
Primary causes include myocardial infarction (MI) and conditions that impair the heart muscle’s ability to contract.
What happens during left-sided heart failure?
Blood becomes congested in the left ventricle, left atrium, and pulmonary vasculature, leading to impaired gas exchange and hypoxia.
What are common causes of chronic heart failure?
Common causes include hypertension, tachydysrhythmias, valvular disease, cardiomyopathy, and renal failure.
What is cor pulmonale?
Cor pulmonale is a condition where the heart is affected secondarily by lung damage, leading to right-sided heart failure.
What are compensatory mechanisms in heart failure?
Compensatory mechanisms include increased heart rate, vasoconstriction, and fluid retention to maintain blood pressure and cardiac output.
What are the signs and symptoms of left-sided heart failure?
Signs include fatigue, dyspnea, orthopnea, cough with pink frothy sputum, and hypoxia.
What are the signs and symptoms of right-sided heart failure?
Signs include weight gain, dependent edema, ascites, and jugular vein distention.
What diagnostic findings are associated with left-sided heart failure?
Findings include cardiac enlargement and fluid accumulation in the lungs seen on chest radiography.
What diagnostic findings are associated with right-sided heart failure?
Findings include right ventricular enlargement on chest radiograph and ECG.
What is the medical management for heart failure?
Management includes dietary modifications, drug therapy, and lifestyle changes to reduce the heart’s workload.
What is the mechanism of action of cardiac glycosides?
They increase cardiac output by slowing heart rate and increasing the force of contraction.
What are common side effects of diuretics?
Common side effects include dizziness, dehydration, and orthostatic hypotension.
What nursing considerations are important for ACE inhibitors?
Monitor for hypotension and administer 1 hour before or 2 hours after meals.
What should be assessed in a client with congestive heart failure?
Assess for dyspnea, heart rate, blood pressure, distended neck veins, and signs of peripheral edema.
What should the nurse monitor in a client on diuretics?
The nurse should note laboratory test results of serum electrolytes, particularly potassium levels, as certain diuretics can deplete potassium.
Monitor intake and output measurements and evaluate fluid volumes at least every 8 hours.
What is the expected outcome for a client with decreased cardiac output?
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.
What should be done before administering a cardiac glycoside?
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.
What medications may be administered for decreased cardiac output?
Administer prescribed medications such as cardiac glycosides, diuretics, and antihypertensives.
Cardiac glycosides slow heart rate and increase force of contraction; diuretics decrease afterload; antihypertensives promote vasodilation.
What is the expected outcome for excess fluid volume?
Fluid volume will be reduced as evidenced by reduced weight and peripheral edema, normal BP measurements, increased urine output, and no adventitious lung sounds.
What dietary recommendation is made for managing excess fluid volume?
Provide a sodium-restricted diet as prescribed, since sodium attracts water and reducing sodium decreases water retention.
What is the expected outcome for risk of impaired gas exchange?
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.
What position should the client be maintained in to aid gas exchange?
Maintain the client in a high Fowler’s, semi-Fowler’s, or orthopneic position to maximize lung expansion.
What should be avoided to prevent impaired gas exchange?
Avoid gas-forming foods and offer small, frequent feedings to prevent stomach distention and increase thoracic cavity space for lung expansion.
What is the expected outcome for activity intolerance?
The client will tolerate activities of daily living without becoming breathless, hypertensive, or tachycardic.
What should be monitored for hypokalemia in clients on diuretics?
Monitor for clinical signs of hypokalemia such as fatigue, muscle weakness, and abnormal sensations.
Observe the ECG for a U wave or dysrhythmia.
What foods are good sources of potassium?
Foods rich in potassium include potatoes, bananas, orange juice, and yogurt.
These foods can help manage serum potassium levels.
What should the nurse instruct the client and family about heart failure?
The nurse should instruct about the disease process, signs of impending CHF, and the importance of taking medications regularly.
This includes monitoring weight and pulse daily, scheduling rest periods, and avoiding extreme temperatures.
What should be reported to the physician in heart failure management?
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.
