Heart Failure Flashcards
What diseases can lead to HF?
Cardiomyopathy Valvular heart disease Endocarditis Acute MI HTN
Left sided HF
What happens?
Blood doesnt move forward into aorta and out to body. If it doesnt move forward then it backs up to lungs
Left sided HF
What congestion?
Pulmonary
Left sided HF
Breathing
Dyspnea
Cough
Left sided HF
Sputum
Blood tinged frothy sputum
Left sided HF
Appearace
Restlessness
Left sided HF
Heart
Tachycardia
S3
Left sided HF
Sleep
Orthopnea (SOB when laying down–need to sleep propped up)
Nocturnal dyspnea (SOB/cough attacks at night)
Right sided HF
What happens
Blood destine move forward into lungs so it goes back into venus system
Right sided HF
Veins?
Distended neck veins
Right sided HF
Fluid?
Edema
Enlarged organs
Weight gain
Ascites
Systolic HF?
Heart can’t contract and eject
Diastolic HF?
Ventricles can’t relax and fill
BNP
How is it secreted?
Ventricular tissues in the heart when ventricular volumes and pressures in the heart are increased
BNP
Is it a sensitive indicator?
Yes
BNP
Can be ___ for HF when CXR does not indicate a problem
Positive
BNP
If the client is on nesiritide, turn it off ___ prior to drawing a BNP
2 hours
CXR will show what?
Enlarged heart, pulmonary infiltrates
What will echocardiogram show?
Looks at pumping action or EF of heart. Also gives info about back flow and valve disease
A balloon flotaton catheter than can be floated into the RIGHT side of the heart and pulmonary artery
Swan-Ganz (pulm. artery) catheter
What does Swan-Ganz do?
Provides info to rapidly determine hemodynamic pressures, CO, and provides access to mixed venous blood sampling
What is DOC for HF: ACE or ARB?
ACE (but ARB is used too)
Treatment: ACE (-pril)
What do they do?
Suppress RAS
Treatment: ACE (-pril)
Prevent conversion of ?
Angiotensin I to angiotensin II
Treatment: ACE (-pril)
Results in arterial ___ and ___ SV
Arterial dilation and increased stroke volume
Treatment: ACE (-pril)
Reasons to stop an ACE?
Dry cough
Angioedema
Treatment: ARBs (-sartan)
Block angiotensin II receptors and cause a ____ in arterial resistance and decreased BP
Decrease
Treatment: ARBs (-sartan)
ACE and ARB both block ____. When we block this, what happens?
Block aldosterone
- we loose NA and H20
- we retain K
Treatment: Digoxin
Monitor for drug toxicity, esp in the __
Elderl
Treatment: Digoxin
Used when the client is in sinus rhythm or a-fib and had accompanying ___
Chronic HF
Treatment: Digoxin
Often given in combo with what?
ACE
ARB
BB or
Diuretics
Treatment: Digoxin
Contraction?
Increases
Treatment: Digoxin
HR?
Decreases
Treatment: Digoxin
When the HR is slowed, this gives the ventricles more time to fill with blood. Good for systolic or diastolic HF?
Diastolic HF
Treatment: Digoxin
CO?
Increase
Treatment: Digoxin
Kidney perfusion
Increase (UO goes up)
Would diuresis be a good thing or bad thing for this client?
Good
We always want to ___ HF clients
Diuresis
Normal level of Dig?
0.5-2
How do you know dig is working?
CO goes up
S/s of dig toxicity (early)?
ANorexia
NV
S/s of dig toxicity (late)?
Arrhythmias
Vision changes
Before giving dig, do what?
HR check
When to hold dig for infant, toddler, child, and adult?
Infant: Hold if 90-110
Toddler: Hold if less than 70
Child and adult: Hold if less than 60
Normal HR for infant? toddler? child?
Normal RR for infant? toddler? child?
Infant: HR 140, RR 40
Toddler: HR 120, RR 30
Child: HR 100, RR 20
___ + Dig = toxicity
Potassium
T/F: ANy electrolyte imbalance can promote dig. toxicity
T
Treatment: Diuretics
Action?
Decreases preload
Treatment: Diuretics
When to give?
Morning
Why give low Na diet?
Decreases fluid retention and helps decrease preload
*watch salt substitutes bc they contain excess potassium chloride
HOB?
Elevate
Weight
Daily and report weight gain of 2-3 lbs
Fluid retention think what first?
Heart problems
HF, pulm. edema
Your natural pacemaker is SA node or sinus node. It sends out impulses that make heart __. If your HR drops to 60 or below, CO can ____
Contract Be reduced (vital organs don't perfuse well though!)
Pacemakers are used to increase the HR with ____
Symptomatic bradycardia
Pacemakers depolarize the heart muscle and a contraction will occur (_____)
Electricity goes through the muscle
Repolarization is ?
When ventricles are resting and filling with blood
Always worry if HR drops below ___
Set rate
Any pacemaker will maintain a certain minimal HR depending on the settings aka the ___
Set rate
A demand pacemaker kicks in when?
When client needs it to
Fixed rate PM fire at ___
Fixed rate constantly
Its ok for the rate to increase but never ____
Decrease below set rate
Always worry if the rate ____ below set rate
Decreases
Post procedure care for PPM
Monitor what?
Most common complication?
Arm?
ROM?
- Monitor incision
- Complication: Misplacement
- Immobilize arm; keep client from raising arm higher than shoulder height (wires could come out)
- Passive ROM to prevent frozen shoulder
S/S of PPM malfunction
Failure to capture
No contraction will follow stimulus
S/S of PPM malfunction
Failure to sense
Fire at inappropriate times
S/S of PPM malfunction
What can cause loss of capture, failure to sense or any malfunction?
- May not be programmed correctly
- Electrodes can dislodge
- Battery may deplete
S/S of PPM malfunction
Watch for sign of decreased CO or decreased __
Rate
Client edu/teaching for PM
Check what daily?
Need what?
Avoid what?
Airport?
Check HR daily
Need ID card/bracelet
Avoid electromagnetic fields (cell phones, large motors), MRI, and contact sports
May set of alarm at airport
What is ICD? and why?
Implantable cardiac device (aka implantable cardioverter defibrillator)
May be used to pace heart or defibrillate people in V-fib
(post op care same as PM)