Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

med surg 2 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

what is it?

A

the clinical syndrome described as the inability of the heart to pump an adequate amount of oxygenated blood to meet the body’s demands (adequate cardiac output)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

problem with filling

A

poor compliance or lack of space to fill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

contracting problem

A

poor contractility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Facts

A
  • most common reason for hospitalization in adults >65

- there is no cure , only preventative measures and treatment of symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Primary risk factors

A
  • coronary artery disease (CAD)

- advancing age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

HF 101

A

The goal is to improve cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cardiac output

A

the amount of blood ejected out of the ventricles each minute

co=sv x hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cardiac index

A

is cardiac output adjusted for body size

ci= co/bsa
bsa= height x weight /3600
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Stroke volume

A

the amount of blood ejected from the ventricles with each ventricular systole (contraction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hemodynamics

A 
co = 4-8 liters /min
CI= 2.5-4 liter/min
SV= 60-130mls
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

3 parts of stroke volume

A
  1. preload
  2. afterload
  3. contractility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Preload

A
  • measurement of volume
  • amount of blood in the heart at the end of diastole
  • increased with volume replacement
  • decreased by blood loss and diuretics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Afterload

A
  • measurement of resistance

- influenced by vascular resistance, blood pressure, blood viscosity, and aortic /pulmonic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

contractility

A
  • cannot directly measure but can be seen with echocardiogram
  • the strength of myocardial contraction
  • influenced by preload
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Frank starling’s law (or curve)

A
  • as you increase preload contractility will improve…to a point
  • too much preload can overstretch the heart and weaken the cardiac muscle causing worsened contractility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what causes the heart to fail

A
  1. impaired myocardial function (endocarditis,CAD, cardiomyopathy)
  2. increased cardiac workload(hypertension, anemia, valve disorders)
  3. non- cardiac conditions( volume overload, massive pulmonary embolus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Compensatory mechanisms in the heart

A
  • when the heart begins to fail the body attempts to compensate
  • initially these mechanisms are helpful but ultimately they harm the patient only worsening their heart failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

compensation cascade in heart failure

A
  1. decreased cardiac output stimulates the SNS to release norepinephrine
  2. norepinephrine increases HR and contractility but also causes vasoconstriction
  3. vasoconstriction increases venous return to the heart which increases ventricular filling
  4. overfilling stretches the heart causing myocardial hypertrophy
  5. the hypertrophied ventricle has deceased contractility which in turn decreases cardiac output
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Heart failure affects every body system

A

respiratory- fluid overload (pulmonary edema)

neuro- poor cardiac output( confusion, lethargy)

integumentary- poor perfusion and edema puts patients at risk for skin breakdown(swollen, cyanotic)

gastrointestinal- liver congestion and enlargement, ascites, malnutrition

urinary- poor renal perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

the kidney’s role in heart failure

A
  1. decreased renal perfusion (low cardiac output)
  2. angiotensin and aldosterone are released
  3. causes increased anti diuretic hormone
  4. ADH causes the kidneys to reabsorb more water
  5. this combination of increased sodium and water leads to a further increase preload
  6. the weak heart cannot handle the excess fluid (preload) and congestion worsens , heart becomes more dilated and cardiac output drops even more
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Types of heart failure

A
  1. systolic
  2. diastolic
  3. right
  4. left
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Systolic heart failure

A

-decreases in the amount of blood ejected from the ventricle

causes:

  • heart attack
  • increased preload
  • cardiomyopathy
  • mechanical abnormalities
23
Q

Diastolic heart failure

A

-when the heart cant fill effectively due to increased resistance to filling

Causes:

  • left ventricular hypertrophy from chronic hypertension
  • aortic stenosis
  • hypertrophic cardiomyopathy
24
Q

