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Care of Adult/Older patients > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q
  • an abnormal clinical syndrome involving impaired cardiac pumping and/or filling.
  • characterized by ventricular dysfunction, reduced exercise tolerance, diminished quality of life, and shortened life expectancy.
A

Heart Failure

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2
Q

Heart Failure

A
  • an abnormal clinical syndrome involving impaired cardiac pumping and/or filling.
  • characterized by:
    • ventricular dysfunction
    • reduced exercise tolerance
    • diminished quality of life
    • shortened life expectancy.
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3
Q

HF Risk Factors

A
  • Hypertension
    • Modifiable risk factor
    • Properly treated/managed can decrease incidence by 50%
  • Coronary artery disease (CAD)
  • Myocardial infarction
  • Advancing age
  • Diabetes
  • Cigarette smoking
  • Obesity
  • High serum cholesterol
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4
Q

Precipitating Causes for HF?

A
  • Anemia - decreases O2 carrying capacity
  • Infection - increases O2 demand
  • Hypothyroidism - increases rate of atherosclerosis
  • Dysrhythmias - decrease CO, increase workload
  • Endocarditis - increase O2 demand, damage vessels
  • Pulmonary embolism - increase pressure = pulmonary HTN and decrease CO
  • Can be caused by any interference in the normal mechanism regulating CO
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5
Q

Most common form

of HF?

A

Left-Sided Failure

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6
Q

Effects of Systolic HF?

A
  • Reduced EF
  • Inability to pump blood forward
  • Decreased LV ejection fraction (EF)
  • end result = pulmonary congenstion
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7
Q

Causes of Systolic HF?

A
  • Impaired contractile function
  • Increased afterload
  • Cardiomyopathy
  • Mechanical abnormalities
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8
Q

Effects of Diastolic HF?

A
  • preserved EF
  • Impaired ability of the ventricles to relax and fill during diastole, resulting in decreased stroke volume and CO
  • Same end result as systolic failure = pulmonary congestion
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9
Q

Causes/Risk factors of Diastolic HF?

A
  • left ventricular hypertrophy from:
    • hypertension
    • older age
    • female gender
    • diabetes
    • obesity
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10
Q

Seen in disease states such as dilated cardiomyopathy (DCM)

A

Mixed Heart Failure

- diastolic and systolic

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11
Q

Effects of Mixed HF?

A
  • Poor EFs (<35%)
  • High pulmonary pressures
  • Biventricular failure
    • Both ventricles may be dilated and have poor filling and emptying capacity
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12
Q

Type of HF seen in disease states such as dilated cardiomyopathy (DCM)?

A

Mixed HF

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13
Q

Right-Sided Heart Failure

A
  • RV fails to pump effectively
  • Fluid backs up in venous system
  • Fluid moves into tissues and organs
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14
Q

Causes of Right-Sided Heart Failure?

A
  • Left-sided HF is most common cause
  • RV infarction
  • Pulmonary Embolism
  • cor pulmonale (RV dilation and hypertrophy)
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15
Q

Ventricular failure leads to:

A
  • Low blood pressure (BP)
  • Low CO
  • Poor renal perfusion
  • Abrupt or subtle onset
  • Compensatory mechanisms mobilized to maintain adequate CO
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16
Q

The main compensatory mechanisms for Heart Failure?

A
  • neurohormonal responses
  • renin-angiotensin-aldosterone-system (RAAS)
  • SNS
  • ventricular dilation
  • ventricular hypertrophy (last response)
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17
Q

What are Natriuretic peptides?

A
  • Counterregulatory Mechanisms in HF
  • Atrial natriuretic peptide (ANP),
  • b-type natriuretic peptide (BNP) release from ventricles
  • Released in response to increased blood volume in heart
  • Causes: diuresis, vasodilation, and lowered BP
  • Counteracts effects of SNS and RAAS
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18
Q

Renal effects of Natriuretic peptides?

A
  • increased glomerular filtration rate and diuresis

- excretion of sodium (natriuresis).

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19
Q

CV effects of Natriuretic peptides?

A
  • vasodilation

- decreased BP.

20
Q

hormonal effects of Natriuretic peptides?

A
  • inhibition of aldosterone and renin secretion

- interference of ADH release.

21
Q

Manifestations of Left-Sided HF?

