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NURSING 241 (Fall 2018) > Heart Failure > Flashcards

Heart Failure Flashcards

Spring 2019

1
Q

S/S of Digoxin toxicity

A 
Abdominal pain
anorexia
nausea
vomiting
bradycardia
arrhythmias
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2
Q

Percutaneous Coronary Revascularization (PCR)

A

purpose if to improve blood flow through a coronary artery

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3
Q

LVAD and VAD (2 types of therapy)

A

DESTINATION THERAPY——long term tx for patients not qualified for heart transplant.

BRIDGE TO TRANSPLANT THERAPY—–used until heart becomes available

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4
Q

How does the “compensatory mechanism” work?

A

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

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5
Q

Contractility

A

Strength of the hearts cells to shorten and contract

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6
Q

Medications for Pulmonary Edema (5)

A

“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)

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7
Q

Nursing Care of Pulmonary Edema (10)

A

“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
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8
Q

S/S of RIGHT-SIDED heart failure (

A

“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
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9
Q

Loop and thiazide diuretics can cause___________, so ________ supplementation should be given

A

hypokalemia

potassium

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10
Q

Describe S/S stage 4 heart failure

A

1) severe
2) signs of heart failure at rest
3) any activity increases signs of failure

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11
Q

Implantable Cardioverter Defibrillator

A

provides electrical countershock when lethal arrhythmia is detected

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12
Q

Stroke Volume

A

Amount of blood pumped by a ventricle with each beat

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13
Q

What happens to the BNP level if the heart failure continues to worsen?

A

The BNP continues to increase as long as HF is worsening

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14
Q

What makes “heart function” successful? (2)

A

1) blood flow is forward
RIGHT SIDE GOES TO LUNGS
LEFT SIDE GOES TO THE BODY

2) Blood flow is efficient = adequate cardiac output

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15
Q

PRELOAD

A

volume of blood in ventricles at the end of diastole

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16
Q

—PALLIATIVE CARE—

END-STAGE HF SYMPTOMS (4)

A

1) DYSPNEA
2) PAIN
3) FATIGUE
4) DEPRESSION

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17
Q

S/S of LEFT-SIDED Heart Failure (10)

A

“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

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18
Q

_______, ________ and ________ are the 1st to show decreased function when heart failure and poor oxygenation occur.

A

brain
lungs
kidney

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19
Q

AFTERLOAD

A

resistance that the left ventricle must overcome to circulate the blood

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20
Q

PRE LOAD

A

Amount the ventricles stretch at the end of diastole

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21
Q

teaching points for LVAD & VAD

A

NO chest compressions
NO MRI
OK to give ACLS drugs
OK for cardiac defibrillation

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22
Q

Hormone released by the heart muscle when the left ventricle is stretched and pulmonary blood pressure backs up

A

BNP

23
Q

Hormone released by the heart muscle when the left ventricle is stretched and pulmonary blood pressure increases as blood backs up during heart failure

A

BNP

24
Q

normal potassium value

A

3.5 - 5 mEq /L

25
Q

normal sodium value

A

135 - 145 mEq /L

26
Q

Teaching Points for ICD device

A
  • 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
27
Q

AFTERLOAD

A

pressure the ventricles must work against to open the semilunar valves and pump blood out of the heart

28
Q

normal chloride value

A

96 - 106 mEq /L

29
Q

TX OF STAGE 4 HEART FAILURE

**MEDICATIONS

A

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
30
Q

—PALLIATIVE CARE—

for DEPRESSION

A
  • *often goes undiagnosed
  • *research shows increased risk of death with hospitalization with increased depressive symptoms
  • *SSRI therapy
  • *Psychosocial & spiritual support
31
Q 
---PALLIATIVE CARE---
GENERAL INTERVENTIONS (4)
A

1) ACTIVITY AS TOLERATED
2) DIETARY SODIUM RESTRICTIONS (2000mg day)
3) FLUID RESTRICTIONS
4) CONTINUE MEDICATIONS

32
Q

What is the purpose of IV Morphine when used with Pulmonary Edema? (3)

A
  • decrease anxiety
  • respiratory distress
  • decrease venous return
33
Q

Assessment of Pulmonary Edema (11)

A

“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

34
Q

How does heart failure result in tissue hypoxia?

A

decreased oxygen being carried to the cells = hypoxia

35
Q

Risk Factors for Pulmonary Edema (4)

A

Acute MI
Left Sided heart failure
Valvular heart disease
fluid volume overload

36
Q

How does the LVAD / VAD work?

A

Pulls blood from left ventricle through the pump and into the Aorta

37
Q

the main pumping chamber of the heart

A

Left Ventricle

38
Q

What makes heart function a failure (4)

A

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

39
Q

complication of heart failure

A

Pulmonary edema

40
Q

—PALLIATIVE CARE—

for PAIN

A
  • ANGINA and EDEMA (Cardiac sources)
  • OPIOIDS for any type
  • avoid NSAIDS - interferes with diuretics and ace inhibitors
  • Relaxation
  • repositioning
  • distraction
  • music / pet/ aroma therapy
41
Q

‘4” concepts related to heart failure? how does each one affect the patient?

A

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

42
Q

Diagnostics testing for heart failure (4)

A

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

43
Q

Therapeutic DIGOXIN serum level

A

0.5 - 2 ng/mL

44
Q

Cardiac Output

A

amount of blood the heart pumps per minute

normally the heart pumps 4-8 liters of blood per minute

45
Q

The amount of blood that the left ventricle pumps out with each contraction

A

Ejection Fraction

46
Q

This patient is FLUID OVERLOADED and HYPOXIC and is an emergent situation

A

Pulmonary Edema

47
Q

—PALLIATIVE CARE—

for Dyspnea

A
  • 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

48
Q

Tx of Stage 4 Heart Failure (4 general classifications)

A

MEDICATIONS - primary treatment

DEVICES - they support the patients heart function

SURGERY - limited types of surgical procedures

PALLIATIVE CARE - when all other options have failed

49
Q

PCR—POST PROCEDURE nursing duties

A
  • 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)
50
Q

___________will increase the strength of the contraction

A

Digoxin

51
Q

PCR—complications

A
  • HEMATOMA
  • CARDIAC TAMPONADE
  • ACUTE KIDNEY INJURY r/t contrast dye
  • BLEEDING AT INSERTION SITE
52
Q

How does the Heart failure rescue work?

A

1) decreased Cardiac output
2) Rescue with water / sodium retention & vasoconstriction
3) leading into increased BP, HR and AFTERLOAD

53
Q

PCR —PRE-PROCEDURE nursing duties

A
  • 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

NURSING 241 (Fall 2018) (10 decks)

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