LEFT SIDED HEART FAILURE

A
  • most common type of HF from left ventricular dysfunction

- the fluid back up reaches the pulmonary bed and causes pulmonary edema

25
Q

SIGNS AND SYMPTOMS OF LEFT SIDED HEART FAILURE

A

-capillary refill >3 sec
-orthopnea
-dyspnea on exertion nocturnal dyspnea
-cough with frothy sputum (indicative of pulmonary edema)(pink in color)
- tachypnea
-diaphoresis
-basilar crackles or rhonci
-cyanosis
-hypoxia (respiratory acidosis)
- elevated pulmonary artery pressure
low o2=low cardiac output

26
Q

PULMONARY EDEMA

A
  • the accumulation of fluid in the interstitial tissue and alveoli of the lungs
  • rapid interventions necessary of death is eminent
  • treat people with :
    diuretics
    nitrates
    morphine
27
Q

PULMONARY EDEMA ASSESSMENT FINDINGS

A 
cough with frothy sputum blood tinged
crackles, wheezes, rhonchi
tachycardia
hypotension or hypertension
orthopnea 
dyspnea, tachypnea
use of accessory muscles
cyanosis
cool and clammy skin
28
Q

RIGHT SIDED HEART FAILURE

A
  • not as common as left sided
  • usually caused by left sided HF
  • other causes include
    tricuspid valve problems
    pulmonic valve problems
    pulmonary hypertension
    pulmonary embolus
    coronary artery disease of the vessels that feed the right heart
29
Q

WHAT HAPPENS IN RIGHT SIDED HEART FAILURE

A
  • increased pressure from the pulmonary vasculature causes the right heart to become distended
  • the right heart cant effectively empty and fluid backs up in the systemic circulation
  • abdominal organs become congested and peripheral tissues become edematous
30
Q

RIGHT SIDED HEART FAILURE SIGNS AND SYMPTOMS

A
  • hepatomegaly
  • splenomegaly
  • dependent pitting edema
  • venous distention
  • hepatojugular reflux
  • oliguria
  • arrhythmias
  • elevated cvp pressure
  • elevated right atrial/ventrical pressure
  • narrowing pulse pressure
  • murmur or tricuspid insufficiency
  • audible s3 and s4 heart tones
  • fatigue/weakneses
  • abdominal pain
  • anorexia
  • weight gain
  • ascites
  • enlarged right atrium/ ventricle
31
Q

DIAGNOSING AND MONITORING HF

A
  1. chest x ray- cardiomegaly , pleural effusions
  2. echocardiogram- wall motion abnormalities, valvular problems, ejection fraction
  3. electrocardiogram- dysrhythmias
  4. cardiac catheterization- valves, ejection fraction
  5. pulmonary artery catheter- response to diuretic therapy pulmonary pressures (ICU)
32
Q

CHEST XRAY

A

black- air

white- something

33
Q

EJECTION FRACTION

A

the amount of blood ejected during systole compared to the amount of blood in the heart at the end of diastole

  • normal =50-70%
  • HF=
34
Q

DIAGNOSTIC LABS

A
  • beta natriuretic peptide(BNP)
35
Q

GOALS FOR TREATMENT FOR HF

A
  1. slow the progression of HF
  2. Reduce cardiac workload
  3. improve cardiac function
  4. control fluid retention
    ex;sodium
36
Q

ACE INHIBITORS

A
  • blocks the RAAS in kidney
  • reduce afterload through vasodilation
  • reduce ventricular remodeling through suppression of myocyte growth
  • decreases preload and left ventricular filling pressures which increase cardiac output

example:
lisinopril
trandolapril
catopril

37
Q

ARBS

A
  • angiotensin II receptor blockers
  • affect similar to ace inhibitors

example:
irbesartan
losartan
valsartan

38
Q

DIURETICS

A

-inhibit the absorption of sodium and water and promote their excretion

example:
Lasix
bumex
Diamox
hydrochlorothiazide
spirolactone
39
Q

DIgoxin

A

-cardiac glycoside inhibits the sodium -potassium
pump system and increase cardiac contractility

