Heart Failure

Question 1

Congestive Heart Failure

Answer 1

• also known as “pump” failure
• a pathologic state in which the weakened mycardium is unable to pump sufficient blood from the ventricles to sustain normal circulation required to meet the metabolic demands of the body
• caused by depressed myocardial contractillity is the primary underlying cause

Question 2

Treatment of Heart Failure

Answer 2

• remove excess water and salt in the body by restricting sodium and fluid, reducing physical activity, and initiation of diuretic/digitalis glycoside therapy
• enhance myocardial contraction through digitalis

Question 3

Right and left sided heart failure

Answer 3

• in right sided heart failure, the kidneys respond to a decrease in cardiac output by retaining more water and electrolytes, producing fluid retention and electrolyte disturbance (shown through jugular venous distention, hepatomegaly, ascites, and peripheral edema)
• in left sided heart failure there is an acccumulation of fluids in the lungs (piulmonary edema), which produces dyspnea, and interferes with oxygen and carbon dioxide exchange
• failure on one side always leads to failure on the other

Question 4

Digitalis Glycosides (DIgoxin)

Answer 4

• the prototype for this classification of drugs is called Digoxin
• generally effects the heart by slowing down and strengthening the force of the heartbeat
• digoxin also slows conduction velocity at sites on the heart which also helps to slow down heart rate
• Main treatments include treating coronary heart failure and cardiac arrhythmias
• almost completely absorbed orally, can be rapid acting or long acting, looking to take in between 0.125 and 0.5 mg daily
• side effects include anorexia, bradycardia, nausea, stomach pain, and dysrhythmias (seen with toxicity)

Question 5

Nursing Management of Digitalis

Answer 5

• assess the patient’s medical history, drug history, EKGs, lab work including electrolyte levels and renal function, and the current medical regimen of the patient
• antacids and anti-diarrheals can reduce absorption
• CCbs can cause dysrhthmias in conjunction with
• Indomethacin and Quinidine can cause toxicity
• SULCRALFATE WHEN USED CONCURRENTLY CAN DECREASE ABSORPTION, SPACE APART BY 2 HRS

Question 6

Digitalis Patient Education

Answer 6

• take drug at same time each day
• take pulse and record each time before taking med
• withhold med is pulse is under 60 bpm or over 110 bpm
• report anorexia, diarrhea, n/v, sudden wt gain/edema, blurred vision, green or yellow halos immediately

Question 7

Antidote for Digitalis Toxicity

Answer 7

• Digoxin Immune Fad (digibind)

Question 8

Normal Lab Values

Answer 8

potassium: 3.0 - 3.5 mEq/L

Sodium: 135-145 mEq/L

Chloride: 95-105 mEq/L

digoxin: 0.5 - 0.8 in CHF or 1.5 - 2.0 in irregular heart beat