Heart Failure Flashcards
1
Q
What is heart failure?
A
condition in which your heart is unable to pump blood efficiently, meaning that it cannot meet the body’s demands for blood + oxygen.
2
Q
- Describe the characteristics of systolic heart failure (heart failure with reduced ejection fraction [HF-REF]).
A
- Occurs when the contraction of the muscle wall of the left ventricle malfunctions, compromsing it’s pumping action. Wall becomes stretched, floppy, thin and weak.
- a decrease in the ejection fraction below the normal range and enlargement of ventricle.
- heart is too weka to pump blood.
3
Q
- Describe the characteristics of diastolic heart failure (heart failure with preserved ejection fraction [HF-PEF])
A
- occurs when the left ventricle muscle wall is unable to relax normally, because the muscle has become stiff and thick.
- heart does not fill properly due to hypertrophy (less space) but ejection fraction usually remains within the normal range.
- stroke volume is reduced.
4
Q
signs and symptoms of left sided heart failure
A
-SOB/increase WOB
-decrease SPO2
-fatigue
-weakness
-rapid breathing
-orthopnea
-paroxysmal nocturnal dyspnea
-crackling nosises in lungs
- pink frothy sputum
5
Q
characteristics of right sided heart failure
A
- usually result of left sided HF.
- fluid retention (pitting edema) in your limbs. Dependant edema = legs if ambulatory, sacrum if bed bound.
- peripheral edema that can lead to nocturia
6
Q
What is cardiac output
A
- The amount of blood the heart pumps in 1 minute.
7
Q
- In the early stages of heart failure, how does the heart compensate for decreased cardiac output?
A
SNS activation.
Neurohormonal responses.
ventricular dilation.
ventricular hypertrophy.
8
Q
What diseases can lead to systolic HF (HF-REF)
A
-myocardial ischemia, HTN, cardiomyopathy, valvular heart disease
9
Q
- What is ejection fraction?
A
- the percentage of total amount of end-diastolic blood volume that is ejected during each systole
10
Q
- What is a normal ejection fraction?
A
- Normal EF is 55-70%
11
Q
- What is the ejection fraction in systolic [HF-REF] heart failure?
A
- an EF of 40% or lower
12
Q
- What is the ejection fraction in diastolic [HF-PEF] heart failure?
A
- an EF of 40% or greater
13
Q
- What structural changes occur in the heart during diastolic [HF-PEF] heart failure?
A
- poorly compliant ventricles = venous engorgement in both pulmonary and systemic vascular system.
14
Q
- What are the common causes of diastolic heart failure [HR-PEF]?
A
- left ventricular hypertrophy.
- myocardial ischemia,
- valve disease (e.g., aortic, mitral),
- cardiomyopathy.
15
Q
- What happens when heart failure becomes decompensated (when the compensatory mechanisms begin to fail)?
A
- CO and tissue perfusion becomes insufficient.
-Fatigue,
-dyspnea,
-paroxysmal nocturnal dyspnea,
-tachycardia,
-edema,
-nocturia,
-skin changes,
-behavior changes,
-chest pain,
-weight changes.
16
Q
- What diagnostic tests provide evidence of heart failure?
A
- Chest radiograph.
-ECG
-B-type natriuretic peptide - (CBC, Lytes, renal function, urinalysis, glucose, thyroid function)
17
Q
- Describe the New York Heart Association Functional Classification for heart failure.
A
-class 1: no limitation of activity, does not cause fatigue, dyspnea, palpitations of anginal pain.
-class 2: slight limitation of activity, no symptoms at rest. Ordinary activity results in fatigue and dyspnea of palpitations, or anginal pain.
-class 3: marked limitation, usually comfortable at rest. Ordinary physical activity causes fatigue, dyspnea, palpitations or anginal pain.
-class 4: inability to carry on physical activity without discomfort. Cardiac insufficiency or angina may be present even at rest.
18
Q
New York Heart Association classification system determines what
A
determines the severity of the client’s heart failure according to their tolerance for physical activity.