  • increases the refractoriness of AV node which decreases the ventricular response to strial rate (lowers HR)
  • is used as a first line drug for pt with HDF who are in AFIB
40
Q

DIGITALIS S&S

A
  • nausea
  • vomiting
  • bradycardia
  • confusion
41
Q

BETA BLOCKERS

A
  • improves left ventricular function by inhibiting the sympathetic nervouse system
  • anti-arrhythmic properties
  • slows HR
  • works on contractility

examples:
carvedilol, metoprolol, atenolol

42
Q

CALCIUM CHANNEL BLOCKERS

A

softens heart muscle

43
Q

NITRATES

A

-cause vasodilation of the vessels which help to decrease cardiac oxygen demand, cardiac preload and afterload while increasing cardiac output.

example:
nipride
ntg
hydralazine
prazosin
amiodipine
44
Q

SYMPATHOMIMETIC AGENTS

A

stimulate the heart to improve the force of contraction

example:
dopamine
dobutamine

45
Q

PHOSPHODIASTERASE INHIBITORS

A

increases contractility and causes vasodilation resulting in decreased afterload and increased cardiac output

example:
amrinone
mirinone

46
Q

NONPHARMACOLOGICAL TREATMENTS FOR HF

A
  1. Intra-Aortic balloon pump (IABP placement)
  2. Ventricular assistive device (VAD) implantation
  3. Heart transplant
47
Q

IABP

A
  • balloon placed in aorta that inflates during diastole and deflates during systole
  • offers afterload reduction through vacuum effect and increases coronary perfusion upon inflation
  • temporarily solution to improve cardiac output for patients in cardiogenic shock
  • multiple risks associated with IABP
  • decreases workload, only used for two weeks
48
Q

VENTRICULAR ASSIST DEVICE PLACEMENT

A
  • electromechanical pump which augments or fully replaces the work of the ventricle
  • most commonly used in the left ventricle, attaches in the apex of the LV-> blood is redirected through a hose and the pump which allows the blood to bypass the aortic valve -> blood enters the system circulation in the ascending aorta
  • “bridge to transplant” “destination therapy”
  • patents are at high risk for bleeding
49
Q

HEART TRANSPLANT

A
  • surgery involves removing the recipients heart , except for the posterior right and left atrial walls and their venous connections
  • recipients heart is replaced with the donor heart
  • anti rejection medication usually started in OR
  • patient is at high risk for infection (compromise host) for rest of their life

FK506 lab done daily

50
Q

HEART TRANSPLANT LIST

A
  • placed on list according to severity of HF
  • waiting period is long, many die
  • candidacy is determined by a multi disciplinary health care team
  • psych evaluations are done
51
Q

LIFE WITH A TRANSPLANT

A
  • HIGH DOSE OF IMMONOSUPRESSANTS
  • strict regiment
  • endomyocardial biopsies
  • high risk of infection that lead to complications
  • rejection of heart
52
Q

HEART FAILURE ASSSESSMENT

A
  • monitor vitals/oxygenation/ neuro status
  • daily weight
  • breath sounds
  • capillary refill
  • assess for signs: peripheral edema/JVD/ hepatomegaly/ ascities
  • pain level
  • output
  • electrolytes
53
Q

BASIC NURSING CARE FOR HEART FAILURE PATIENTS

A
  • ABC’s
  • oxygen therapy
  • continuous cardiac/ pulse oximetry monitoring
  • HOB 30 degrees
  • pharmacological therapy
  • cluster care
  • monitor restlessness, anxiety, pain, bowels
  • restrict sodium and fluid intake (strict iand o)
54
Q

PATIENT AND FAMILY DISCHARGE TEACHING

A
  • mediaction
  • diet/fluid restrictions
  • smoking cessation support
  • the importance of follow up Dr’s appointments
  • daily weights self- monitoring community resources

med surg 2 (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions