Heart Failure Flashcards
What is heart failure?
Inability of the heart to pump and/or fill which leads to an inability of the heart to supply the body tissues with enough oxygen.
What can heart failure lead to?
Decreased Cardiac Output
Inadequate tissue perfusion
Impaired organ function
Associated Factors with Heart Failure
CAD and HTN
Valvular Disease
MI
A-Fib
Most common reason for hospital admission in adults > 65
Heart Failure
Average length of stay for patients w/ heart failure?
6.5 days
Risk factors for heart failure
CAD; Advanced age; HTN; DM; cigarette smoking; obesity
Factors that determine cardiac output
Preload (volume)
After load (pressure/resistance)
Stroke volume
Heart Rate
Areas of Heart Failure
Systolic Failure
Diastolic Failure
Mixed Systolic and Diastolic Failure
Heart failure characterized by a defective pumping issue reflecting impaired contractility and increased afterload
Systolic Failure
What is the hallmark characteristic of systolic heart failure
Low ejection fraction (EF) -> < 45%
Heart failure caused by chronic HTN seen w/ left ventricular hyper trophy and or cardiomyopathy. The heart has a problem with filling.
Diastolic Failure
What does diastolic heart failure result in? How does this present?
Decreased stroke volume and cardiac output;
Presented by backup of blood in the pulmonary and systemic systems
Biventricular failure; issue with the heart’s ability to pump and fill; often seen with cardiomyopathy
Mixed systolic and diastolic failure
What is the main difference between Systolic and Diastolic HF?
EF is normal in diastolic heart failure because less blood is going into the ventricles so the heart doesn’t have to pump as much and as hard.
Compensatory Mechanisms of Heart Failure:
Ventricular dilation;
Ventricular Hypertrophy;
Activation of the SNS;
Neurohormonal responses
Result of high pressures in the heart overtime resulting in the heart becoming overstretched.
Ventricular Dilation
What is an advantage of Ventricular dilation? What is the disadvantage?
Heart muscle fibers are stretching to increase contractility;
Only helps for a short while and the heart becomes a poor pump because of overstretched ventricle.
Thickening of the cardiac wall following chronic dilation
Ventricular hypertrophy
What is an advantage to ventricular hypertrophy? What is a disadvantage?
Initially helps to improve cardiac output;
Decreases Cardiac output over time because of increased workload and stiffening/stretching of the heart wall.
What does the release of epinephrine and norepinephrine do to the heart?
Increase HR and contractility; vasoconstriction increases systemic vascular resistance
What is a disadvantage in the activation of SNS on someone with heart failure?
Increased cardiac workload
What system does neurohormonal response target?
Renin-Angiotensin-Aldosterone System (RAAS)
How does activation of RAAS affect someone with heart failure?
Decreases CO to kidneys which ultimately leads to retention of sodium and water leading to fluid overload. This increases cardiac preload.
What is ventricular remodeling? How does this affect someone with heart failure?
Hypertrophy often seen in left ventricle; Makes heart a less effective pump.
Protein Secreted in response to increased pressure in the ventricles caused by the stretching of the heart from increased fluid retention.
Brain Natriuretic Peptide (BNP)
How does BNP try to compensate for compensatory mechanisms of heart failure?
Vasodilation;
Dieresis and Natriuresis;
Blockage of RAAS
Types of heart failure:
Left-Sided HF
Right-Sided HF
Left-Sided Heart Failure is caused by
Left ventricular dysfunction; backup of blood into left atrium
Signs and Symptoms of left-sided HF
SOA, wheezing/crackles, moist cough, cyanosis (pulmonary edema and congestion)
Cause of right-sided HF
Right ventricle dysfunction; back up of blood in right atrium; result of left-sided or cor pulmonale
Signs and symptoms of right-sided HF
JVD;
Peripheral edema;
Vascular congestion of GI tract (Asites)
Hepatomegaly
Cause of acute decompensated HF
L ventricular failure
Manifestation of acute decompensated Hf
Pulmonary edema
S/S of acute Decompensated HF
Anxious; pale, cool, clammy skin
Pulmonary edema
Respiratory acidosis
Chronic Heart Failure Symptoms (Faces)
Fatigue; Activity Limitations
Chest congestion/Pulmonary Edema
Edema
Shortness of Breath
Complications of heart failure:
Renal Failure
Left Ventricular Thrombus
Pleural Effusion
Dysrhythmias; Hepatomegaly
Diagnostic studies of HF
History & Physical
Chest X-Ray
Echocardiogram
BNP (normal = 0 - 100 pg/mL)
Care for ACUTE HF
Improve Gas Exchange and Oxygenation
Decrease Intravascular Volume/Reduce Preload
Decrease Afterload
Improve Cardiac Function
What are some things we can do to improve gas exchange and oxygenation
High Fowler’s; Supplemental Oxygen (2-4L);
Morphine
Why would giving patient morphine help improve gas exchange and oxygenation?
Helps to decrease preload & afterload and myocardial oxygen demands
What are some things we can do to decrease intravascular volume and/or reduce preload?
- High Fowler’s position w/ legs dangling or horizontal in bed
- Loop Diuretics
- Vasodilator
- Fluid Restriction
What are some things we can do to decrease afterload?
Nitroglycerin
Sodium Nitroprusside (watch for hypotension; thiocyanate toxicity)
Nesiritide (on IV pump; watch for hypotension)
ACE Inhibitors: watch for angioedema and cough
Ways to improve cardiac function
Intropic therapy - increase myocardial contractility and CO
- Digoxin
- Dobutamne
* *Not first choice!!!
Goals for the treatment of Chronic HF
- Treat cause
- Maximize CO
- Symptom management
- Improve quality of life & Decrease Mortality
- Preserve Target organ function
Collaborative and nursing care for Chronic HF
Work together on meeting goals;Oxygen Therapy;
Improve Activity levels; Drug Therapy (diuretics; ACE inhibitors; vasodilators);Nutritional therapy; Limit Alcohol/Smoking; Avoid Herbals/NSAIDS; Edu s/s acute decompensation; psychosocial issues
How to improve activity levels for stable chronic HF
Start slow then increase few min each day
Drug therapy for HF
Diuretics (loops and thiazides)
ACE I’s
Vasodilators for patients who cannot tolerate ACE I’s
Nutritional therapy for Chronic HF
Sodium Restriction: < 2Gm/day
Fluid Restriction: for class 3-4; < 2L/day
Daily Wt./ Monitor Fluid Balance: report wt gain of 3lb over 2 days or 3-5lb per week
Ways to assess fluid balance
Ankle swelling
ABD swelling
Orthopedic; Paroxysmal Nocturnal Dyspnea; Weight Gain (1st sign)
End Stage/Advanced HF
Biventricular pacing
ICD
Cardiac Transplantation (strict criteria to meet)
Nursing Diagnoses for Chronic HF
Activity intolerance;Excessive fluid volume;
Impaired gas exchange; Anxiety; Decreased Cardiac Output;
Knowledge deficit