19
Q
How does nutrition help slow progression of early HF
A
- sodium restriction
(2g Na for HF)
(1.5g for HF and HTN) - DASH diet
20
Q
**Which diagnostic test will be the most useful to the nurse in determining whether a client admitted with acute shortness of breath has heart failure?
**
A) B-type natriuretic peptide (BNP)
B) Serum creatine kinase (CK)
C) Arterial blood gases (ABG)
D) 12-lead electrocardiogram (ECG)
A
A) B-type natriuretic peptide (BNP)
21
Q
An older adult with a history of left ventricular hypertrophy is being admitted to hospital. While completing the admission history, the nurse notes that the client demonstrates increased work of breathing while walking to the bed, and the client has 2+ pitting edema in the ankles. Based on these observations, what should the nurse PRIORITIZE?
A) Weigh the client
B) Perform a respiratory assessment
C) Call the lab to draw blood for laboratory studies
D) Administer the client’s scheduled dose of furosemide
A
B) Perform a respiratory assessment
22
Q
An echocardiogram is performed on a client being evaluated for heart failure. Upon reviewing the results, the nurse reads that the client has an ejection fraction of 56%. What does this value indicate?
A) The client has a borderline ejection fraction
B) The client has a normal ejection fraction
C) The client has a reduced ejection fraction
D) The client has an elevated ejection fraction
A
B) The client has a normal ejection fraction
23
Q
A nurse is teaching a client newly diagnosed with heart failure to recognize which “heart failure zone” they are in. Which client is currently in the GREEN zone?
A) Client who has increased swelling in feet and ankles
B) Client who feels more tired than usual and doesn’t having the energy to do daily activities
C) Client who needs to prop up head and shoulders on 2-3 extra pillows to sleep
D) Client who gains 1 kg (2 lbs) over 2 days
A
D) Client who gains 1 kg (2 lbs) over 2 days
24
Q
What clinical manifestations should alert the nurse that a client with heart failure is developing pulmonary edema? Select all that apply.
A) Cough with frothy pink sputum
B) Presence of a pleural friction rub
C) Rapid respiratory rate (usually greater than 30 breaths per minute)
D) Use of accessory muscles to breathe
E) Skin is cool, clammy, and pale
A
A, C, D, E
25
**Following an acute myocardial infarction, a previously healthy 67 year old client develops clinical manifestations of heart failure with reduced ejection fraction (HFrEF). What discharge teaching should the nurse anticipate providing for the client?**
A) Use of a β-adrenergic agonist
B) Use of NSAIDs
C) Use of an angiotensin-converting enzyme (ACE) inhibitor
D) Use of a calcium channel blocker
C) Use of an angiotensin-converting enzyme (ACE) inhibitor
26
**A nurse is evaluating the knowledge of a client with heart failure. What statement by the client indicates a misunderstanding that requires further education?**
A) I can go for a daily walk in my neighborhood.
B) I can do light housework, such as dusting or washing dishes.
C) I will avoid activities that require me to work above my head, such as washing walls.
D) If I am feeling stressed, I can relax in a hot tub or sauna.
D) If I am feeling stressed, I can relax in a hot tub or sauna.
27
**A client with a history of heart failure and atrial fibrillation is admitted to hospital.
Upon assessment, the nurse finds that the client's heart rate is 46 and irregular, and his blood pressure is 96/68. He is reporting a headache with photophobia and green halos around lights. He is lethargic and has nausea with abdominal tenderness.
The client's current medications include: furosemide, spironolactione, diltiazem, digoxin, rivaroxaban, and a nitroglycerine patch.
What laboratory test(s) should the nurse anticipate will be ordered MOST urgently?**
A) Coagulation panel, including PT, INR, and aPTT.
B) Serum digoxin level.
C) Blood alcohol content (BAC).
D) White blood cell (WBC) count and erythrocyte sedimentation rate (ESR).
B) Serum digoxin level.