A
  • S3, S4 heart sounds
  • Fatigue
  • Dyspnea
  • Orthopnea
  • Dry, hacking cough
  • Pulmonary edema
  • Nocturia
22
Q

Manifestations of Right-Sided HF?

A
  • Hepatomegaly
  • Splenomegaly
  • Congestion of the GI tract
  • Jugular vein distention (JVD)
  • Peripheral edema
23
Q

AHA stages of HF?

A

(A) high risk, no structural heart disease or symptoms
(B) structural heart disease, without S/S
(C) structural heart disease, with S/S
(D) refractory HF requiring specialized interventions

24
Q

NYHA stages of HF?

A

I - no limitations of physical activity
II - slight limitation
- comfortable at rest but ordinary PA causes symptoms
III - marked limitations
- comfortable at rest, but less than ordinary PA causes symptoms
IV - unable to cary on any PA without symptoms, or symptoms at rest

25
Q

Manifestations of Acute decompensated heart failure (ADHF)?

A
  • pulmonary edema, — is an acute, life-threatening situation.
26
Q

manifestations of HF depend on:

A
  • Age

- type and extent of heart disease.

27
Q

Common symptoms of Chronic HF?

A
  • fatigue
  • cough
  • dyspnea
  • tachycardia
  • edema
  • limitations of ADLs
28
Q

Chronic Heart Failure Manifestations

A
  • Fatigue
  • Dyspnea
  • Paroyxsmal nocturnal dyspnea
  • Tachycardia
  • Edema
  • Nocturia
  • Skin changes
  • Behavioral changes
  • Chest pain
  • Weight changes
29
Q

Diagnostic Studies for HF?

A
  • H & P
  • Chest x-ray
  • Electrocardiogram (ECG)
  • Stress testing
  • Laboratory data
  • Echocardiogram
  • Cardiac catheterization
30
Q

Common Labs for HF?

A
  • Cardiac enzymes
  • b-type natriuretic peptide [BNP]
  • basic metabolic panel, - liver function studies
  • complete blood count
31
Q

BNP normal lab value?

A

< 100 pg/mL

32
Q

BNP value indicative of HF?

A

> 100 pg/mL

33
Q

Nursing Interventions for HF?

A
  • HIGH FOWLERS POSITION
  • Oxygen therapy
  • Vital signs and ECG monitoring
  • Monitor laboratory
    • values (H/H, BNP, MG, K)
  • Intake/output
  • Daily weights
  • Administer medications
  • Patient teaching
  • Cardiac resynchronization therapy (if uncontrolled Afib occurs)
34
Q

Psychological Interventions for HF?

A

Assess and treat

  • Depression
  • Anxiety
  • Social isolation
35
Q

Drug Therapy: Diuretics

A
  • mobilize fluid,
  • reduce pulmonary
  • venous pressure
  • reduce preload
  • risk for electrolyte imbalance
36
Q

What is the primary drug of choice in chronic HF patients with systolic dysfunction

A

Angiotensin-converting enzyme (ACE) inhibitors

37
Q

may be used in patients who are ACE inhibitor intolerant.

A

Angiotensin II receptor blockers (ARB)

38
Q

Anticoagulants

are recommended for?

A
  • all patients with EF <20% and /or Afib
39
Q

Dig toxicity s/s?

A

Blurred or yellow vision, n/v fatigue

40
Q

Dietary restriction of sodium, how much?

A

< 2000 mg

41
Q

In moderate to severe HF fluid is restricted to>

A

< 2000 ml daily

42
Q

Contact primary care provider for a weight gain of?

A

3 lb over 2 days or 3 to 5 lb over a week

43
Q

Complication of ADHF and HF?

A
  • Pulmonary edema
  • Pleural effusion
  • Dysrhythmias -Atrial Fibrillation
  • Hepatomegaly
  • Renal failure
44
Q

Treatment for A fib can include:

A
  • Medications
  • Long term anticoagulation
    • Coumadin (Monitor INR)
  • Cardiac resynchronization therapy (CRT)-cardioversion
45
Q

Promotes thrombus/embolus formation, increasing risk for MI & CVA

A

Atrial Fibrillation

46
Q

Treatment of choice for patients with refractory end-stage HF, inoperable CAD, and cardiomyopathy?

A

Cardiac Transplantation

47
Q

End of Life supportive therapies?

A
  • Analgesia
  • O2
  • nutritional support

Care of Adult/Older patients (5 decks)

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