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NSC 386 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is heart failure?

A

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.

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2
Q

What can heart failure lead to?

A

Decreased Cardiac Output
Inadequate tissue perfusion
Impaired organ function

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3
Q

Associated Factors with Heart Failure

A

CAD and HTN
Valvular Disease
MI
A-Fib

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4
Q

Most common reason for hospital admission in adults > 65

A

Heart Failure

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5
Q

Average length of stay for patients w/ heart failure?

A

6.5 days

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6
Q

Risk factors for heart failure

A

CAD; Advanced age; HTN; DM; cigarette smoking; obesity

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7
Q

Factors that determine cardiac output

A

Preload (volume)
After load (pressure/resistance)
Stroke volume
Heart Rate

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8
Q

Areas of Heart Failure

A

Systolic Failure
Diastolic Failure
Mixed Systolic and Diastolic Failure

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9
Q

Heart failure characterized by a defective pumping issue reflecting impaired contractility and increased afterload

A

Systolic Failure

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10
Q

What is the hallmark characteristic of systolic heart failure

A

Low ejection fraction (EF) -> < 45%

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11
Q

Heart failure caused by chronic HTN seen w/ left ventricular hyper trophy and or cardiomyopathy. The heart has a problem with filling.

A

Diastolic Failure

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12
Q

What does diastolic heart failure result in? How does this present?

A

Decreased stroke volume and cardiac output;

Presented by backup of blood in the pulmonary and systemic systems

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13
Q

Biventricular failure; issue with the heart’s ability to pump and fill; often seen with cardiomyopathy

A

Mixed systolic and diastolic failure

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14
Q

What is the main difference between Systolic and Diastolic HF?

A

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.

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15
Q

Compensatory Mechanisms of Heart Failure:

A

Ventricular dilation;
Ventricular Hypertrophy;
Activation of the SNS;
Neurohormonal responses

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16
Q

Result of high pressures in the heart overtime resulting in the heart becoming overstretched.

A

Ventricular Dilation

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17
Q

What is an advantage of Ventricular dilation? What is the disadvantage?

A

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.

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18
Q

Thickening of the cardiac wall following chronic dilation

A

Ventricular hypertrophy

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19
Q

What is an advantage to ventricular hypertrophy? What is a disadvantage?

A

Initially helps to improve cardiac output;

Decreases Cardiac output over time because of increased workload and stiffening/stretching of the heart wall.

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20
Q

What does the release of epinephrine and norepinephrine do to the heart?

A

Increase HR and contractility; vasoconstriction increases systemic vascular resistance

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21
Q

What is a disadvantage in the activation of SNS on someone with heart failure?

A

Increased cardiac workload

22
Q

What system does neurohormonal response target?

A

Renin-Angiotensin-Aldosterone System (RAAS)

23
Q

How does activation of RAAS affect someone with heart failure?

A

Decreases CO to kidneys which ultimately leads to retention of sodium and water leading to fluid overload. This increases cardiac preload.

24
Q

What is ventricular remodeling? How does this affect someone with heart failure?

A

Hypertrophy often seen in left ventricle; Makes heart a less effective pump.

25
Q

Protein Secreted in response to increased pressure in the ventricles caused by the stretching of the heart from increased fluid retention.

A

Brain Natriuretic Peptide (BNP)

26
Q

How does BNP try to compensate for compensatory mechanisms of heart failure?

A

Vasodilation;
Dieresis and Natriuresis;
Blockage of RAAS

27
Q

Types of heart failure:

A

Left-Sided HF

Right-Sided HF

28
Q

Left-Sided Heart Failure is caused by

A

Left ventricular dysfunction; backup of blood into left atrium

29
Q

Signs and Symptoms of left-sided HF

A

SOA, wheezing/crackles, moist cough, cyanosis (pulmonary edema and congestion)

30
Q

Cause of right-sided HF

A

Right ventricle dysfunction; back up of blood in right atrium; result of left-sided or cor pulmonale

31
Q

Signs and symptoms of right-sided HF

A

JVD;
Peripheral edema;
Vascular congestion of GI tract (Asites)
Hepatomegaly

32
Q

Cause of acute decompensated HF

A

L ventricular failure

33
Q

Manifestation of acute decompensated Hf

A

Pulmonary edema

34
Q

S/S of acute Decompensated HF

A

Anxious; pale, cool, clammy skin
Pulmonary edema
Respiratory acidosis

35
Q

Chronic Heart Failure Symptoms (Faces)

A

Fatigue; Activity Limitations
Chest congestion/Pulmonary Edema
Edema
Shortness of Breath

36
Q

Complications of heart failure:

A

Renal Failure
Left Ventricular Thrombus
Pleural Effusion
Dysrhythmias; Hepatomegaly

37
Q

Diagnostic studies of HF

A

History & Physical
Chest X-Ray
Echocardiogram
BNP (normal = 0 - 100 pg/mL)

38
Q

Care for ACUTE HF

A

Improve Gas Exchange and Oxygenation
Decrease Intravascular Volume/Reduce Preload
Decrease Afterload
Improve Cardiac Function

39
Q

What are some things we can do to improve gas exchange and oxygenation

A

High Fowler’s; Supplemental Oxygen (2-4L);

Morphine

40
Q

Why would giving patient morphine help improve gas exchange and oxygenation?

A

Helps to decrease preload & afterload and myocardial oxygen demands

41
Q

What are some things we can do to decrease intravascular volume and/or reduce preload?

A
  1. High Fowler’s position w/ legs dangling or horizontal in bed
  2. Loop Diuretics
  3. Vasodilator
  4. Fluid Restriction
42
Q

What are some things we can do to decrease afterload?

A

Nitroglycerin
Sodium Nitroprusside (watch for hypotension; thiocyanate toxicity)
Nesiritide (on IV pump; watch for hypotension)
ACE Inhibitors: watch for angioedema and cough

43
Q

Ways to improve cardiac function

A

Intropic therapy - increase myocardial contractility and CO

  1. Digoxin
  2. Dobutamne
    * *Not first choice!!!
44
Q

Goals for the treatment of Chronic HF

A
  1. Treat cause
  2. Maximize CO
  3. Symptom management
  4. Improve quality of life & Decrease Mortality
  5. Preserve Target organ function
45
Q

Collaborative and nursing care for Chronic HF

A

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

46
Q

How to improve activity levels for stable chronic HF

A

Start slow then increase few min each day

47
Q

Drug therapy for HF

A

Diuretics (loops and thiazides)
ACE I’s
Vasodilators for patients who cannot tolerate ACE I’s

48
Q

Nutritional therapy for Chronic HF

A

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

49
Q

Ways to assess fluid balance

A

Ankle swelling
ABD swelling
Orthopedic; Paroxysmal Nocturnal Dyspnea; Weight Gain (1st sign)

50
Q

End Stage/Advanced HF

A

Biventricular pacing
ICD
Cardiac Transplantation (strict criteria to meet)

51
Q

Nursing Diagnoses for Chronic HF

A

Activity intolerance;Excessive fluid volume;
Impaired gas exchange; Anxiety; Decreased Cardiac Output;
Knowledge deficit

NSC 386 (11 decks)

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