Heart Failure Flashcards
HF priority problems
impaired gas exchange
decreased CO
fatigue/weakness
potential for pulm edema
ways improve gas exchange
high-Fowler’s position
admin O
O2 sat 90%
improve CO
meds reduce pre/afterload
improve contractility of heart
hemodynamic regulation
meds reduce afterload
ACE inhibitor
ARBs
synthetic BNP - vasodilate, increase GFR get rid of Na
meds reduce preload
diuretic
venous dilators/nitrates
morphine
meds enhance contractility
digoxin
inotropic drugs
beta-adrenergic blockers ie dobutamine
nonsurgical options for HF
CPAP - improve oxygenation
CRT - pacemaker/icd
gene therapy - help healthy genes grow
surgical options for HF
heart transplant
VAD - mechanical pump bypass ventricle
decrease fatigue and weakness
rest for energy management
HR no more than 20 above baseline
do not skip days
gradually increase exercise tolerance
prevent/manage pulm edema
early signs - crackles in bases dyspnea on rest, disorientation, confusion high-Fowler's position O2, Nitro, rapid-acting diuretics IV morphine
MAWDS
meds activity weight diet symptoms
indications HF worsening
rapid weight gain decreased activity tolerance for 2-3 days cold symptoms nocturia dyspnea/angina at rest increased edema in feet, ankles, hands
Acute HF interventions
cardiac monitoring O2 sat monitoring supplemental O2 meds labs daily weights Na/fluid restriction accurate I&O abd girth measurement measure periph edema careful and frequent cardiac/resp assessment
valvular disease assessment
hx rheumatic fever, infective endocarditis, IV drug user
CXR - hypertrophy
ECG
stress test - how respond to stress
ECHO - see structure, EF, look in front of heart
TEE - look back of heart
nonsurgical management of valvular disease
rest
meds - diuretics, beta blockers, digoxin, O2, nitrates, vasodilators, anticoags
surgical management of valvular disease
repair balloon valvuloplasty direct/open commissurotomy mitral valve annuloplasty replacement
home care/pt teaching
abx for all invasive procedures
rest and conserve energy
infective endocarditis
microbial inf involving endocardium
those at risk - IV drug users, valve replacement, systemic inf, structural cardiac defects
endocarditis manifestations
murmur
HF
arterial embolization
petechiae
how dx endocarditis
positive blood culture
new murmur
nonsurgical management of endocarditis
antimicrobials
activity balanced w/ rest
surgical management of endocarditis
remove infected valve
repair/remove congenital shunts
repair injured valve and chordae tendineae
drain abscess of heart
causes of pericarditis
inflammation/alteration of pericardium
Dressler’s syndrome/inflammation post-MI
pericarditis assessment
substernal precordial pain radiating left side neck, shoulder, back
grating pain aggravated by breathing, coughing, swallowing
pain worsen w/ supine position, relieved by sitting up/leaning forward
pericardial friction rub
pericarditis intervention
NSAID for pain/inflammation
antibiotics for bacteria
pericardiectomy
manifestation acute cardiac tamponade
JVD paradoxical pulse - BP higher when breathe in than out decreased CO muffled breath sounds circulatory collapse
acute cardiac tamponade emergency care
increased fluid volume hemodynamic monitoring pericardiocentesis pericardial window pericardiectomy
rheumatic carditis
usually caused by Strep moving from throat to heart
formation of Aschoff bodies - small nodules/scar tissue formation
impaired contractile fx of myocardium, thickening of pericardium, valvular damage
manifestations of rheumatic fever
tachy cardiomegaly new/changed murmur pericardial friction rub pericardial pain change in ECG indication HF existing Strep inf
cardiomyopathy
subacute/chronic disease cardiac muscle
CO drops in dilated and hypertrophic cardiomyopathy
nonsurgical management of cardiomyopathy
meds - diuretics, vasodilating agents, cardiac glycosides
ICD - implantable cardiac defibrillator
avoid toxins
avoid etoh