28
**A nurse is caring for a client admitted to hospital with an acute exacerbation of heart failure with reduced ejection fraction (HFrEF). Which of the following should the nurse expect to see in the client's chart?**
A) Cardiac echocardiogram shows left ventricular ejection fraction = 52%
B) Serum BNP level = 92 pg/mL
C) Order to implement a 1500 mL fluid restriction
D) Order to administer verapamil
C) Order to implement a 1500 mL fluid restriction
29
**A client with heart failure develops dyspnea and chest auscultation reveals crackles and decreased air entry to the bases of both lung fields. What should the nurse recognize will be the most likely first-line treatment?**
A) Prescription for hydrochlorothiazide.
B) Insertion of an implantable cardioverter defibrillator (ICD).
C) Prescription for an inhaled corticosteroid.
D) Administer an intravenous infusion of a hypertonic saline solution.
A) Prescription for hydrochlorothiazide.
30
**What statement by Sheila would indicate that she has paroxysmal nocturnal dyspnea?**
“When I lie down in bed, that makes me cough. Coughing all night long keeps me awake and makes
me feel exhausted”
“I wake up in the morning exhausted and feeling short of breath”
“I can’t fall asleep at night because I feel short of breath”
“A few hours after I fall asleep, I suddenly wake up feeling panicked and unable to breathe”
“A few hours after I fall asleep, I suddenly wake up feeling panicked and unable to breathe”
31
**In what position should the nurse place a client who is experiencing an exacerbation of left-sided heart failure?**
Supine, with the feet elevated
Trendelenburg position
Lateral position
Fowler’s position
Fowler’s position
32
**When the heart begins to fail, how does the body compensate? **
Reduce preload
Reduce heart rate
Increase muscle mass of the heart
Increase blood flow and diuresis
Increase muscle mass of the heart
33
**What medication should the nurse recognize as the most likely cause of hyperkalemia in a client with heart failure? **
Furosemide
Hydrochlorothiazide
Spironolactone
Metoprolol
Spironolactone
34
**What should the nurse understand about an elevated BNP level in a client with heart failure? **
BNP is produced by the kidneys in response to decreased blood flow through the glomeruli
BNP is produced by the ventricles of the heart in response to excessive stretching of the heart muscle
cells
BNP is produced by the pituitary gland in response to decreased osmolality of the blood
BNP is produced by the vascular endothelium in response to stimulation of the carotid baroreceptors
BNP is produced by the ventricles of the heart in response to excessive stretching of the heart muscle cells
35
**What’s the most common cause of heart failure with reduced ejection fraction? **
COPD
Coronary artery disease
Venous thromboembolism
Patent ductus arteriosus (PDA)
Coronary artery disease
36
**If a client with acute decompensated heart failure receives an IV infusion of dobutamine, the nurse should understand that the primary action of this drug is to: **
Increase contractility of the heart
Reduce systemic venous return
Promote diuresis
Block the effects of the renin-angiotensin-aldosterone system
Increase contractility of the heart
37
**What should a nurse teach a client with heart failure to help them effectively manage their health at home? **
Restrict your sodium intake to 1000 mg per day
If your heart rate is faster than 100 beats/minute, don’t take your digoxin
Restrict your fluid intake to 1.5-2 litres per day
Spending 30-60 minutes in a hot tub or sauna is an effective way to relax
Restrict your fluid intake to 1.5-2 litres per day
38
**The nurse teaches Sheila about the heart failure zones. What are the characteristics of the red zone?**
Gain of 1 kg in one week, no shortness of breath, no chest pain, and moderate lower leg edema that
hasn’t changed from previous weeks
Dry hacking cough, feeling tired or lightheaded, and needing to use extra pillows to sleep at night
Gain of 2 kg over 2 days, feeling short of breath, and lower leg edema that’s increasing
Struggling to breathe, chest pain that doesn’t go away with rest or medicine, and having trouble
thinking or feeling confused
Struggling to breathe, chest pain that doesn’t go away with rest or medicine, and having trouble
thinking or feeling confused
39
**What is the most likely reason that he’d be sitting bolt upright in bed, dyspneic and unable to speak in full sentences, with audible respiratory crackles and frothy pink sputum? **
Pulmonary edema
Pneumothorax
Acute angina
Pericarditis
Pulmonary edema
40
What is Cor pulmonale
when the ventricle on the right
side of the heart develops hypertrophy
41
- Conditions that can lead to right slided HF.
