Heart Failure Flashcards
Spring 2019
S/S of Digoxin toxicity
Abdominal pain anorexia nausea vomiting bradycardia arrhythmias
Percutaneous Coronary Revascularization (PCR)
purpose if to improve blood flow through a coronary artery
LVAD and VAD (2 types of therapy)
DESTINATION THERAPY——long term tx for patients not qualified for heart transplant.
BRIDGE TO TRANSPLANT THERAPY—–used until heart becomes available
How does the “compensatory mechanism” work?
Increased volume in the vascular system that this creates only makes the struggling heart work harder
The retention of water and sodium and vasoconstriction of the arteries make it harder for the heart to pump
It increases blood pressure
It increased heart rate
It increases afterload and all of these things are bad for a heart that is already struggling
Contractility
Strength of the hearts cells to shorten and contract
Medications for Pulmonary Edema (5)
“MAD IV”
M-orphine——decrease anxiety—–cause vasodilation
A-ntihypertensives—decrease afterload (ACE inhib
beta blockers)
D-iuretics—-promotes fluid excretion (furosemide)
I-notropes—-improve cardiac output (digoxin)
V-asodilators—decrease preload & afterload (nitro)
Nursing Care of Pulmonary Edema (10)
“BIV Phobias”
B-lood gases
I-ntake & Output
V-itals
P-Potassium H-igh fowlers O-xygen w/hi-flo rebreather B-ipap I-ntubation or/ventilation A-irway S-low (or) d/C Iv's
S/S of RIGHT-SIDED heart failure (
“SWELLING”
S-Swelling W-eight gain E-dema (ankles-legs-sacrum) L-Large distended neck vein L-lethargic I-rregular heart rate N-octuria G-irth of abdomen / ascites
Loop and thiazide diuretics can cause___________, so ________ supplementation should be given
hypokalemia
potassium
Describe S/S stage 4 heart failure
1) severe
2) signs of heart failure at rest
3) any activity increases signs of failure
Implantable Cardioverter Defibrillator
provides electrical countershock when lethal arrhythmia is detected
Stroke Volume
Amount of blood pumped by a ventricle with each beat
What happens to the BNP level if the heart failure continues to worsen?
The BNP continues to increase as long as HF is worsening
What makes “heart function” successful? (2)
1) blood flow is forward
RIGHT SIDE GOES TO LUNGS
LEFT SIDE GOES TO THE BODY
2) Blood flow is efficient = adequate cardiac output
PRELOAD
volume of blood in ventricles at the end of diastole
—PALLIATIVE CARE—
END-STAGE HF SYMPTOMS (4)
1) DYSPNEA
2) PAIN
3) FATIGUE
4) DEPRESSION
S/S of LEFT-SIDED Heart Failure (10)
“DROWNING AD”
D-ifficulty breathing R-Rales/crackles O-Orthopnea W-eakness/fatigue N-Nocturnal Paroxysmal Dyspnea
I-ncreased heart rate
N-Nagging cough
G-aining 2-3 lb/day (or) 5lb/week
A-ltered mental status
D-ecreased Urine Output
_______, ________ and ________ are the 1st to show decreased function when heart failure and poor oxygenation occur.
brain
lungs
kidney
AFTERLOAD
resistance that the left ventricle must overcome to circulate the blood
PRE LOAD
Amount the ventricles stretch at the end of diastole
teaching points for LVAD & VAD
NO chest compressions
NO MRI
OK to give ACLS drugs
OK for cardiac defibrillation
Hormone released by the heart muscle when the left ventricle is stretched and pulmonary blood pressure backs up
BNP
Hormone released by the heart muscle when the left ventricle is stretched and pulmonary blood pressure increases as blood backs up during heart failure
BNP
normal potassium value
3.5 - 5 mEq /L
normal sodium value
135 - 145 mEq /L
Teaching Points for ICD device
- will feel like “kick in chest”
- monitoring Q 3-6 months by doctor
- doctor notified of “shocks” given
- be cautious around airport security
- special MRI protocol
- Turn off ICD during ESWL
- Turn off during radiation therapy
AFTERLOAD
pressure the ventricles must work against to open the semilunar valves and pump blood out of the heart
normal chloride value
96 - 106 mEq /L
TX OF STAGE 4 HEART FAILURE
**MEDICATIONS
IMPROVEMENT OF CARDIAC OUTPUT
- Ace Inhibitors (enalapril)
- Arbs (losartan)
- Beta Blockers (metoprolol)
- Aldosterone Antagonist (spironolactone)
CONTROL OF SYMPTOMS
- Loop Diuretics (furosemide, HCTZ)
- Digoxin
PALLIATION
- Opioids (morphine)
- antidepressants
- Oxygen
—PALLIATIVE CARE—
for DEPRESSION
- *often goes undiagnosed
- *research shows increased risk of death with hospitalization with increased depressive symptoms
- *SSRI therapy
- *Psychosocial & spiritual support
---PALLIATIVE CARE--- GENERAL INTERVENTIONS (4)
1) ACTIVITY AS TOLERATED
2) DIETARY SODIUM RESTRICTIONS (2000mg day)
3) FLUID RESTRICTIONS
4) CONTINUE MEDICATIONS
What is the purpose of IV Morphine when used with Pulmonary Edema? (3)
- decrease anxiety
- respiratory distress
- decrease venous return
Assessment of Pulmonary Edema (11)
“SOUR PATCH AD”
S-putum (pink, frothy)
O-rthopnea
U-rine (decreased)
R-ales/crackles
P-ersistent Cough A-ltered mental status T-achycardia / Tachypnea C-yanosis H-ypoxemia
A-nxiety
D-sypnea
How does heart failure result in tissue hypoxia?
