Heart Failure Flashcards
What can cause heart failure?
Coronary artery disease Cardiomyopathy Chronic HTN Heart valve disease/disorders Myocardial Infarction Dysrhythmias such as Atrial Fibrillation
What events lead to left sided heart failure?
Increased peripheral vascular resistance
Increased afterload
If left sided heart failure occurs, what happens to blood flow?
The left ventricle weakens and is unable to keep up with the high demand of work
Blood backs up from the left ventricle, through the mitral valve, to the left atrium, through the pulmonary vein, and into the lungs
When blood backs up into the lungs, what occurs?
Increased pulmonary pressure Alveolar Edema (leads to Pulmonary Edema)
This causes decreased gas exchange
List signs and symptoms of left sided heart failure
Paroxysmal Nocturnal Dyspnea Elevated pulmonary pressure Pulmonary Congestion/Edema --> cough, crackles, wheezes, pink frothy sputum, tachypnea Restlessness and confusion Orthopnea Tachycardia Exertional Dyspnea Fatigue Cyanosis
What ventricle usually fails first?
Left ventricle
What is a primary reason right sided heart failure develops
Due to left sided heart failure
List signs and symptoms of right sided heart failure
Fatigue Increased peripheral venous pressure Ascites Hepatomegaly Spleenomegaly Jugular Venous Distention Anorexia GI Distress: feelings of fullness, loss of appetite Weight gain Dependent edema
What compensatory mechanisms occur to increase cardiac output during heart failure?
Activation of Sympathetic Nervous System
Activation of Renin Angiotensin Aldosterone System
Dilation of heart chambers
Hypertrophy of heart chambers
What blood test can diagnose heart failure?
Brain Natriuretic Peptide
Will troponin be elevated when a patient has chronic heart failure?
Not usually
When would troponin be elevated in a patient with chronic heart failure?
During an acute exacerbation of the chronic heart failure
If a patient has chronic heart failure without acute exacerbation, the Brain Natriuretic Peptide level is most likely in what range (hundreds or thousands)
Hundreds to low thousands
If a patient has chronic heart failure with acute exacerbation, the Brain Natriuretic Peptide level is most likely in what range (hundreds or thousands)
Low thousands to high thousands
The higher the value, the more severe the exacerbation
What nursing interventions should be implemented when a patient has chronic heart failure?
Weigh the patient daily Apply oxygen if necessary Balance rest and activity Position in high fowlers Restrict fluids Create an individualized activity plan Administer medications and educate on medications the patient is taking Encourage a low sodium diet Educate on s/s of heart failure Help patient learn to cope with the disease
When should the nurse be considered about weight gain in the patient with chronic heart failure?
Greater than 2 pounds gained in 24-48 hours
What nursing diagnoses are applicable for chronic heart failure?
Impaired gas exchange
Decreased cardiac output
Excess fluid volume
What evidence may be present if the nursing diagnosis impaired gas exchange is chosen?
Decreased oxygen saturation, adventitious lung sounds, tachypnea, dyspnea, capillary refill >3 seconds, cool extremities, cyanosis, etc.
What evidence may be present if the nursing diagnosis Excess fluid volume is chosen?
Weight gain, edema, jugular venous distention, ascites, anorexia, dyspnea, fatigue, crackles in the lobes
What is the end goal of chronic heart failure after implementation of therapeutic interventions
To improve the heart’s pumping ability
Decrease the hearts oxygen demands
Decrease the cardiac workload
What medication drug classes can be administered either together or separately to help manage chronic heart failure and its symptoms?
Diuretic Angiotensin Converting Enzyme inhibitor Angiotensin 2 Receptor Blocker Beta Blocker Digoxin Vasdilator
Why is a patient with heart failure is given an Angiotensin Converting Enzyme inhibitoror an Angiotensin 2 Receptor blocker?
To block Renin Angiotensin Aldosterone System: decrease fluid volume, decrease serum sodium, promote vasodilation, decrease sympathetic nervous system response
(Reduce cardiac preload and afterload –> decrease cardiac workload)
What vital signs must the nurse monitor when administering an Angiotensin Converting Enzyme inhibitor or an Angiotensin 2 Receptor blocker to a patient with chronic heart failure?
Blood pressure
Even though these medications aren’t given to treat hypertension, they can still alter the blood pressure and lower it.
Which medication drug class is the first line therapy for chronic heart failure treatment?
Angiotensin Converting Enzyme inhibitor