* COPD, due to pulmonary HTN. (Can progress to cor pulmonale).
* interstitial lung disease,
* problems with valves (tricuspid regurgitation)
* MI
* trauma.
42
What assessments should a nurse prioritize for a patient who has right sided heart failure?
-altered LOC or confusion.
-weight gain.
-increasing venous pressure (JVD)
-dependant edema
-liver and spleen enlargement (palpate)
-asictes = leads to GI symptoms anorexia, nausea, abd. pain
-fatigue
43
What conditions can lead to left sided heart failure
-valvular heart disease.
-aortic stenosis.
-MI
-CAD
-chronic HTN
-substance abuse (coke/alcohol)
-congenital heart disease
44
What assessments should the nurse prioritize in a patient who has left sided heart failure
-altered LOC (confusion, restlessness, lethargy, brain fog)
-focused resp assessment
-need for orthopneic position
-ask if pt is being woken up by paraoxysmal noctural dyspnea.
-cyanosis
-fatigue
45
What alterations in vital signs will a nurse observe in a patient with HF
-decreased SPO2
-increased RR and HR due to compensation.
-low BP in Left sided (could also be drug induced).
-may be high in Right sided
-narrow pulse pressure
46
what MH conditions are patients with HF at risk for developing
-stress.
-depression.
-anxiety.
47
What blood condition is common in people with HF and what things contribute to the development of this?
**Anemia**
-*poor nutrition* (iron deficiency)
-*decreased kidney function* (decreased production of erythropoietin to stim RBC production).
-*drug therapy* (ACEI)
48
Spironolactone blocks what hormone effect and causes the kidneys to do what
-Aldosterone.
-re-aborb potassium and increase excretion of sodium and water.
| -aldosterone blocker
49
What can cause dilutional hyponatremia in patients with HF
Reduced blood flow to the kidneys, (poor perfusion).
If kidneys become compromised too much fluid can build up and dilute sodium in the bloodstream.
50
What BNP would indicate the possiblility of HF
-100-500 picograms/mL.
-over 500 = much more likely.
51
# RAAS in response to low BP
-What do the kidneys secrete:
-which converts what:
-Than what happens in the lungs:
-what does the adrenal glands secrete -and what triggers it:
-kidney- renin
-angiotensinogen to angiotensin 1.
-angiotensin 1 --> 2 by ACE enzyme. =vasocontriction.
-aldosterone triggered by angiotensin 2. = kidneys retain more NA and water.
52
Why is the RAAS not helpful in HF
adding extra volume in vascular space makes HF worse, makes a cycle inwhich kidneys become less perfused which leads to more stimulation of RAAS = fluid retention, repeat.
53
What happens when the SNS is activiated in response to HF
| particularly left sided HF
-Decreased CO activates baroreceptors in carotid arteries and aortic arch.
-stimulates SNS = release of Epinephrine.
=increase of HR, contractibility, vasocontriction and systemic vascular heart.
=increase venous return bringing more blood back to heart= increased workload which can lead to decompensation
54
how does the secretion of natriuretic hormones (ANP/BNP) help people with HF
**They block the RAAS and sympathetic nervous system. **
-reduce secretion of aldosterone.
-increase GFR and diuresis (blood flow to kidneys)
-increase NA+ excretion.
-inhibit renin secretion.
-promote vasodilation.
55
what is a unfortunate part with natriuretic hormones.
the effects of RAAS and SNS activation are much strnoger and become overpowered by other hormone systems.
56
In regards to heart failure what will a chest-xray show
if theres any enlargement of the heart
57
In regards to heart failure what will a ECG show
if there is any alterations in electrical activity
58
In regards to heart failure what will a echocardiogram show
structures of the heart, including ventricles, thickness of the heart walls and movement of the valves.
59
# systolic HF
What is the most common cause of heart failure with reduced ejection fraction
-CAD
75% are due to ischemic heart disease
60
# diastolic HF
What is the most common cause of heart failure with preserved ejection fracture
HTN
61
What does dobutamine do and what type of agent is it
-Increases the contracility of the heart. = increased cardiac output.