decreased oxygen being carried to the cells = hypoxia
Risk Factors for Pulmonary Edema (4)
Acute MI
Left Sided heart failure
Valvular heart disease
fluid volume overload
How does the LVAD / VAD work?
Pulls blood from left ventricle through the pump and into the Aorta
the main pumping chamber of the heart
Left Ventricle
What makes heart function a failure (4)
1) Blood flow is NOT forward
2) Not enough force behind blood flow = decreased CO
3) Tissue hypoxia results r/t decreased oxygen being carried to the cells.
4) Compensatory mechanisms eventually fail because they increase the workload of the failing heart
complication of heart failure
Pulmonary edema
—PALLIATIVE CARE—
for PAIN
- ANGINA and EDEMA (Cardiac sources)
- OPIOIDS for any type
- avoid NSAIDS - interferes with diuretics and ace inhibitors
- Relaxation
- repositioning
- distraction
- music / pet/ aroma therapy
‘4” concepts related to heart failure? how does each one affect the patient?
OXYGENATION: decreased oxygenation throughout the body
COGNITION: r/t cerebral hypoxia
COMFORT: r/t ischemic tissue becoming necrotic and painful
FLUID AND ELECTROLYTES: r/t fluid volume excess with pulmonary congestion
Diagnostics testing for heart failure (4)
CXR - can reveal cardiomegaly and pleural effusion
12 lead EKG - tachycardia / bradycardia
ECHOCARDIOGRAM- evaluates for a decreased LV ejection fraction (NORMAL=55% - 70%)
BNP - <100pg/ml = no heart failure
>100pg/ml = positive for heart failure
Therapeutic DIGOXIN serum level
0.5 - 2 ng/mL
Cardiac Output
amount of blood the heart pumps per minute
normally the heart pumps 4-8 liters of blood per minute
The amount of blood that the left ventricle pumps out with each contraction
Ejection Fraction
This patient is FLUID OVERLOADED and HYPOXIC and is an emergent situation
Pulmonary Edema
—PALLIATIVE CARE—
for Dyspnea
- orthopnea & paroxysmal nocturnal dyspnea
- Diuretics and vasodilators for fluid overload
- Opioids to decrease preload /afterload (lesses breathlessness)
*elevate legs and HOB
Oxygen via NC
*fan
Tx of Stage 4 Heart Failure (4 general classifications)
MEDICATIONS - primary treatment
DEVICES - they support the patients heart function
SURGERY - limited types of surgical procedures
PALLIATIVE CARE - when all other options have failed
PCR—POST PROCEDURE nursing duties
- continuous VS & ECG monitoring
- medications: IV NITRO,anticoagulants, CCB
- assess for chest pain, bleeding at insertion site
- Bedrest with HOB at 30 degrees or less
- no flexion of the affected leg
- neurovascular checks affected leg: pulse quality, color, movement, sensation, temperature of affected leg
- Monitor I & O: contrast dye may cause renal damage
- check coagulation studies and electrolytes (arrhythmia)
___________will increase the strength of the contraction
Digoxin
PCR—complications
- HEMATOMA
- CARDIAC TAMPONADE
- ACUTE KIDNEY INJURY r/t contrast dye
- BLEEDING AT INSERTION SITE
How does the Heart failure rescue work?
1) decreased Cardiac output
2) Rescue with water / sodium retention & vasoconstriction
3) leading into increased BP, HR and AFTERLOAD
PCR —PRE-PROCEDURE nursing duties
- teach client about procedure
- verify allergies (ie, contrast dye)
- meds used (anticoagulant, nitro, CCB)
- alert pt to possible “metallic taste in mouth”
- assess peripheral circulation-baseline pulse-skin color-temperature-capillary refill-sensation
