Heart failure Flashcards
What is the normal CO in an adult?
4-6 L/min
What is a normal ejection fraction in an adult?
50-70%
HR x SV=
CO
What is preload?
When myocardial muscle stretches that allows for VENTRICULAR FILLING
What is afterload?
What the ventricle has to push against to eject blood into circulation.
What meds can reduce afterload?
CCB’s, BB, nitroglycerin (vasodilator)
What meds can increase afterload?
epinephrine/norepinephrine, dopamine (vasopressors)
How can a persons MAP be calculated?
2(diastolic)+systolic/3
What is a normal MAP range?
70-105 mmHg
Once the MAP is failing to be maintained the oxygen metabolizes anaerobically and causes what to build up?
Lactic acid (lactic acidosis)
____ ____ happens when the heart is unable to pump enough blood to meet the bodies demands due to heart muscle being damaged/stressed.
Heart failure
What Medical emergency involving fluid in the interstitial tissue and alveoli of lung is a consequence of HF, that can lead to sudden cardiac death?
Pulmonary edema
This mechanism involves the stretching of muscle fibers past the limit = ineffective contractions = increased CO.
(The more the heart fills with blood, the stronger the contractions.)
Frank Starling Mechanism
What mechanism occurs when the increased cardiac workload causes the muscles to hypertrophy and ventricles to dilate?
Ventricular hypertrophy
What happens when the heart chambers and myocardium adapt to increased fluid volume and pressure?
Ventricular remodeling
What sign would we see in a patient that is at a critical level of cardiac decompensation?
activity intolerance at rest
What classification of HF, is when ventricles fail to contract adequately to eject enough volume of blood into the arterial system?
systolic failure
What classification of HF is when the heart cant relax during diastole which then disrupts normal filling?
Diastolic Failure
What are two common causes of Left sided HF?
- -HTN
- -Coronary Heart disease
Low output HF is usually caused by….
- -HTN
- -cardiomyopathy
High output HF is usually caused by….
—Hypermetabolic state (anemia, hyperthyroidism, infection)
What are some RF for HF?
- -hx. of MI
- -CAD
- -Smoking
- -HTN
- -Diabetes
- -Heart valve disease
- -Sleep apnea (can also lead to HF)
What are some clinical manifestations of Left sided HF?
- -Fatigue (early sign)
- -Dyspnea, SOB, and cough
- -Orthopnea
- -Cyanosis
- -crackles (hallmark sign)
What are some clinical manifestations of right sided HF?
- -Edema
- -Anorexia, nausea
- -RUQ
- -Engorged Liver
- -JVD (hallmark sign)
If someone has right sided HF, where can they develop edema?
- -feet and legs
- -sacrum (if bedridden)
What signs may a person see with (Class 3) moderate HF?
- -Increased physical limitations
- -fatigue
- -SOB
- -palpitations
What are some manifestations of Pulmonary edema?
- -SOB
- -Orthopnea
- -Pink Frothy Sputum
- -Crackles
- -Anxiety (impending doom)
What hormone is released by the heart muscle in response to the heart muscle stretching?
BNP (increased)
What OTC meds should be avoided with heart meds?
NSAIDS
What type of diet should a patient with heart failure be on?
- -2g sodium
- -heart healthy
- -fluid restriction
How often should a patient that is not on bed rest exercise per week?
3-7 days per week
If a pt. had a heart transplant, What should the nurse remember with a patient that has a chest tube?
- -Dont strip tubing
- -Monitor q15min. initially
- -maintain patency
What are two major concerns after a heart transplant?
- -infection
- -rejection
After a heart transplant what type of meds therapy is a patient started on?
–immunosuppresants
What alternative therapy acts as a natural ace inhibitor?
–Hawthorne (shrubby tree)
What nutritional supplements can be taken in a patient with HF?
- -Coenzyme Q10
- -Magnesium
- -Thiamine
What should the nurse monitor in a patient with HF?
- -BNP
- -VS
- -MAP
- -I and O’s
- -abdominal girth
What are some nursing interventions for a pt. with HF?
- -O2
- -encourage bed rest, rest periods
- -Elevate HOB
- -Restrict fluids
- -Mouth care (offer ice chips/hard candies)
- -offer 6 small meals/day
The nurse should auscultate heart and breath sounds every ___ hours.
4
The patient should be educated on signs of a cough. What would the nurse tell the patient?
- -Ace inhibitors cause dry cough (normal)
- -Wet cough indicates Left side HF
The pt. should call the doctor if they gain….
> 2 lbs. in a day
When the nurse gets a daily weight, they should make sure to….
–weigh same time each day in the morning in same clothes, use bathroom
What is going on when a person has right sided HF?
Lose perfusion to the lungs, blood congests backwards to the body.
What is going on when a person has left sided HF?
Blood congests backwards to the lungs and lose perfusion to the body.
What is activated in response to low perfusion to the kidneys?
RAAS (Renin angiotensin Aldosterone System)
How can RAAS worsen HF?
Increasing volume overload and increasing afterload
What source of oxygen should be used if a person has decompensated HF?
Bi-Pap
What maneuver should be avoided in a patient with HF because it puts strain on heart, especially if they are hemodyamically unstable?
Valsalva maneuver
When a patient has decompensated HF, what signs would the nurse see?
- -Increased preload
- -increased afterload
- -low cardiac index (CO)
- -Tachycardia
What signs may a person see in stage 4 (severe) HF?
- -Any physical activity causes discomfort
- -cardiac insufficiency at rest