-Typically only used for a short period of time in the ICU or hemodynamically unstable.
-Inotropic agent
| beta-1 adrenergic agonist
62
What are three goals in regards to medication regimens for patients with HF
Remove drugs that are harmful to people with HF and add ones that will help:
1. improve symptoms.
2. reverse clients deterioration.
3. reduce risk of death
63
What drugs should be avoided in patients with HF because they increase fluid and sodium retention
NSAIDs, corticosteriods, thiazolidinediones.
-in patients with HF-rEF, calcium channel blockers should be avoided too.
64
What are the five medications that have been shown to reduce mortality in people with HF with reduced ejection fraction
1. ACEI
2. ARB's
3. Beta blockers
4. Aldosterone antagonists (spironolactone)
5. ARNI (sacubitril-valsartan)
65
Why is digoxin not prescribed for HF? Regardless of this, how can it help.
Digoxin is not a 1st line drug for heart failure and does not reduce risk of death.
It however can be helpful for dyspnea, fatigue, and exercise intolerance.
66
What does digoxin do
-strengthens heart contractility (positive inotropic effect)
-slows HF (negative chronotropic effect)
-can be helpful in people who have A-fib with HF.
67
why is digoxin not used anymore for treatment of HF.
adverse signs?
-High risk of toxcity.
-CNS symptoms (drowiness, confusion, HA)
-visual changes (photophobia, light sensitivity, yellow, red or green halos are light)
-GI symptoms (N/V, abd pain
-Cardiac symptoms (palpitations, bradycardia, HoTN.
- potassium imbalances
68
What is the relationship between digoxin and potassium imbalances
Hypokalemia: increases risk for digoxin toxicity
Digoxin toxicty: increases risk for hyperkalemia.
69
What medications are common in the treatment of HF with preserved ejection failure
-Mineralocorticoid receptor antagonists (MRAs) = spironolactone.
-ACEI
-ARBs
-CCB's
-Thiazide diuretics
| There are not many medications that are shown to reduce mortality.
70
What is the typical dose of spironolactone in HF and what are the benefits
25-50 mg
This is a low dose so it does not have strong diuretic effect. IT helps to reduce workload of the heart, reduces dyspnea and reduces edema.
71
What is the most accurate way for a patient to monitor fluid balance and identify if HF is worsening
**Daily weights, **
same time,
same clothes,
same scale
72
what are some types to help patients cope with fluid restrictions
-use a smaller cup.
-sipping fluid slowly.
-avoid sweet or salty foods.
-brush teeth often or rinse mouth.
-chew sugar free gum.
-lip balm.
73
What benefits are associated with exercise and HF
better sleep, feel less tired, feel less breathless
74
What amount of exercise should people with HF aim for
30 minutes of exercise/day in the 3-5 range which is moderate to hard (enough breath to carry on a conversation.
- balance exercise with rest and remember to take 5 minutes to warm up and cool down.
75
what activities should patients with HF avoid
-climbing a lot of stairs,
-heavy housework or yard work,
-activities that involve working above their head (such as painting or washing windows),
-straining or holding their breath to do an activity,
-lifting or pushing heavy objects (such as mowing the lawn or shoveling snow).
76
What is pulmonary edema usually caused by
acute decompensated HF especially in people with L sided HF.
77
What are some conditions that can cause HF to decompensate and progress to pulmonary edema
-fluid overload.
-hypertensive crisis
-MI
78
What are some appropiate tmts for pulmonary edema
-opioids (morphine)
-vasodilators (nitrates like nitroglycerine).
-diuretics (furosemide)
-oxygen therapy
-non-invasive ventilation (BIPAP or Optiflow)
79
**Which diagnostic test will be the most useful to the nurse in determining whether a client admitted with acute shortness of breath has heart failure?**
B-type natriuretic peptide (BNP)
Serum creatine kinase (CK)
Arterial blood gases (ABG)
12-lead electrocardiogram (ECG)
