Heart Failure

Question 1

HF priority problems

Answer 1

impaired gas exchange
decreased CO
fatigue/weakness
potential for pulm edema

Question 2

ways improve gas exchange

Answer 2

high-Fowler’s position
admin O
O2 sat 90%

Question 3

improve CO

Answer 3

meds reduce pre/afterload
improve contractility of heart
hemodynamic regulation

Question 4

meds reduce afterload

Answer 4

ACE inhibitor
ARBs
synthetic BNP - vasodilate, increase GFR get rid of Na

Question 5

meds reduce preload

Answer 5

diuretic
venous dilators/nitrates
morphine

Question 6

meds enhance contractility

Answer 6

digoxin
inotropic drugs
beta-adrenergic blockers ie dobutamine

Question 7

nonsurgical options for HF

Answer 7

CPAP - improve oxygenation
CRT - pacemaker/icd
gene therapy - help healthy genes grow

Question 8

surgical options for HF

Answer 8

heart transplant

VAD - mechanical pump bypass ventricle

Question 9

decrease fatigue and weakness

Answer 9

rest for energy management
HR no more than 20 above baseline
do not skip days
gradually increase exercise tolerance

Question 10

prevent/manage pulm edema

Answer 10

early signs - crackles in bases
dyspnea on rest, disorientation, confusion
high-Fowler's position
O2, Nitro, rapid-acting diuretics
IV morphine

Question 11

MAWDS

Answer 11

meds
activity
weight
diet
symptoms

Question 12

indications HF worsening

Answer 12

rapid weight gain
decreased activity tolerance for 2-3 days
cold symptoms
nocturia
dyspnea/angina at rest
increased edema in feet, ankles, hands

Question 13

Acute HF interventions

Answer 13

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

Question 14

valvular disease assessment

Answer 14

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

Question 15

nonsurgical management of valvular disease

Answer 15

rest

meds - diuretics, beta blockers, digoxin, O2, nitrates, vasodilators, anticoags

Question 16

surgical management of valvular disease

Answer 16

repair
balloon valvuloplasty
direct/open commissurotomy
mitral valve annuloplasty
replacement

Question 17

home care/pt teaching

Answer 17

abx for all invasive procedures

rest and conserve energy

Question 18

infective endocarditis

Answer 18

microbial inf involving endocardium

those at risk - IV drug users, valve replacement, systemic inf, structural cardiac defects

Question 19

endocarditis manifestations

Answer 19

murmur
HF
arterial embolization
petechiae

Question 20

how dx endocarditis

Answer 20

positive blood culture

new murmur

Question 21

nonsurgical management of endocarditis

Answer 21

antimicrobials

activity balanced w/ rest

Question 22

surgical management of endocarditis

Answer 22

remove infected valve
repair/remove congenital shunts
repair injured valve and chordae tendineae
drain abscess of heart

Question 23

causes of pericarditis

Answer 23

inflammation/alteration of pericardium

Dressler’s syndrome/inflammation post-MI

Question 24

pericarditis assessment

Answer 24

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

Question 25

pericarditis intervention

Answer 25

NSAID for pain/inflammation antibiotics for bacteria pericardiectomy

Question 26

manifestation acute cardiac tamponade

Answer 26

``` JVD paradoxical pulse - BP higher when breathe in than out decreased CO muffled breath sounds circulatory collapse ```

Question 27

acute cardiac tamponade emergency care

Answer 27

``` increased fluid volume hemodynamic monitoring pericardiocentesis pericardial window pericardiectomy ```

Question 28

rheumatic carditis

Answer 28

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

Question 29

manifestations of rheumatic fever

Answer 29

``` tachy cardiomegaly new/changed murmur pericardial friction rub pericardial pain change in ECG indication HF existing Strep inf ```

Question 30

cardiomyopathy

Answer 30

subacute/chronic disease cardiac muscle | CO drops in dilated and hypertrophic cardiomyopathy

Question 31

nonsurgical management of cardiomyopathy

Answer 31

meds - diuretics, vasodilating agents, cardiac glycosides ICD - implantable cardiac defibrillator avoid toxins avoid etoh